Abstract
Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.
Highlights
The 1986 Ottawa Charter for Health Promotion set out a broad vision and inclusive framework to guide the global movement for advancing health equity (1)
One way this has been addressed in health care is through the provision of direct health promotion services and programs which aim to be culturally competent for the targeted communities and populations
This literature review has a dual focus. It aims to (1) inform the planning and implementation of cultural competency services and programs by reviewing interventions strategies; and (2) inform further evaluations of cultural competency services and programs to help improve the quality of the evidence base by reviewing outcomes, measurement tools, and reporting on study quality. This scoping review is extracted from a broader rapid systematic review, commissioned by the SAX Institute and Closing the Gap Clearinghouse in Australia, to identify publications on cultural competency interventions in health care for indigenous peoples and other minority ethnic/cultural groups in Australia, New Zealand, Canada, and the United States
Summary
The 1986 Ottawa Charter for Health Promotion set out a broad vision and inclusive framework to guide the global movement for advancing health equity (1). Take into account differing social, cultural and economic systems” (1) Despite this call for local adaptation, many health promotion strategies and programs have failed to design programs for populations with complex and diverse needs that reflect social and cultural realities and are meaningful to people’s health practices and beliefs (2). The challenge of developing and implementing programs which meet culturally diverse community needs while simultaneously drawing out and enhancing individual and community assets is of utmost importance to the development of health promotion globally (3). One way this has been addressed in health care is through the provision of direct health promotion services and programs which aim to be culturally competent for the targeted communities and populations. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes
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