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PubMed2004

Evaluating the effect of cultural competency training on medical student attitudes.

BACKGROUND AND OBJECTIVES: Developing skills for taking care of patients from a wide variety of backgrounds is a growing area of importance in medical education. Incorporating cultural competency training into undergraduate medical education is an accreditation requirement. Although there are an increasing number of such curricula reported in the literature, there has been little evaluation of their effectiveness. We describe a new undergraduate cultural competency curriculum, the reliability of an instrument for assessing student attitudes in this area, and the effects of our curriculum on student attitudes. METHODS: Two introductory clinical medicine courses focused on the importance of providing culturally competent care to all patients. The courses used problem-based learning and a history-taking mnemonic to teach students to assess patients' perspectives. The authors verified the reliability of the Health Beliefs Attitudes Survey (HBAS) and used it to determine changes in students' attitudes on issues relating to cultural competency. RESULTS: The HBAS reliably measured four cultural competency concepts. Student attitudes regarding the importance of assessing patient opinions and determining health beliefs improved significantly following the courses. CONCLUSIONS: The method used here to teach students cultural competency skills early in medical school positively affects student attitudes on cultural competency issues.

Adult↗
PubMed2005

Evaluating cultural competence among behavioral health professionals.

Persistent racial and ethnic disparities in access and utilization of behavioral health services have highlighted the need for cultural competence among providers. In response, many agencies are now implementing education and training programs to ensure that behavioral health professionals improve their skills when serving diverse ethnic, racial, and cultural populations. The evaluation of these trainings is vital to ensure that they both improve the cultural competence of providers and promote recovery among persons with severe mental illnesses. This paper discusses the philosophical and practical issues related to measuring cultural competence, based on the evaluation of statewide cultural competence trainings for behavioral health professionals. The evaluation process illustrates the challenges of operationalizing cultural competence, balancing the needs of program implementers and evaluators, and developing a robust and feasible evaluation design, which assesses outcomes both for persons in recovery and providers.

Behavioral Medicine↗
PubMed2006

Working conditions and cultural competence when interacting with children and parents of foreign origin--Primary Child Health Nurses' opinions.

BACKGROUND: Interaction with children and parents of foreign origin is an important part of Primary Child Health Care (PCHC) services. Cultural competence among Primary Child Health Nurses' (PCHNurses') must therefore be regarded as essential. Cultural competence has been described as a process with different steps through which an individual must proceed. AIM: The present study investigates PCHNurses' opinions regarding their working conditions and cultural competence. The focus will be placed on their interaction with children and parents of foreign origin. METHODS: A total of 270 PCHNurses working in the PCHC services in Stockholm County responded to a questionnaire (response rate 70%). The association between experiences of difficulties and nine explanatory variables were analysed with logistic regression. RESULTS: Many of the PCHNurses reported inadequate working conditions and dissatisfaction with the quality of their healthcare work and said that they lacked written guidelines, support and help. A majority (84%) experienced difficulties in their interactions with children and parents of foreign origin, although to different degrees. The odds of experiencing difficulties were increased when nurses were responsible for a high proportion of children of foreign origin, when nurses had long professional experience and when they worked more than 50% on child-health-services assignments. Many nurses had no formal training in cultural competence and the majority felt that their formal and clinical cultural competence was insufficient. CONCLUSIONS: Deficiencies were found regarding the PCHNurses' working conditions and cultural competence when interacting with children and parents of foreign origin. Improvements are needed to facilitate the nurses' healthcare work and to enable high quality health care on equal terms for all children and parents visiting the PCHC services.

Adult↗
PubMed2005

A health professional students' cultural competence and attitudes toward the poor: the influence of a clinical practicum supported by the National Health Service Corps.

To provide quality health care today, practitioners must be culturally competent. Funding sources, such as the federal government, recognize the need to prepare culturally competent clinicians. The mission of the National Health Service Corps (NHSC), a federal program, is to increase access to primary care services and reduce health disparities by assisting in the preparation of community-responsive, culturally competent primary care clinicians. This study evaluated an NHSC program that funded, in part, health professional students' educational programs. Following their participation in an NHSC-supported clinical experience, students were assessed on their cultural competence, perceptions of the poor, and intention of serving in an underserved community. Health professional students completed a survey before and after the clinical practicum. Participants included students who were studying to be physicians, physician assistants, social workers, and nurse practitioners. Results of the study found no change in students' cultural competence after their clinical practicum. Although they remained in the "culturally aware" stage, they were not considered either "culturally proficient" or "culturally competent." However, their attitudes toward those in poverty were more positive than in previous studies of health professionals. The greatest impact from the students' clinical experience was their increased intention to practice in an underserved community following their practicum. They found their experience with the underserved to be rewarding, challenging, and humbling. Documenting the influence that government-funded programs have on health professional students is extremely important in studies such as this.

Attitude of Health Personnel↗
PubMed1999

Cultural competence: a priority for performance improvement action.

