Cultural Competence Interventions Research Articles

Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec

ObjectiveThe overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received.MethodsWe adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques.ResultsThree prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery.Conclusions and implications for practiceThese findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population.

Cultural Competence Interventions in European Healthcare: A Scoping Review.

Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.

Association of Lesbian, Gay, Bisexual, and Transgender (LGBT) Cultural Competency Training With Provider Practice Characteristics and Perceptions of Patient Care.

While issues related to lesbian, gay, bisexual, and transgender (LGBT) health are increasingly incorporated into medical training, there remains limited guidance and opportunities for continuing medical education in LGBT health. It is unclear how participation in LGBT-specific training is distributed across physician specialties and practice regions. Additionally, national data assessing cultural competency training for physicians are scarce and do not delineate LGBT-specific training or training completed prior to, during, or after graduate medical education. Using data from the 2016 National Culturally and Linguistically Appropriate Services Physician Survey, this study evaluated patterns of post-residency cultural competency training, as well as associations between LGBT-specific training and provider perceptions of patient care outcomes. Provider specialty, practice region, and receiving cultural competency training as a trainee were associated with post-residency LGBT-specific training. Surgical providers (odds ratio [OR]: 0.42; confidence interval [CI] 0.25-0.73; p = .002) and those practicing in the South (OR: 0.49; CI: 0.26-0.92; p = .025) had lower odds of completing LGBT-specific cultural competency training while in independent practice. Post-residency LGBT-specific training was associated with provider agreement that cultural competency training improves the quality of care (OR: 2.76; CI: 1.44-5.28; p = .002), patient satisfaction (OR: 2.55; CI: 1.32-4.93; p = .005), and patient comprehension (OR: 2.03; CI: 1.05-3.90; p = .034). Our findings provide disaggregated analyses that nuance the assessment of cultural competency interventions and support a broader effort to increase attention to LGBT health in continuing medical education.

Teaching and Learning Interventions Designed to Improve Cultural Competence in Health Profession Students: A Systematic Review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy.

451 A systematic review exploring cultural competence in pharmacy education

Abstract Introduction There is an increased need for a healthcare workforce that is culturally competent to improve health outcomes and reduce health disparities for patients from diverse cultural backgrounds. This is important in the context of pharmaceutical care for patients, as the inability to recognise a patient’s health beliefs, which could be influenced by their cultural background, can lead to reduced medication adherence and poor treatment outcomes (1, 2). This review is registered with PROSPERO (Reference number CRD42021295875). Aim This systematic review aims to explore cultural competence teaching and training in pre-qualification pharmacy education. Methods This study is reported using the PRISMA Checklist. Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were systematically searched for studies that explored cultural competence in pharmacy education and were published in English from January 2012 to December 2021. Methodological quality of studies were assessed using the Mixed Methods Appraisal Tool (MMAT). Data from included studies were thematically analysed. Results Overall, 47 papers (46 studies) were included in the review. Of these, 40 papers focused on interventions for teaching cultural competence to pharmacy students only, the remaining studies included students from pharmacy and other health discipline programmes. Half of the studies focused on cultural competence in general (n = 20, 50%), while the remaining studies focused on competence on specific aspects e.g. cultures, religions and disabilities. Most studies (n = 24, 60%) report implementation of interventions that took place over a week. Twenty-one studies reported that cultural competence interventions were compulsory. There were variations in how cultural competence is conceptualised in studies; some studies focused on the need to increase knowledge about different cultures or ‘knowing how’; other studies focused on behavioural aspects that would help students while they work with patients from diverse backgrounds, or ‘showing how’; some studies described cultural competence as a continuum that includes both ‘doing’ knowledge and behavioural aspects. Conclusion There is variation in how cultural competence is taught in pharmacy education programmes, which could be a consequence of differences in how authors conceptualised cultural competence. It is also challenging to know whether or not current interventions improve ‘cultural competency’ due a range of outcome measures used in the studies. Therefore, it is important to develop a set of key principles that underpin the understanding and operationalisation of the concept of cultural competence into the pre-qualification pharmacy curricula – this forms our future work. A limitation of the study was the inclusion of only papers written in English, which may therefore have inadvertently excluded relevant papers published in other languages. Additionally, grey literature was not included, which often is a key step in the dissemination of pedagogical research and scholarship.

Eliciting social stressors, supports, and determinants of health through the DSM-5 cultural formulation interview.

