title: A systematic review of cross-cultural comparison studies of child, parent, and health professional outcomes associated with pediatric medical procedures.
abstract: The purpose of this review was to evaluate systematically all published and unpublished research concerning culture and medical procedural pain in children. Databases, reference lists, and electronic list servers were searched as data sources. Fifteen studies met the inclusion criteria. Most studies (80%) were conducted solely in the United States comparing Caucasian American groups to other local subculture(s) (ie, African American, Hispanic, or Japanese). The studies compared, cross culturally, pediatric pain-related outcomes in children, parents and/or health professionals. The medical procedural experiences included surgery, immunization, spinal tap, bone marrow aspiration, needle procedures, orthopedic, and wound-related injuries. The evidence published to date suggests that cultural factors may be associated with children's pain experiences when elicited by medical procedural pain, specifically children's pain behavior. Nevertheless, research using more sophisticated research methods is needed to develop culturally sensitive behavioral pain measures. Measures that include physiological pain parameters in addition to other behavioral outcomes may be helpful. Culturally comparative research would benefit from the use of theoretical frameworks to advance our understanding of the cultural underpinnings of child pain development and guide future research.
  
  
  CONCLUSIONS
  The current evidence supports that children and parents belonging to cultural minority groups, and in need of health care, are a vulnerable population. Together, researchers and clinicians are encouraged to explore this understudied area, and take advantage of sophisticated methods developed by disciplines like cross-cultural psychology.
authors.affiliation: Dalhousie University, Halifax, NS, Canada. OL939557@DAL.CA
authors.forename: Olöf
authors.initials: O
authors.lastname: Kristjánsdóttir
authors.forename: Anita M
authors.initials: AM
authors.lastname: Unruh
authors.forename: Linda
authors.initials: L
authors.lastname: McAlpine
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003431:Cross-Cultural Comparison; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010146:Pain / Q000517:prevention & control / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D013315:Stress, Psychological / Q000517:prevention & control / Q000523:psychology