An increase in diversity that has been accompanied by a sharp decrease in white Caucasian "mainstream" culture has made cultural competence a priority in nursing performance improvement. Each culturally diverse group defines health and illness differently. Most have a long and well-established tradition of folk health beliefs and practices, which strongly impact members' reactions to American standards of care--an influence on both patient satisfaction and treatment compliance. This article describes the culture--health care relationship and lists 10 indicators for measuring cultural competency. It presents a practical, systemwide model for the improvement of nursing care quality through enhanced cultural competency and lists resources, which can be used to both support and improve cultural competency throughout an integrated health care system.

Clinical Competence↗
PubMed2005

Evaluation of a cultural competence course.

This study addressed the perceived lack of an integrated course with theoretical and experiential knowledge related to cultural competence for public health nurses (PHNs) and the importance of providing culturally competent services to clients. Mixed methods were used to examine the effectiveness of a course to increase 76 PHNs' level of cultural competence. A one-group repeated measures design was used to ascertain the pattern of change in participants over time. The qualitative results complemented the quantitative findings, which were significant in relating to the five dimensions of Campinha-Bacote's model of cultural competence.

Adult↗
PubMedDate not supplied

Cultural competence in nursing: foundation or fallacy?

Propelled by a national concern with social justice and health disparities, the notion of cultural competency is being incorporated into both government regulation and professional standards. Although most of the standards that are being developed nationally apply at the institutional level, it is in the clinical setting where the expectation of cultural competency is the most demanding. The recommendations for clinicians to become culturally competent generally fall into 2 major categories. The first focuses on the content and structure of the clinical encounter between provider and patient. The second category charges providers with becoming knowledgeable about the cultures of their constituent patients and learning their lifestyles,health beliefs, and behaviors. Although individuals may belong to the same cultural group, the assumption that they are, in fact, the same, is an ecological fallacy. The health care system has nested the accountability for cultural competence with the clinician who provides direct services to individuals, where the application of cultural information is likely to be least useful. We contend that cultural competence is really nursing competence.

Cognition↗
PubMed2006

Psychometric analysis of a scale assessing self-efficacy for cultural competence in patient counseling.

BACKGROUND: The Accreditation Council for Pharmacy Education adopted revised accreditation standards and guidelines for the PharmD degree program in January 2006. The revised standards mandate the inclusion of cultural competence in pharmacy curricula. Assessment tools to evaluate the impact of training are needed. OBJECTIVE: To examine the psychometric properties of a 12 item scale designed to estimate the impact of cultural competence training on pharmacy students' self-efficacy in providing culturally appropriate patient care. METHODS: A 12 item scale to assess the impact of an elective course on pharmacy students' (N = 175; 173 analyzable) perceived self-efficacy in providing culturally competent patient care was used before and after students completed the training. Principal components analysis was conducted to examine the underlying structure of the scale, and the Cronbach alpha statistic was computed as an estimate of internal consistency. Pre-versus posttraining responses for each item and for the total scale scores were compared as an indicator of concurrent validity. RESULTS: The principal components analysis yielded a one-component solution, "self-efficacy for cultural competence," which included all 12 contributing items and accounted for 46% of the total variance. Item communalities ranged from 0.25 to 0.58. Component loadings ranged from 0.50 to 0.76. Overall, the scale exhibited a Cronbach alpha estimate of internal consistency of 0.89. Posttraining scores were significantly higher than pretraining scores for both the total scale scores (posttest and pretest mean +/- SD score = 47.96 +/- 5.15 and 34.21 +/- 6.19, respectively; p < 0.001) and for each item (p values < 0.001). These comparisons provide evidence of concurrent validity. CONCLUSIONS: Our results suggest that our 12 item scale exhibits acceptable psychometric properties and is a useful tool for estimating the impact of cultural competence training on pharmacy students' perceived self-efficacy for providing culturally competent care and services.

Cultural Diversity↗
PubMedDate not supplied

Cultural competence in the care of abused women.

This article explains the concept of cultural competence, adding advocacy to models of culturally competent health care already in the literature and demonstrating how it relates to domestic violence. Abuse stages according to Landenburger's model of entrapment and recovery are presented with applicable cultural differences and specificities. Cultural issues related to specific childbearing-stage abuse interventions are also discussed. The principles of cultural competence, abuse- and childbearing-stage specificity, and empowerment are used as the basis for this model of clinical intervention with abused women.

Clinical Competence↗
PubMed2006

Cultural competency and nursing care: an Australian perspective.

AIMS: To propose a process that will facilitate cultural competence in Australian nursing practice. BACKGROUND: Cultural diversity is a prominent feature of the Australian health system and is impacting significantly on nursing care quality. A fictitious, but typical clinical exemplar is profiled that identifies cultural insensitivity in care practices leading to poor quality outcomes for the health consumer and her family. Strategies are proposed that will reverse this practice and promote culturally competent nursing care and that locates overseas qualified nurses in this process. CONCLUSION: This paper contributes to nursing care quality internationally by articulating strategies to achieve cultural competence in practice. Nurses must pay attention to interpersonal relationships and develop respect for the health consumer's value systems and ways of being, in order to protect their rights and avoid the tendency to stereotype individuals from particular cultures. The expertise of qualified nurses from different cultures can greatly assist this process.