As recognition of the importance of social determinants of mental health has increased, the limitations of clinical competence-enhancing interventions that do not emphasize this approach have emerged. The Cultural Formulation Interview (CFI) is a cultural competence intervention that emerges from a confluence of social medicine and medical anthropology traditions. Limited research has examined how patients respond to CFI questions on social-structural aspects of illness and care to assess whether the CFI adequately elicits information on social determinants of mental health. Patients' responses during a first intake appointment to three CFI questions on social stressors, supports, or barriers to care from 27 patient-clinician dyads are analyzed through qualitative content analysis. The data come from a hyper-diverse clinical setting in Queens, New York, where no ethnoracial group has a majority and all patient-clinician dyads reflect cross-cultural interactions. At least one social determinant was coded in 89 of all cases, and nearly 44% included themes related to multiple determinants of health. The most-commonly coded theme was social relationships (n = 21), followed by financial instability (n = 7), stigma (n = 5), housing instability (n = 2), and poor access to healthcare, involvement in the criminal justice system, employment instability, area-level poverty, and immigration policies (n = 1 each). Our work shows that social determinants of mental health can be elicited through the CFI. Future work should examine how this information is included in clinicians' formulations and whether the cultural formulation approach would benefit from additional revision to facilitate assessment of socio-structural factors.

Cultural Competence Interventions for Health Care Providers Working With Racialized Foreign-born Older Adults: Protocol for a Systematic Review.

BackgroundIntegrating culturally competent approaches in the provision of health care services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of health care providers to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among health care workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults.ObjectiveWe seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of interventions to improve the cultural competence of health professionals who care for racialized foreign-born older adults. The aim of this paper is to outline a protocol for a systematic review of available published evidence.MethodsOur protocol will follow the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Protocols) for systematic review protocols. We will conduct a systematic search for relevant studies from four electronic databases that focus on health and social sciences (PubMed, CINAHL, Scopus, and Cochrane Database). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research.ResultsThe systematic review is currently at the search phase where authors are refining the search strings for the selected databases; the search strings will be finalized by July 2022. We anticipate the systematic review to be completed by December 2022.ConclusionsThis study will inform the future development and implementation of interventions to support culturally competent, person-centered care of racialized foreign-born older adults.Trial RegistrationPROSPERO CRD42021259979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259979International Registered Report Identifier (IRRID)PRR1-10.2196/31691

Exploring the End-of-Life Experiences of Advanced Cancer Patients from India

Paying attention to the socio-cultural characteristics of advanced cancer patients as they pass through the final stages of life can help healthcare professionals and mental health professionals assess the end-of-life experiences of terminally ill patients better. A comprehensive study of this population in the Indian context is helpful to devise individualized end-of-life care that aligns with their preferences and focuses on their comfort. The dataset comprised information-rich cases of 10 advanced cancer patients from Bangalore, India, selected using the purposive sampling method. The semi-structured interviews with the participants were audio-recorded, transcribed, and translated. Identification of patterns and commonalities in the dataset helped generate codes. The codes were used to narrow down to overarching themes. The standout themes were outlook on life, unfulfilled goals, end-of-life expectations, and death anxieties and attitudes to impending death. The study highlights the psychosocial and cultural needs of the patients in end-of-life care. How advanced cancer patients long for psychological care from mental health professionals and empathy from their loved ones. This study argues for renewed attention on the socio-cultural characteristics of terminally ill patients to enhance individualized care through culturally-competent interventions.

A Study of a Cultural Competence and Humility Intervention for Third-Year Medical Students.

ObjectiveThis study evaluates the effectiveness of a cultural competence and humility intervention for third-year medical students by assessing changes in clinical evaluation assessments in patient encounters.MethodsThis study examines the effect of a 1-h educational intervention on cultural competence and cultural humility for third-year medical students. Clinical assessments during observed patient encounters are compared in the clerkship before and after the intervention. The intervention adapts a previously studied cultural competence didactic and emphasizes cultural humility practices. Change in scores from the intervention cohort (clinical year 2019–2020) is compared to a pre-intervention cohort (2018–2019).ResultsStudents who completed the intervention demonstrate greater clinical competency in “relating to patients in a respectful, caring, empathetic manner” as assessed by supervising physicians compared with pre-intervention cohort students (2.7% difference in earning top two scores in subsequent clerkship, P value 0.05, Cramer’s V 0.04). Greater clinical competencies were also found in the intervention students compared with pre-intervention students in the domains “demonstrates accountability, contribution and commitment to patient care” and “develops insightful, focused, pertinent questions based on clinical scenarios” (3.8% difference in earning top two scores in subsequent clerkship, P value 0.01 and 5.1% difference, P-value 0.003 with Cramer’s V of 0.05 and 0.06, respectively).ConclusionsEducational interventions to improve cultural competence and cultural humility are important during clinical years to shape future physicians. Our study suggests that brief interventions may improve medical students’ clinical competencies. A future study with a more robust intervention is expected to yield more substantial results.

