Cultural Competency Training Research Articles

Bridging the mental health gap: unveiling and mitigating the hidden toll of workplace behaviors on diverse populations.

This study investigates the critical issue of mental health disparities within diverse populations in modern workplaces, a concern that significantly affects both individuals and organizational structures. By focusing on how prevailing workplace behaviors, including implicit biases, microaggressions, and the scarcity of diversity in leadership, exacerbate these disparities, the research highlights the urgent need for attention and action in this area. The mental health gap-disparities in conditions and access to care among different workplace groups-emerges from systemic inequalities and stigmatization, deeply influencing employee productivity, creativity, collaboration, and retention. Our research underscores the disproportionate impact of this gap on diverse populations, characterized by varying ethnicity, gender, age, socio-economic status, and other unique identity attributes. The paper articulates the substantial economic repercussions for organizations, manifesting as reduced productivity, increased absenteeism, and higher turnover rates. Recommendations include the implementation of cultural competency training, promotion of inclusive leadership, investment in tailored mental health resources and fostering open dialog about mental health. These strategies are pivotal in creating an inclusive, resilient, and harmonious work environment. Our findings aim to catalyze a shift in organizational practices toward mental well-being, advocating for comprehensive strategies to bridge the mental health divide in workplaces, thereby enhancing overall organizational health and cohesion.

Racial Disparity in Hematopoietic Stem Cell Transplant Clinical Trial Recruitment

Introduction: Race significantly influences phenotypic and genetic diversity in hematological diseases, consequently affecting disease prognosis, Human Leukocyte Antigen-matching and Hematopoietic Stem Cell Transplant (HSCT) outcomes. To ensure the development of novel transplant strategies effective for patients from diverse backgrounds, all racial groups must have equal opportunities to take part in HSCT clinical trials. Methods: Using ClinicalTrials.gov, a web-based resource that registers all studies meeting the definition of a clinical trial according to the International Committee on Medical Journal Editors, we identified all phase 1 to phase 4 HSCT clinical trials registered from 2006 to 2022. We manually abstracted data on the racial distribution of enrolled participants, sex distribution, transplant type, trial phase, location, and year of trial reporting. We calculated observed ratios of racial participation and compared them with the estimated probability of finding adequate donors from different racial subgroups reported by the National Marrow Donor Program to define the disproportionate enrolment factor. We then conducted subgroup racial distribution based on the trial phase, location, and type of transplant. We further evaluated trends in racial disparity within clinical trial enrolment over the years. Results: We identified 398 clinical trials related to HSCT between 2006 and 2022, of which 72% were allogenic and 28% were autologous HSCT trials. Most of these were phase 2 clinical trials (64.3%) and the majority (78.1%) were conducted in the United States. The racial distribution of enrolled participants was publicly available in 235 (59%) of these clinical trials, including 57.7% allogeneic and 62.5% autologous HSCT. The race distribution of enrolled subjects was reported in 80% of Phase 1 and 79% of Phase 3, whereas only 48% of Phase 1/2 and 44% of Phase 2/3 clinical trials reported racial distribution. The race distribution among 25,075 study participants in 235 clinical trials was: 80.4% Whites (20,175), 7.4% Blacks (1858), 5.3% Asians (1336), 1.6% other races (396), and 5.3% (1310) subjects with unreported race. The same race distribution trend was observed across all subgroups of clinical trials based on phase, location, and transplant type (Table 1). The disproportionate enrolment factor was 0.27 for Black participants, and 0.11 for Asian participants, compared to 1.02 for Whites. From 2006 to 2022, yearly trends for the absolute number of clinical trial enrollees showed a 2.5% and 1.5% increase in Black and Asian subject representation; however, minorities still accounted for only 20.3% of total representation in 2022 (Figure 1). Conclusions: Our results emphasize the significant racial underrepresentation of minority populations with a very low disproportionate enrolment factor in HSCT clinical trials despite the increased probability of finding a suitable donor resulting from novel HSCT technologies in recent years. Addressing these disparities requires urgent action and a multi-faceted approach. Efforts such as targeted outreach, cultural competence training and community engagement to focus on eliminating barriers are urgently needed to increase the enrolment of the minority population to achieve racial equity in HSCT.

Establishing an evidence-based cultural competency program with advanced practice providers in a community oncology setting.

199 Background: The United States continues to grow in both population and diversity. The trigger for this project was the dramatic increase in patient diversity in Texas and the lack of adequate cultural competency training for providers at a Texas Oncology clinic network. Clinicians must increase their self-awareness and knowledge to provide culturally competent care. The literature review found multiple educational modalities, across many health care disciplines, used by researchers to improve the cultural competency of health care providers. Methods: This project sought to improve satisfaction and adherence of patients over the age of 25 diagnosed with cancer by increasing provider cultural sensitivity and self-awareness of bias within 1 month of cultural competency training. The project sample was 14 advanced practice providers, 10 APRNs and 4 PAs. The educational plan for this project included an evidence-based course and a follow-up focus group to reinforce learning. Quantitative data were analyzed using the Cultural Competence Assessment tool to compare participants’ anonymous pre- and posteducation with the Wilcoxon signed-rank test. Qualitative data was obtained during focus groups. Results: The quantitative data indicated that cultural awareness and sensitivity increased following training, with median scores increasing from 6.09 to 6.55, p = 0.03. However, the data do not suggest that cultural competence and behavior changed after training, as median scores went from 3.96 to 4.23 after training, p = 0.06. Overall, the focus group participants agreed about improving self-awareness, identifying biases, improving patient experience by asking more open-ended questions, and being vulnerable. Conclusions: Despite the small sample size, the quantitative and qualitative data suggest that cultural awareness and sensitivity improved following the EBP course and focus group meetings. Cultural competency and behavior did not change according to the data. However, the project implications include improvement in provider knowledge and increased self-awareness, which promote individualized, culturally sensitive care.

