Cultural Competence Of Health Care Providers Research Articles

Healthcare Providers’ Cultural Competence from the Perspective of Newly Arrived Refugees and Asylum Seekers: A Qualitative Study in Greece

Cultural competence (CC) in the refugee context remains under-addressed in the literature. This study explores the perceptions of asylum seekers and refugees (N = 25) concerning the CC of healthcare providers. This study was conducted in 2019, on the island of Lesvos in Greece. A major finding is that, for the participants, CC means the provision of equal and human treatment and not the knowledge of culture-specific information from healthcare providers. Moreover, our findings highlight the necessity of rethinking CC in the refugee context and integrating relevant components to enhance the provision of equal treatment and ultimately end perceived or existing discrimination.

Attitudes, beliefs and behaviors of religiosity, spirituality, and cultural competence in the medical profession: A cross-sectional survey study.

Religion and spirituality play important roles in the lives of many, including healthcare providers and their patients. The purpose of this study was to examine the relationships between religion, spirituality, and cultural competence of healthcare providers. Physicians, residents, and medical students were recruited through social platforms to complete an electronically delivered survey, gathering data regarding demographics, cultural competency, religiosity, and spirituality. Four composite variables were created to categorize cultural competency: Patient Care Knowledge, Patient Care Skills/Abilities, Professional Interactions, and Systems Level Interactions. Study participants (n = 144) were grouped as Christian (n = 95)/non-Christian (n = 49) and highly religious (n = 62)/not highly religious (n = 82); each group received a score in the four categories. Wilcoxon rank sum and Chi-square tests were used for analysis of continuous and discrete variables. A total of 144 individuals completed the survey with the majority having completed medical school (n = 87), identifying as women (n = 108), white (n = 85), Christian (n = 95), and not highly religious (n = 82). There were no significant differences amongst Christian versus non-Christian groups or highly religious versus not highly religious groups when comparing their patient care knowledge (p = .563, p = .457), skills/abilities (p = .423, p = .51), professional interactions (p = .191, p = .439), or systems level interaction scores (p = .809, p = .078). Nevertheless, participants reported decreased knowledge of different healing traditions (90%) and decreased skills inquiring about religious/spiritual and cultural beliefs that may affect patient care (91% and 88%). Providers also reported rarely referring patients to religious services (86%). Although this study demonstrated no significant impact of healthcare providers' religious/spiritual beliefs on the ability to deliver culturally competent care, it did reveal gaps around how religion and spirituality interact with health and healthcare. This suggests a need for improved cultural competence education.

Towards a culturally competent health professional: a South African case study

BackgroundSouth Africa (SA) has a growing multilingual and multicultural population of approximately 55 million people, and faces service delivery challenges due to a shortage in skilled health professionals. Many health care facilities still depict distinct racial and ethnic characteristics that date back to the apartheid era, and there are reports of racial intolerance or preferential treatment at some facilities. There is limited literature in South Africa on cultural competence or on how to train health professionals to provide culturally competent care. This paper describes a study conducted to gain a better understanding of final year medical students’ perceptions regarding concepts related to cultural and linguistic competence in the SA healthcare setting.MethodsAn exploratory, cross-sectional, analytical study used a questionnaire to collect data from final year students at the medical school.ResultsThe demographic profile indicated considerable diversity in the respondents for languages spoken, ethnicity and religion. Responses indicated a level of cultural awareness and, according to the Cross Framework, a position of cultural pre-competence. This position was supported by the majority expressing high levels of agreement with the items deemed to indicate responsiveness: a desire for cultural competence to be promoted in the medical curriculum and for professional development to improve delivery of services and support to linguistically and culturally diverse groups. No significant association was found when analysing the latter item against demographic grouping variables. However, although not significant, a diminishing trend emerged in the rankings of monolingualism, bilingualism and multilingualism, suggesting that the ability to speak more than one language could possibly be a facilitating factor in acquiring cultural competence.ConclusionsIn response, it is recommended that specific learning objectives be included in the medical curriculum. Understanding of concepts related to both individual and institutional cultural competence would improve insights into their relevance in responding to the challenges related to culture in SA healthcare. Further research in teaching cultural competence is recommended. In order to respond to local needs, this should include research at a community level to analyse patients’ perspectives and satisfaction with the cultural competence of healthcare providers and organisations serving the SA public.

Cultural Competence of Healthcare Providers: A Systematic Review of Assessment Instruments.

Few articles in the literature identify and describe the instruments that are regularly used by scholars to measure cultural competence in healthcare providers. This study reviews the psychometric properties of the several instruments that are used regularly to assess the cultural competence of healthcare providers. Researchers conducted a systematic review of the relevant articles that were published between 1983 and 2013 and listed on academic and government Web sites or on one or more of the following databases: CINAHL, MEDLINE, ERIC, PsycINFO, Psyc ARTICLES, PubMed, Cochrane, Pro Quest, Google Scholar, CNKI (China), and the National Digital Library of Theses and Dissertations (Taiwan). This study included 57 articles. Ten instruments from these articles were identified and analyzed. These instruments included five that were presented in English and five that were presented in Chinese. All were self-administered and based on respondent perceptions. Five of the 10 instruments were designed to measure cultural competence, two were designed to measure cultural sensitivity, two were designed to measure transcultural self-efficacy, and one was designed to measure cultural awareness. The six cultural dimensions addressed by these instruments were attitudes, knowledge, skills, behaviors, desires, and encounters. An expert panel validated the content of the 10 instruments. The subscales explained 33%-90% of the variance in scores for eight of the instruments. The reliability of the 10 instruments was estimated based on the internal consistency, which ranged from .57 to .97. This systematic review may assist researchers to choose appropriate instruments to assess the cultural competence of healthcare providers. The findings of this review indicate that no single instrument is adequate to evaluate cultural competence in all contexts.