The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: a scoping review.

PurposeCultural competence in healthcare assists in the delivery of culturally sensitive and high-quality services. This scoping review aims to provide an overview of the available evidence and to examine the effectiveness of classroom-based intervention strategies used to enhance the cultural competence of undergraduate health science students.MethodsA comprehensive and systematic literature search was undertaken in databases, including Cochrane Library, Medline, and Emcare. Articles were eligible if they employed an experimental study design to assess classroom-based cultural competency education for university students across the health science disciplines. Two reviewers independently screened and extracted relevant data pertaining to study and participant characteristics using a charting table. The outcomes included knowledge, attitudes, skills, and perceived benefits.ResultsTen studies were analysed. Diverse approaches to cultural education exist in terms of the mode, frequency, and duration of interventions. For the knowledge outcome, students who experienced cultural education interventions yielded higher post-test scores than their baseline cultural knowledge, but without a significant difference from the scores of students who did not receive interventions. Data relating to the skills domain demonstrated positive effects for students after experiencing interventions. Overall, students were satisfied with their experiences and demonstrated improvements in confidence and attitudes towards culturally competent practice.ConclusionAcross health science disciplines, cultural competency interventions were shown to be effective in enhancing knowledge acquisition, performance of skills, attitudes, and student satisfaction. Future research is necessary to address the significant absence of control arms in the current literature, and to assess long-term effects and patient-related outcomes.

Capsule Commentary on Deliz et al., Cultural Competency Interventions during Medical School: a Scoping Review and Narrative Synthesis.

Capsule Commentary on Deliz et al., Cultural Competency Interventions during Medical School: a Scoping Review and Narrative Synthesis.

Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis.

Many medical accreditation bodies agree that medical students should be trained to care for diverse patient populations. However, the teaching methods that medical schools employ to accomplish this goal vary widely. The purpose of this work is to summarize current cultural competency teaching for medical students and their evaluation methods. A scoping review was completed by searching the databases PubMed, Scopus, MedEdPORTAL, and MEDLINE for the search terms "medical education" and "cultural competency" or "cultural competence." Results were summarized using a narrative synthesis technique. One hundred fifty-four articles on cultural competency interventions for medical students were systematically identified from the literature and categorized by teaching methods, length of intervention, and content. Fifty-six articles had a general focus, and ninety-eight articles were focused on specific populations including race/ethnicity, global health, socioeconomic status, language, immigration status, disability, spirituality at the end of life, rurality, and lesbian, gay, bisexual, transgender, and queer. About 54% of interventions used lectures as a teaching modality, 45% of the interventions described were mandatory, and 9.7% of interventions were not formally evaluated. The authors advocate for expansion and more rigorous analysis of teaching methods, teaching philosophies, and outcome evaluations with randomized controlled trials that compare the relative effectiveness of general and population-specific cultural competency interventions.

Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision.

BackgroundCulturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions.Methods and findingsA systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare–Individual level; Components of culturally competent healthcare–Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers.ConclusionThis scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.

Educational interventions designed to develop nurses’ cultural competence: A systematic review

