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Results for “Cultural Competency”

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PubMed2003

Addressing disparities through dental-medical collaborations, part 1. The role of cultural competency in health disparities: training of primary care medical practitioners in children's oral health.

This paper introduces a series of articles examining specific dental-medical educational collaborations intended to decrease oral health disparities. The first article discusses cultural competency and its relationship to oral health disparities. The next two articles present pediatric oral health educational programs for medical practitioners, one targeting primary care practitioners and the other training family practice residents. This introductory article reviews the national public health agenda for oral health, explains the rationale for targeting dental-medical educational collaborations to address health disparities, and identifies important gaps in dental as well as medical education, especially in the area of infant oral health. Key findings of the two projects are reviewed as well as lessons learned. We call for leadership in dental education in three critical areas: cultural competency, infant oral health, and ethical and professional values. Given the historical isolation of dentistry, strong leadership at the level of the dean's office is needed to advance the agenda of eliminating oral health disparities through collaborations among dentistry, medicine, and the other health professions. Finally, an appreciation of the professional obligations of dental educators, practitioners, and the profession of dentistry can add resolve to this new prioritization.

Child↗

PubMed2006

Teaching cultural competence to reduce health disparities.

As part of the Genesee County, Michigan, REACH 2010 initiative, a new course, Cultural Competence in Health Care, was developed at the University of Michigan-Flint. The objective of this course is to improve the cultural competence of future health and human service providers and to reduce persistent racial and ethnic health disparities. This article describes the course and the important role that REACH 2010 partners played in its development and implementation. Course materials, methods, and student feedback are summarized, along with lessons learned.

Community Health Services↗

PubMed2002

Reaching underserved populations and cultural competence in diabetes education.

Diabetes self-management education has gained in importance over the past decade as research has documented the benefits of such interventions in improving glucose control and reducing diabetes-related complications. Although minority populations bear a disproportionate burden of diabetes, past strategies have not addressed cultural characteristics of groups typically underrepresented in diabetes research. Recent research literature on the development of culturally competent diabetes self-management is summarized and an example of a culturally competent intervention designed for Spanish-speaking Mexican Americans is presented. Recent research is laying the foundation for future intervention development to meet the cultural needs of racial/ethnic groups.

Clinical Competence↗

PubMed2004

Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children.

OBJECTIVE: More than half of Medicaid enrollees are now in managed care. Scant information exists about which policies of practice sites improve quality of care in managed Medicaid. Children with asthma are a sentinel group for Medicaid quality monitoring because they are at elevated risk for adverse outcomes. The objective of this study was to identify practice-site policies and features associated with quality of care for Medicaid-insured children with asthma. METHODS: A prospective cohort study with 1-year follow-up was conducted in 5 health plans in California, Washington, and Massachusetts. Data were collected via telephone interviews with parents at baseline and 1 year, surveys of practice sites and clinicians, and computerized databases. The practice site survey asked about policies to promote cultural competence, the use of several types of reports to clinicians, support for self-management of asthma, case management and care coordination, and access to and continuity of care. Quality of care was evaluated on the basis of 5 measures: 1) preventive medication underuse based on parent report; 2) the parent's rating of asthma care; 3) the 1-year change in the child's asthma physical status based on a standardized measure; 4) preventive medication underprescribing based on computerized data; and 5) the occurrence of a hospital-based episode. RESULTS: Of the 1663 children in the study population, 67% had persistent asthma at baseline based on parent report of symptoms and medications. At 1-year follow-up, 65% of the children with persistent asthma were underusing preventive medication based on parent report. In multivariate analyses, patients of practice sites with the highest cultural competence scores were less likely to be underusing preventive asthma medications based on parent report at follow-up (odds ratio [OR]: 0.15; 95% confidence interval [CI]: 0.06-0.41 for the highest vs lowest categories) and had better parent ratings of care. The use of asthma reports to clinicians was predictive of less preventive medication underprescribing based on computerized data (OR: 0.33; 95% CI: 0.16-0.69), better parent ratings of care, and better asthma physical status at follow-up. Patients of practice sites with policies to promote access and continuity had less underuse of preventive medications (OR: 0.56; 95% CI: 0.34-0.93). Among the 83 practice sites, the practice site's size, organizational type, percentage of patients insured by Medicaid, mechanism of payment for specialty care, and other primary care features were not consistently associated with quality measures. CONCLUSIONS: Practice-site policies to promote cultural competence, the use of reports to clinicians, and access and continuity predicted higher quality of care for children with asthma in managed Medicaid.

Adolescent↗

PubMed2002

The Purnell Model for Cultural Competence.

