Transcultural Perspectives in Nursing: Understanding the Role of Healers and the Evil Eye in Modern Healthcare

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Hi there, this is a fascinating area of research and in terms of the current discourse concerning cultural safety it is timely. The paper is beautifully written and insightful, a pleasure to read. My comments here are very minor.

Abstract: "This study was not registered" - what does this mean and why is it in the abstract? registered with what? If the authors are referring to the fact that this study was not approved by a registered ethics committee then I would keep that information to the methods of the text and remove this sentence from the abstract.

Methods: the first time you use the term  Interpretative phenomenological analysis it should have acronym. You need to move the acronym up.

Data availability - the authors have stated data is available upon request. I wonder whether the authors would consider publishing the deidentified dataset on Figshare or OSF and provide a link to that instead? This is optional of course.

Many thanks and best wishes for it.

Author Response

Responses to Comments from Reviewer 1

Hi there, this is a fascinating area of research and in terms of the current discourse concerning cultural safety it is timely. The paper is beautifully written and insightful, a pleasure to read. My comments here are very minor.

Response:

Thank you very much, we appreciate your support. We are very happy with your appreciation of our work. In addition, we feel that your valuable comments have further improved the manuscript.

Abstract: "This study was not registered" - what does this mean and why is it in the abstract? registered with what? If the authors are referring to the fact that this study was not approved by a registered ethics committee then I would keep that information to the methods of the text and remove this sentence from the abstract.

Response:

Thank you for your suggestion. The authors agree with this comment. As you suggested, we have moved this information to the Materials and Methods section (line 151).

Methods: the first time you use the term Interpretative phenomenological analysis it should have acronym. You need to move the acronym up.

Response:

Thank you very much for your comment. In this new version of the manuscript, as you suggested, the authors have corrected the placement of the acronym Interpretative Phenomenological Analysis (IPA), ensuring that it is inserted appropriately the first time it is mentioned. 

Data availability - the authors have stated data is available upon request. I wonder whether the authors would consider publishing the deidentified dataset on Figshare or OSF and provide a link to that instead? This is optional of course.

Response:

Thank you very much, we appreciate the suggestion to publish de-identified data on platforms such as Figshare or Open Science Framework (OSF). We are considering this option and are evaluating the necessary steps to do so appropriately. If we decide to proceed, we will add the corresponding link in the manuscript. In any case, we will keep your suggestion in mind for future work. 

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The article "Transcultural Perspectives in Nursing: Understanding the Role of Healers and the Evil Eye in Modern Healthcare" focuses on the integration of cultural practices and traditional beliefs within the context of contemporary healthcare, using Madeleine Leininger's theory of transcultural nursing as its theoretical foundation.

The article addresses the importance of cultural beliefs in health, specifically the practice of the "evil eye" in Sardinia, Italy. This focus is relevant as it recognises that cultural beliefs and practices continue to influence people's health behaviours, especially in rural or more isolated communities. It justifies the need for a nursing approach that integrates these beliefs to provide culturally sensitive care.

The theoretical framework is supported by Madeleine Leininger's theory, which emphasises the importance of culturally competent care in nursing. The study applies this theory to explore the role of "feminas and ominis de mexinae" and the practice of "sa mexina de s'ogu" (the medicine of the evil eye) as a bridge between traditional medicine and religious practices.

The use of an interpretative phenomenological approach is appropriate, as it allows for an in-depth understanding of cultural experiences and the perceptions of healers regarding the practice of the "evil eye".

Data collection was carried out through semi-structured face-to-face interviews to explore themes and obtain rich, detailed data. The participants are healers ("feminas and ominis de mexina") with experience in the practice of "sa mexina de s'ogu". The inclusion criteria are clearly defined, and the geographical context of the study is detailed, which contributes to the transparency and replicability of the study.

The findings emphasise the importance of incorporating cultural practices into healthcare. The authors reinforce that the "feminas and ominis de mexina" play a key role as mediators between Western medicine and traditional practices, which is consistent with Leininger's model. This connection to an established theory lends credibility to the study and situates the findings within an existing body of knowledge.