BackgroundDue to a steady rise in cultural and linguistic diversity in healthcare settings and evident challenges associated with this diversity, there is an urgent need to address cultural competency of nurses. Ongoing, continuing professional development is needed to ensure nurses can provide culturally congruent nursing care. ObjectivesThe aim of this systematic review was to identify current best evidence on the types of educational interventions that have been developed to improve nurses’ self-assessed cultural competence and on the effectiveness of these interventions. DesignA systematic literature review. Data sourcesFour electronic databases (PubMed, CINAHL, Medic, Eric) were searched for studies using a quasi-experimental design or randomised controlled trial published between January 2000 and June 2018. Review methodsGuidelines from the Centre for Review and Dissemination and the Joanna Briggs Institute guided the review. Two researchers independently assessed the eligibility of the studies by title, abstract and full-text and the methodological quality of the studies. Data tabulation and narrative analysis of study findings was performed. ResultsSix studies met criteria for inclusion in the review. Studies used a quasi-experimental study design (n = 5) and a randomised controlled trial (n = 1). The participants (n = 334) were mainly nurses and interventions were conducted in various healthcare settings. Cultural competence education was offered through traditional contact teaching (n = 5) or web-based modules (n = 1) and ranged from one to 17 hours in length. Learning was enhanced through lectures, group discussions, case studies, reflective exercises and simulations. In two studies, following cultural competence interventions, participants in the intervention group had statistically significantly increased levels of competence in culture-related outcomes when compared to the control group. The four remaining studies did not include control group comparisons. Effect sizes (Cohen’s d) of the studies varied from small (d = 0.22) to very large (d = 1.47). ConclusionsThere continues to be a need for high quality studies investigating educational interventions to develop nurses’ cultural competence. Further research should focus on reporting specific components of interventions that result in an increase in cultural competence.

Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community.

BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.

Improving quality of life among latino cancer survivors: Design of a randomized trial of patient navigation

Latino cancer survivors have lower survival rates for most cancers relative to non-Latino whites, including, colorectal, prostate, and breast. In addition, Latinos experience health disparities in both access to care and quality of care. Experts recommend providing psychosocial services as an integral part of quality cancer care; however, there continues to be a paucity of information on the efficacy of Patient Navigators (PNs) in linking Latino cancer survivors to appropriate psychosocial services. Redes En Acción: The National Latino Cancer Research Network partnered with LIVESTRONG Cancer Navigation Services Patient Navigation program (PN-LCNS) to provide an intervention to improve wellness and increase access to psychosocial services among non-metastatic Latino cancer survivors from Texas and Chicago using trained bilingual, bicultural PNs. The study design involved a mixed-methods approach in two phases. Phase I used a Community-Based Participatory Research (CBPR) approach wherein PNs engaged community partners who provide services to breast, colorectal and prostate Latino cancer survivors. Phase II was a randomized controlled trial (RCT) that evaluated the efficacy of combining PN-facilitated interventions with the culturally tailored and CBPR-informed PN-LCNS in 300 breast, prostate and colorectal Latino cancer survivors. Outcomes investigated were improvements in: 1) quality of life (QOL), both general and disease-specific, and; 2) treatment follow-up compliance. While limited work has addressed the psychosocial needs of Latino cancer survivors, culturally-competent interventions using PNs have potential to address these needs and significantly improve Latino cancer survivorship.

Towards Cultural Competence in the Genomic Age: a Review of Current Health Care Provider Educational Trainings and Interventions

The increasing diversity of the USA brings opportunities and challenges for health care providers, health care systems, and policymakers to create and maintain culturally aware services. To reduce health disparities and reflect societal changes, the medical community must evaluate how it is addressing cultural competence in all areas. A focus on genomics is a particular need as the increased availability of and access to genetic testing technologies has led to a new level of understanding of human genetic variation and advances in the individualized care of patients. However, there is a justified concern that these technologies could perpetuate or even widen existing health disparities among patients from historically underrepresented groups. This article reviews the impact of cultural influences on the medical genomics and genetic counseling processes, as well as educational and interventional strategies available for health care professionals. While cultural competence training and educational opportunities are available to most health care providers, there is limited published literature on the utilization and effectiveness of these interventions. Recent reviews acknowledge the equal importance of awareness, knowledge, and skills within cultural competence training and interventions; however, there is a lack of understanding of how a cultural competence framework should be developed and adopted in an increasingly diverse society. This suggests an opportunity to re-evaluate current practices through measured outcomes research. The most beneficial cultural competence training likely occurs when traditional coursework is complemented by cultural awareness and self-reflection activities intimately woven into training and patient encounters. Cultural competence is a complex, multidimensional process that includes cultural awareness, knowledge, and skills. A lifelong commitment to understanding and embracing culture is central to effective practice. Suggestions for promoting cultural competence within the health care professions are presented.