This article provides an overview of the Purnell Model for Cultural Competence and the assumptions on which the model is based. The 12 domains comprising the organizing framework are briefly described along with the primary and secondary characteristics of culture, which determine variations in values, beliefs, and practices of an individual's cultural heritage. All health care providers in any practice setting can use the model, which makes it especially desirable in today's team-oriented health care environment. The model has been used by nurses, physicians, and physical and occupational therapists in practice, education, administration, and research in Australia, Belgium, Canada, Central America, Great Britain, Korea, South America, and Sweden. The model has also been translated into Flemish, French, Korean, and Spanish. Although the model is only 4 years old, it shows promise for becoming a major contribution to transcultural nursing and health care.

Attitude to Health↗

PubMed2006

Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland.

Medical training programs need to prepare physicians to provide care to increasingly diverse patient populations. While the general concepts and approaches of clinical cultural competence are broadly relevant across contexts, the content of cultural competence training should reflect and respond to the specific needs and challenges of clinicians in their local reality. In order to better understand and respond to the needs and challenges of residents working with diverse patients in Geneva, Switzerland, depth interviews with physicians and professional medical interpreters and direct observations of consultations were combined. Cross-cultural communication difficulties were intertwined with more general difficulties related to primary care in an outpatient context, and physicians' frustrations reflected the expectations and image of medicine that they developed during their hospital-centered training. Study results point to the need to understand how cross-cultural communication challenges articulate with other aspects of the clinical context.

Clinical Competence↗

PubMed2006

Envisioning and advancing marginalized men's health disparities scholarship: the marginality-cultural competence integrative framework (M-CCIF).

Given the current focus of the National Institutes of Health (NIH) on eliminating health disparities among minority populations, a substantive body of culturally competent scholarship about marginalized men's health disparities is needed to add knowledge about the complex features, processes, and relationships underlying health disparities, marginality, men's health, interventions, and clinical outcomes. Marginalized men in the United States suffer disproportionately from mental and chronic health problems. Historically disadvantaged, their voices have not been privileged in health care and clinical discourses. Utilizing the concepts of marginalization and culturally competent scholarship, an integrative framework has been created to facilitate clinicians and scholars in envisioning and advancing critical scholarship related to marginalized men's health disparities.

Attitude to Health↗

PubMed1998

Check your cultural competence.

Intrapersonal reactions such as ethnocentrism, prejudice, anxiety, stereotyping, and our comfort zone with the familiar can influence our interactions with culturally diverse people. Here, we explore these stumbling blocks, the dynamics behind these reactions, and strategies nurse managers can employ to enhance their cultural competence.

Clinical Competence↗

PubMed2005

Culturally competent scholarship in nursing research.

PURPOSE: To determine the degree to which research reports published in major nursing research journals reflected Meleis's eight criteria for culturally competent scholarship. DESIGN: Analytic review of 167 studies dealing with race, ethnicity, or culture from four nursing research journals, 1992-2000. METHOD: Four reviewers selected, abstracted, and scored research articles independently, in pairs, and as a group. FINDINGS: The mean and median Meleis scores were 2.92 and 3.00 on an 8-point scale. All scores were assigned at least once. Contextuality, relevance, and communication style were most frequently present; disclosure, empowerment, and time were least frequently present. IMPLICATIONS: Assignment of Meleis scores is feasible and useful for evaluating cultural competence of research reports.

Bibliometrics↗

PubMed2006

Influence of nurse characteristics on the acquisition of cultural competence.

This study examined how nurses' personal and professional characteristics influenced their response to an educational intervention to improve their cultural knowledge and cultural competence. A one-group repeated measures design was used to evaluate the effectiveness of the intervention, which 76 public health nurses (PHNs) attended. Regression analysis showed that nurses with fewer years of nursing experience and higher level of education had a weak association with increased cultural knowledge and cultural competence but learning style and age were not associated with the outcomes.

Adult↗

PubMed2007

A gain in cultural competence through an international acupuncture elective.

OBJECTIVE: This study describes an international acupuncture elective and its impact on medical students' development of cultural competence. METHODS: Collaborating with Chinese colleagues, we created a 4-week elective that teaches medical students about acupuncture in its native cultural environment. Three focus groups were conducted to elicit students' experiences. RESULTS: Students' reflections indicated that studying an alternative medical system in its own cultural setting helped them become open to other medical beliefs and realize the importance of culture in health care delivery. Further, being linguistically isolated allowed students to personally experience what it is like for those patients with limited language proficiency. CONCLUSION: Studying an alternative medical system while immersed in another culture maybe an effective way to enhance cultural competence.

Acculturation↗

PubMed2004

Do general treatment guidelines for Asian American families have applications to specific ethnic groups? The case of culturally-competent therapy with Korean Americans.

To serve Korean American families effectively, marriage and family therapists need to develop a level of cultural competence. This content analysis of the relevant treatment literature was conducted to discover the most common expert recommendations for family therapy with Asian Americans and to examine their application to Korean Americans. Eleven specific guidelines were generated: Assess support systems, assess immigration history establish professional credibility, provide role induction, facilitate "saving face," accept somatic complaints, be present/problem focused, be directive, respect family structure, be nonconfrontational, and provide positive reframes. Empirical support (clinical and nonclinical research) and conceptual support for each guideline are discussed, and conclusions are reached regarding culturally competent therapy with Korean American families.