The authors discuss the complexity of cultural practices surrounding the "evil eye" and their relevance in specific communities, such as those in Sardinia. The discussion highlights how these practices are still widely used and valued, especially in rural areas where Western health systems may not be fully accessible or acceptable. This underlines the need for a culturally sensitive approach in healthcare that considers these deeply rooted beliefs and practices.

The discussion acknowledges that the findings have implications beyond the specific context of Sardinia, suggesting that similar cultural practices may exist in other Mediterranean communities and in global contexts. The authors make recommendations on the need to integrate transcultural knowledge into the training of healthcare professionals, suggesting that a deeper understanding of cultural practices can foster a more harmonious relationship between healthcare professionals and patients. This approach suggests potential improvements in treatment adherence and health outcomes by respecting cultural beliefs. However, it does not provide specific guidance on how nurses should handle these beliefs in practice. The discussion lacks concrete examples of educational strategies or health policies that could be adopted to improve the integration of cultural practices into healthcare.

A more detailed and practical approach would have been useful to guide healthcare professionals and policymakers. The authors tend to interpret the findings in an overly positive way, focusing mainly on the benefits of integrating cultural practices, without sufficiently exploring the challenges and potential risks. For example, the discussion could have considered the risk of reinforcing beliefs that may lead to delays in seeking appropriate medical treatment, or how practices such as the "evil eye" might be seen as conflicting with evidence-based medical interventions. It also lacks a balanced analysis that includes divergent or critical perspectives. By focusing almost exclusively on the appreciation of the "evil eye" practice and the need for a culturally sensitive approach, the discussion does not sufficiently consider the views of conventional healthcare professionals or community members who may view these practices with scepticism. The inclusion of these perspectives would have enriched the analysis, offering a more comprehensive view of how cultural and scientific practices can be reconciled.

Author Response

Responses to Comments from Reviewer 2

The article "Transcultural Perspectives in Nursing: Understanding the Role of Healers and the Evil Eye in Modern Healthcare" focuses on the integration of cultural practices and traditional beliefs within the context of contemporary healthcare, using Madeleine Leininger's theory of transcultural nursing as its theoretical foundation.

The article addresses the importance of cultural beliefs in health, specifically the practice of the "evil eye" in Sardinia, Italy. This focus is relevant as it recognises that cultural beliefs and practices continue to influence people's health behaviours, especially in rural or more isolated communities. It justifies the need for a nursing approach that integrates these beliefs to provide culturally sensitive care.

The theoretical framework is supported by Madeleine Leininger's theory, which emphasises the importance of culturally competent care in nursing. The study applies this theory to explore the role of "feminas and ominis de mexinae" and the practice of "sa mexina de s'ogu" (the medicine of the evil eye) as a bridge between traditional medicine and religious practices.

The use of an interpretative phenomenological approach is appropriate, as it allows for an in-depth understanding of cultural experiences and the perceptions of healers regarding the practice of the "evil eye".

Data collection was carried out through semi-structured face-to-face interviews to explore themes and obtain rich, detailed data. The participants are healers ("feminas and ominis de mexina") with experience in the practice of "sa mexina de s'ogu". The inclusion criteria are clearly defined, and the geographical context of the study is detailed, which contributes to the transparency and replicability of the study.

The findings emphasise the importance of incorporating cultural practices into healthcare. The authors reinforce that the "feminas and ominis de mexina" play a key role as mediators between Western medicine and traditional practices, which is consistent with Leininger's model. This connection to an established theory lends credibility to the study and situates the findings within an existing body of knowledge.

The authors discuss the complexity of cultural practices surrounding the "evil eye" and their relevance in specific communities, such as those in Sardinia. The discussion highlights how these practices are still widely used and valued, especially in rural areas where Western health systems may not be fully accessible or acceptable. This underlines the need for a culturally sensitive approach in healthcare that considers these deeply rooted beliefs and practices.

Response:

Thank you very much, we appreciate your support and meticulous evaluation of the various sections of the article.

The discussion acknowledges that the findings have implications beyond the specific context of Sardinia, suggesting that similar cultural practices may exist in other Mediterranean communities and in global contexts. The authors make recommendations on the need to integrate transcultural knowledge into the training of healthcare professionals, suggesting that a deeper understanding of cultural practices can foster a more harmonious relationship between healthcare professionals and patients. This approach suggests potential improvements in treatment adherence and health outcomes by respecting cultural beliefs. However, it does not provide specific guidance on how nurses should handle these beliefs in practice. The discussion lacks concrete examples of educational strategies or health policies that could be adopted to improve the integration of cultural practices into healthcare.