Health workforce cultural competency interventions: a systematic scoping review

BackgroundAddressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. Research evidence in this area is primarily focused on cultural competency training and its effects on practitioners’ knowledge, attitudes, skills and behaviour. While improvements in measures of healthcare practitioner cultural competency and other healthcare outcomes have been reported, there are concerns around evidence strength and quality. This scoping review reports on the intervention strategies, outcomes, and measures of included studies with the purpose of informing the implementation and evaluation of future interventions to improve health workforce cultural competence.MethodsThis systematic scoping review was completed as part of a larger systematic literature search conducted on cultural competence intervention evaluations in health care in Canada, the United States, Australia and New Zealand published from 2006 to 2015. Overall, 64 studies on cultural competency interventions were found, with 16 aimed directly at the health workforce.ResultsThere was significant heterogeneity in workforce intervention strategies, measures and outcomes reported across studies making comparisons of intervention effects difficult. The two main workforce intervention strategies identified were cultural competency training and other professional development interventions including other training and mentoring. Positive outcomes were commonly reported for improved practitioner knowledge (9/16), skills (7/16), and attitudes/beliefs (5/16). Although health care (6/16) and health (2/16) outcomes were reported in some studies there was very limited evidence of positive intervention impacts. Only four studies utilised existing validated measurement tools to assess intervention outcomes.ConclusionTraining and development of the health workforce remain a principle strategy towards the goal of improved cultural competence in health services and systems. Diverse approaches are available to increase health workforce cultural competence. However, the effects of interventions beyond practitioner knowledge and attitudes remains unclear. Assessment of practitioner behavioural outcomes as well as measures of intervention impact on healthcare and health outcomes are needed to build a stronger evidence base.

Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention

RationaleCorrectional healthcare providers' limited cultural and clinical competence to care for transgender patients represents a barrier to care for incarcerated transgender individuals. ObjectiveThe present study aimed to adapt, deliver, and evaluate a transgender cultural and clinical competence intervention for correctional healthcare providers. MethodIn the summer of 2016, a theoretically-informed, group-based intervention to improve transgender cultural and clinical competence was delivered to 34 correctional healthcare providers in New England. A confidential survey assessed providers' cultural and clinical competence to care for transgender patients, self-efficacy to provide hormone therapy, subjective norms related to transgender care, and willingness to provide gender-affirming care to transgender patients before and after (immediately and 3-months) the intervention. Linear mixed effects regression models were fit to assess change in study outcomes over time. Qualitative exit interviews assessed feasibility and acceptability of the intervention. ResultsProviders' willingness to provide gender-affirming care improved immediately post-intervention (β = 0.38; SE = 0.41, p < 0.001) and from baseline to 3-months post-intervention (β = 0.36; SE = 0.09; p < 0.001; omnibus test of fixed effects χ2 = 23.21; p < 0.001). On average, transgender cultural competence (χ2 = 22.49; p < 0.001), medical gender affirmation knowledge (χ2 = 11.24; p = 0.01), self-efficacy to initiate hormones for transgender women, and subjective norms related to transgender care (χ2 = 14.69; p = 0.001) all significantly increased over time. Providers found the intervention to be highly acceptable and recommended that the training be scaled-up to other correctional healthcare providers and expanded to custody staff. ConclusionThe intervention increased correctional healthcare providers' cultural and clinical competence, self-efficacy, subjective norms, and willingness to provide gender-affirming care to transgender patients. Continued efforts should be made to train correctional healthcare providers in culturally and clinically competent gender-affirming care in order to improve the health of incarcerated transgender people. Future efficacy testing of this intervention is warranted.

Teaching Cultural Competence in Dental Education: A Systematic Review and Exploration of Implications for Indigenous Populations in Australia

Indigenous and other minority populations worldwide experience higher rates of disease including poor oral health than other populations. Cultural competence of practitioners is increasingly being recognized as fundamental to health care and quality of life in addressing these disparities. The aims of this study were to conduct a systematic review of the literature about teaching cultural competence in dental education and to explore the particular relevance of that teaching for the oral health care of Indigenous populations in Australia. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted of published studies that explored cultural competency interventions in dental curricula. A total of 258 studies from 2004 to 2015 were identified; after removing duplications and applying criteria for exclusion, 12 were selected for analysis, involving 1,360 participants. The principal themes identified in the qualitative analysis of these studies were curriculum content, curriculum delivery, community service-learning, reflective writing, and evaluation. Students need knowledge of health disparities and community health to better understand the perspectives of culturally diverse populations and to communicate effectively with people from various cultures. The principal strategies that improved cultural competence in the articles examined in this study were educational seminars, community service-learning, and reflective writing. These findings suggest that integration of cultural competency curricula using a combination of didactic or online training, community engagement, and reflective writing may increase the cultural knowledge and skills of dental students.