Aged↗
PubMed1996

Cultural competence--an essential hybrid for delivering high quality care in the 1990's and beyond.

Establishing guidelines for culturally competent medical care will help all physicians to fulfill their mandate to meet the health care needs of the individual patient as well as of patient populations, and to lower costs by encouraging a healing partnership with the patient, thus increasing patient responsibility for his or her own health. Being culturally sensitive is not enough. Nor is simply classifying patients according to race adequate. Many researchers in social science and health services increasingly agree that race in our heterogeneous U.S. population has limited biological meaning and more often than not is just a poor proxy for culture or socioeconomic status. Guidelines and quality indicators that seek to measure and improve cultural competence must take into account, in an integrated fashion, these three necessary components in the delivery of high-quality services to populations: 1) the health-related cultural factors; 2) the incidence and prevalence of diseases in the population; and 3) treatment outcomes peculiar to that population. To be culturally competent is to incorporate and integrate these critical factors into caring for diverse populations. If health care systems, individually and collectively, are to provide care of high quality that is cost-effective to all populations, researchers and funders of research must invest in an aggressive agenda that pursues two directions: the validation of existing quality indicators in minority populations, and the development of new quality indicators that assess the organization's ability to develop culturally competent care. Only in this way will those of us in the medical profession be able to fulfill our calling to relieve suffering without discriminating against some populations.

Clinical Competence↗
PubMed1992

Culturally competent occupational therapy in a diversely populated mental health setting.

Cultural sensitivity is a crucial component of health care provision, particularly in psychiatric settings. As society becomes more multicultural, it is essential for occupational therapists to continue to develop cultural competence, which is defined in this paper as an awareness of, sensitivity to, and knowledge of the meaning of culture. At San Francisco General Hospital, an innovative multicultural model consisting of special focus programs is used. The key to the success of such programs is a culturally competent professional staff.

Clinical Competence↗
PubMed2004

Racial and ethnic differences in patient perceptions of bias and cultural competence in health care.

OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients' perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables. DESIGN: Cross-sectional telephone survey. SETTING: The Commonwealth Fund 2001 Health Care Quality Survey. SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults. MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents' perceptions of their PCPs' and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P <.001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively). CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.

Adult↗
PubMed2007

Extending cultural competence through systems change: academic, hospital, and community partnerships.

Work on cultural competence has a long history in nursing, yet we have not successfully institutionalized these attitudes and skills throughout education and practice. An effective approach to promoting widespread cultural competence is to work at the system level in which coalitions of community agencies partner with academic and health care organizations. A systems approach includes all health practitioners, reducing current discrepancies across disciplines, and establishes cultural competence as the standard. Work in and with communities places students and practitioners more consistently in cross-cultural circumstances. Implementing this vision will require national as well as local leadership across public and private sectors.

Attitude of Health Personnel↗
PubMed2003

Evaluation of cultural competence and antiracism training in child health services.

AIMS: To evaluate the acceptability and effectiveness of cultural competence and antiracism training to professionals providing services to ill or disabled children. METHODS: Immediate post-training and retrospective questionnaire survey of trainees. Main outcome measures were acceptability; perceived relevance to practice; previous training in this area; perceived impact on professionals' confidence in providing care to diverse communities; and reported changes in behaviour and practice. RESULTS: Cultural competence and antiracism training has been neglected in the health sector but is well received by professionals. It is a positive experience for trainees and perceived to be relevant to their practice. Appropriate and non-threatening training in cultural competence changes attitudes, behaviours, and practice, including promoting good practice in communication across linguistic and cultural differences. CONCLUSIONS: Appropriate cultural competence and antiracism training is both effective and acceptable in child health services.

Attitude of Health Personnel↗
PubMed2007

The relationship between cultural competence education and increasing diversity in nursing schools and practice settings.

This article attempted to examine the relationship between cultural competence education and increasing diversity in nursing schools and practice settings. In addition to the review of the literature, a panel of experts was interviewed regarding institutional practices in response to the challenge of increasing diversity and cultural competence education. Evidence of positive outcomes of cultural competent care and impact of race and ethnic concordance between patients and providers are presented. The challenge of increasing underrepresented minorities in health care professions remains elusive. An ecological analysis is recommended to address the social and cultural barriers that transcend the micro system of the school and the macro system of the society. The challenge of increasing diversity and realizing outcomes of cultural competence education requires social and comprehensive remedies to level life inequities that perpetuate a history of disadvantages in some groups.

Acculturation↗
PubMedDate not supplied

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Attitude of Health Personnel↗