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study

BackgroundAs the diversity of the European population evolves, measuring providers’ skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital.MethodsA survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians’ and nurses’ mean composite scores and proportion of “3-good/4-very good” responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit “sensitized” to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness.ResultsOf 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of “good/very good” responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = −0.34, p < 0.005) was negatively correlated with skillfulness.ConclusionsOverall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

Addressing Disparities and Achieving Equity: Cultural Competence, Ethics, and Health-care Transformation

The passage of health-care reform and current efforts in payment reform signal the beginning of a significant transformation of the US health-care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and of high quality. As described in The Institute of Medicine report "Crossing the Quality Chasm," our nation is charting a path toward quality health care that aims to be safe, efficient, effective, timely, patient-centered, and equitable. As our health-care system rapidly undergoes dramatic transformation, several truths-and challenges-remain. First, racial and ethnic disparities in health care persist and are a clear sign of inequality in quality. Second, although the root causes for these disparities are complex, there exists a well-developed set of evidence-based approaches to address them; among these is improving the cultural competence of health-care providers and the health-care system. Third, as part of our care redesign, we must assure that we are prepared to meet the ethical challenges ahead and reassert the importance of equity, fairness, and caring as key building blocks of a new care delivery system. As we move ahead, it is critical to assure that our health-care system is culturally competent and has the capacity to deliver high-quality care for all, while eliminating disparities and assuring equity. Disparities are unjust, unethical, costly, and unacceptable-and integrating strategies to achieve equity as part of our health-care system's transformation will give us an incredible opportunity to comprehensively address them.

Cultural competency training for health care providers in an urban cancer institute and impact on breast care.

6561 Background: The purpose was to improve the cultural competence of healthcare providers at an urban cancer institute and to assess its impact on breast screening and diagnostic benchmarks. Methods: A web-based learning module was developed to address breast cancer disparities in African American women, identifying common barriers to care and highlighting functions of patient-provider education. The module, a pre-and post-test were administered to providers including physicians, nurses, non-clinical employees, diagnostic technicians and medical office assistants (MOA) of MedStar’s Washington Cancer Institute (WCI) and Breast Imaging Center (BIC). Cultural competency discussions began with providers in BIC in April 2011. The module was available to BIC providers in October 2011 and to WCI providers in December 2011. To increase the cancer knowledge-base, a breast education class was offered to 40 MOAs. Statistical analysis was conducted using SAS v.9.1. Results: October 2011-March 2012, 133 providers were offered the module. Seven providers helped create the module, were removed from analyses. Of the 126, 29 did not complete all parts or complete in proper order and were not used in analyses. Overall, providers (n=97) demonstrated an increase in average pre/post test scores (119 vs. 123; P&lt;.01). All providers, except diagnostic technicians, increased cultural competency scores post module. Physician’s average pre/post test scores showed the greatest increase with 11 points (P&lt;.01). From Nov 2011- April 2012, BIC experienced a 59% decrease in number of patients lost to follow up after a screening mammogram, a 11% decrease in lost to follow up for diagnostic patients as well as a decrease of 1 days in average number of days patients return for diagnostic imaging after a mammogram. There was a 32% increase in employee satisfaction within in BIC. Conclusions: This suggests that our learning module had a positive impact on patient-provider communication. The decrease in screening and diagnostic lost to follow up rates illustrates the learning module’s potential for staff motivation in reducing breast cancer disparities. Supported by Susan G. Komen for the Cure NR-11-33340.

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review

Culturally and linguistically diverse (CALD) communities in Australia experience both significant health disparities and a lack of access to services. Consequently, there have been calls for culturally appropriate services for people with chronic disease in CALD populations. This paper presents a systematic review of the literature on the effectiveness of culturally appropriate interventions to manage or prevent chronic disease in CALD communities. Evidence was sought from randomized controlled trials and controlled studies that examined strategies for promoting cultural competence in health service delivery to CALD communities. The outcomes examined included changes in consumer health behaviours, utilisation/satisfaction with the service, and the cultural competence of health-care providers. Of the 202 studies that were identified only 24 met the inclusion criteria. The five categories of intervention that were identified included: (1) the use of community-based bi-lingual health workers; (2) providing cultural competency training for health workers; (3) using interpreter service for CALD people; (4) using multimedia and culturally sensitive videos to promote health for CALD people and (5) establishing community point-of-care services for CALD people with chronic disease. The review supported the use of trained bi-lingual health workers, who are culturally competent, as a major consideration in the development of an appropriate health service model for CALD communities.