Acculturation↗

PubMed2006

Applying cultural competence to perianesthesia nursing.

The paper stresses the importance of cultural competence in perianesthesia nursing, both in terms of caring for the patient and in dealing with the patient's family. Cultural variations in gender, decision-making, family, communication, and time orientation are presented. A distinction is made between generalizations (potentially useful) and stereotypes (potentially harmful). Several suggestions for specific ways to provide more culturally appropriate care are presented, and resources for further study are provided.

Attitude of Health Personnel↗

PubMedDate not supplied

Culturally competent dietary education for southern rural African Americans with diabetes.

PURPOSE: The purpose of this article is to describe a culturally competent, dietary self-management intervention designed to improve physiological outcomes, diabetes self-management, and costs of care for high-risk African Americans with type 2 diabetes. METHODS: A longitudinal, quasi-experimental design was used to evaluate the effectiveness of the intervention for 23 adult African Americans from a physician practice group in rural South Carolina. The intervention consisted of 4 low-fat dietary education classes, 6 discussion groups, and follow-up. Intervention sessions were provided by a dietitian and nurse case managers and framed as social events; families were encouraged to participate. RESULTS: Data suggest that the intervention significantly improved fat-related dietary habits, A1C values, fasting blood glucose, and frequency of acute care visits. A trend in reduction of lipids and weight also was observed. CONCLUSIONS: Culturally competent dietary self-management provides a meaningful approach to focused diabetes education for rural African Americans. Integrating nursing case management provides an innovative method of addressing the more global issues of delivery of care to underserved rural populations and decreasing the high costs of care.

Adult↗

PubMed2004

'It's different from my culture; they're very different': Providing community-based, 'culturally competent' palliative care for South Asian people in the UK.

This article investigates the challenges faced by those trying to develop 'culturally competent' palliative care for South Asian cancer patients in Luton, UK. It discusses the findings of a phenomenological study of service providers' attitudes to and experiences of caring for South Asian patients. Ten semi-structured in-depth interviews were carried out with a range of staff who work in home and community-based palliative care settings, including nurses, community liaison personnel and representatives of non-statutory organisations. The authors begin by considering how these service providers construct ideas of cultural difference and how these relate to philosophies of palliative care. They then examine attempts to deal with cultural diversity in everyday practice, focusing in particular on the social context of care in the home. The paper considers the ways in which staff attempt to incorporate the cultural needs of patients, family, kin and community. Rather than criticising current working practices, the authors highlight the complexity of delivering culturally competent services from the perspective of those working directly with patients. In doing so, they contribute to ongoing debates about the development of anti-discriminatory practice in health and social care.

Asian People↗

PubMed2004

Developing cultural competence and social responsibility in preclinical dental students.

Dental student development of cultural competence and social responsibility is recognized by educators as an important element in the overall shaping of minds and attitudes of modem dental practitioners. Yet training modalities to achieve these competencies are not clearly defined, and outcome measurements are elusive. This article shows an effective method to meet these desired outcomes. Sixty-one freshmen (class of 2005) participated in forty hours of nondental community service, and reflective journals were completed by the end of second year. Competency outcomes were measured by selecting key words and phrases found in the individual journals. Key phrases were related to compassion, righteousness, propriety, and wisdom. Also, phrases had to be accompanied by written indications of direct program causation. The combination of active-learning (based upon service learning models) in public health settings outside of the dental realm, accompanied by reflective journaling, enhanced cultural understanding and community spirit in the majority of students.

Clinical Competence↗

PubMed2006

Impact of cultural competence on medical care: where are we today?

The Institute of Medicine's 2002 Report on Unequal Treatment calls attention to disparities in health care and proposes corrective steps. Proposed actions included improvement in cross-cultural skills among providers. This article highlights evidence for unequal treatment, and delineates current medical educational efforts aimed at improving cultural competence. Improvement is needed in the uniform adoption of cultural competence curricula and focus needs to be placed on its impact through outcomes research.

Cultural Diversity↗

PubMedDate not supplied

Perspectives of cultural competence in health care.

AIM: The aim of this study was to explore the views of one group of healthcare professionals on the importance of cultural awareness in healthcare practice. METHOD: A qualitative approach was used. Ten nurses of varying age from two counties in Scotland who worked across a range of clinical practice areas were interviewed. The interviews were largely unstructured but included an opening question and prompts for the interviewer FINDINGS: A lack of knowledge and understanding was demonstrated by the participants in relation to the diverse cultural groups who constitute the population of this country, and a gap in nurse education and training provision across a range of healthcare areas. CONCLUSION: Nursing curricula need to include more knowledge and learning about cultural awareness, and nurses need more practical experience of caring for patients from different cultures. The findings assisted in the development of a framework for nurse education that embraces the concept of cultural competency.

Adult↗