Response:

Thank you very much, the authors agree and greatly appreciate your suggestions.We feel that your comments have clarified, improved and strengthened the manuscript.

In this new version of the manuscript, we have deepened and included the aspects you suggested. Specifically, we have added the following text (lines 466-488:

“In the health professionals, it is essential to promote transcultural nursing literacy for the practice of nursing care in both hospital and out-of-hospital settings, promoting skills to foster care for individuals, families and communities based on evidence-based nursing care. The creation of health care guidelines or protocols on common cultural beliefs in regions with geographical or cultural similarities promotes the empower-ment of the nursing profession. It creates a harmonious relationship between nursing professionals and the individuals, families, and communities they care for, as shown in studies by Herrero-Hahn et al. [34], and by Douglas et al. in their book on Global Ap-plications of Culturally Competent Health Care: Guidelines for Practice [35]. Other strategies that can help transcultural nursing to be more effective include actions in which emphasis is placed on cultural anthropology and health in the education of fu-ture nurses. For example, contextualising transcultural nursing theory to the reality in which students find themselves; teaching how to interact respectfully, consistently re-lating in nursing and medicine based on scientific evidence, as highlighted by Lang-ton's 2018 analysis [36]; generate trust in patients, improving adherence to therapeutic treatments based on scientific evidence. In addition, it would be desirable to create ed-ucational materials [37], simulated scenarios for virtual active learning [38] and to maximise the acquisition of knowledge and skills regarding transcultural nursing care in both hospital and out-of-hospital settings, as highlighted by the study by Douglas et al. [35]. With regard to health policies, on the other hand, cultural mediators already exist today; however, specific training on topics such as the evil eye, courses in cultural anthropology and health would help to promote more effective work, as highlighted in the study by Venables et al. [39] and Peres & Sharaby [40].”

A more detailed and practical approach would have been useful to guide healthcare professionals and policymakers. The authors tend to interpret the findings in an overly positive way, focusing mainly on the benefits of integrating cultural practices, without sufficiently exploring the challenges and potential risks. For example, the discussion could have considered the risk of reinforcing beliefs that may lead to delays in seeking appropriate medical treatment, or how practices such as the "evil eye" might be seen as conflicting with evidence-based medical interventions. It also lacks a balanced analysis that includes divergent or critical perspectives. By focusing almost exclusively on the appreciation of the "evil eye" practice and the need for a culturally sensitive approach, the discussion does not sufficiently consider the views of conventional healthcare professionals or community members who may view these practices with scepticism. The inclusion of these perspectives would have enriched the analysis, offering a more comprehensive view of how cultural and scientific practices can be reconciled.

Response:

Thank you very much, we greatly appreciate your support. We reframed the discussion highlighting the risks of over-strengthening beliefs. In addition, we are conducting further studies on the perception of the phenomenon both from the point of view of nurses and people who use this type of traditional medicine. Thanks to your valuable suggestion, we will also be finalising an article comparing the perception of users, nurses and the ‘feminas e ominis de mexina’. We would be delighted if you could read it.

We hope that this change will meet your expectations. In this new version of the manuscript, we have added the following text (lines 491-501):

In light of this, it is important to consider the risk that excessive reinforcement of be-liefs may lead to a conflict with evidence-based medical interventions. This has been extensively documented in the literature. For example, in a study conducted in Turkey, epilepsy patients with superstitious attitudes used magic to cure their illness instead of following medical instructions [42]. In the study by Taher et al. 40% of patients at-tributed their physical illness to superstitious thoughts such as the ‘evil eye’; further-more, patients with hypertension who believed in superstition did not adhere correctly to their treatment regimen [43]. Abrehderi et al. found that diabetic patients with su-perstitious beliefs had poor self-care [44]. Finally, Omeje & Nebo showed that people with beliefs did not correctly follow medical instructions and prescribed medication [45].”

Author Response File: Author Response.docx