Current Resources for Skin of Color Dermatology and Cultural Competency Training for Physician Assistants

Medical education has long held inequities when educating on dermatology for skin of color. More recent awareness of these long-standing issues has highlighted a need to ensure better dermatology education. This review will outline additional resources that can be used for training students and practicing providers in skin of color dermatology. While there are mixed data on how confidence correlates with diagnostic accuracy, studies show that medical students and residents lack confidence in skin of color dermatology. Resources, including digital learning tools, books, and social media platforms, may provide avenues to increase exposure to skin of color dermatology and potentially increase the confidence of medical providers to care for all patients seeking dermatologic care.

Cultural competence of mental health practitioners in the Netherlands.

The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.

Facilitating Faculty Development for Training in Multicultural Competence in Health Service Psychology Graduate Programs Through an International Collaboration

Abstract: A critical aspect of strengthening graduate-level clinical and counseling psychology training in cultural competence is to build capacity among faculty teaching in these programs to provide effective training. We addressed this need through an international collaboration between a university in India and another in the United States that included faculty travel to another country, peer mentoring groups, and review of curricula. This article describes faculty perceptions of this program and its perceived impact on their professional development and outlines curricular and research outcomes that resulted from the program. Across 4 years, a total of eight faculty visits took place with Indian faculty ( n = 13) visiting the United States and US faculty ( n = 11) visiting India. After each visit, faculty at both institutions responded to open-ended questions about the usefulness of these visits and completed a rating scale at the end of the program through an online survey. Faculty from both countries indicated that the visits contributed to enhanced cultural awareness and sensitivity by broadening their perspectives and learning about cultural similarities and differences. Indian faculty described learning about new pedagogical methods and enhanced motivation to engage in research and publish, along with new collaborative opportunities. US faculty described incorporating cultural competence more centrally in their teaching and clinical supervision through increased commitment, as well as inclusion of more global and diverse content and assignments aimed to increase students’ cultural competence. These responses provide preliminary support for the usefulness of cultural immersion experiences for faculty professional development.

Practicing Cultural Humility Will Achieve Recovery-oriented Mental Health Practice and Service Delivery.

The authors have proposed incorporating the concept of cultural humility to achieve better recovery outcomes. While agencies have mandated staff training in cultural competence, health outcomes have not shown promising results. Given the shortcomings of cultural competence training, cultural humility is being suggested as a complementary approach. When providers adopt cultural humility into their interactions with service users, it encompasses underlying principles and values consistent with recovery-oriented practices. Cultural humility addresses power imbalances and emphasizes ongoing self-reflection and openness to interpersonal relationships. The authors believe that embracing cultural humility will promote dignity and respect, create a culture of collaboration and partnership, acknowledge the uniqueness of each individual, enhance person-centered care, and foster self-determination and autonomy. The application of a cultural humility lens can promote a recovery-oriented culture within mental health services, and it is the responsibility of providers to actively cultivate cultural humility. Overall, cultural humility presents new opportunities for practice, and its adoption may be a key factor in promoting a recovery-oriented culture within mental health services.

A preliminary study of intensive transgender-specific cultural competency training: Implications for social workers and psychologists who work with rural transgender clients

Rural transgender individuals face heightened disparities relative to other transgender individuals. However, social workers and psychologists receive minimal training in transgender client care. The current study used one-way repeated measures ANOVAs to investigate the effectiveness of transgender-specific cultural competency training for social workers and psychologists working with rural clients to improve knowledge, awareness, and self-efficacy (i.e., competency) concerning transgender clients’ needs. Results indicated significant differences in the change of competency among participants assigned to a transgender-specific group compared to those assigned to a general multicultural group. Thematic analysis of participants’ responses to course evaluations also supported the course effectiveness.

The impact of a pharmacist-led cultural competence training on provider perceived preparedness and clinical care in patients with diabetes of Asian descent

BackgroundPatients of Asian descent are under-represented in the U.S. health care system and provider cultural competence is inadequate in addressing Asian health disparities. ObjectivesThe purpose of this study was to evaluate the impact of the pharmacist-led cultural competence training on provider self-perceived preparedness and diabetes-related health outcomes in patients of Asian descent. MethodsThis study is a cross-sectional followed by a quasi-experimental design conducted in 2 phases in a primary care clinic. Phase one evaluated the association of providers’ cross-cultural care survey (CCCS) scores with patients’ diabetic health indices: hemoglobin A1c (HbA1C), systolic blood pressure (SBP), diastolic blood pressure, and body mass index. Phase 2 examined the impact of pharmacist-led cultural competence training on providers’ cross-cultural competency using survey analysis as well as pre- and post-training diabetic health indices in patients of Asian descent. ResultsPhase 1 CCCS results showed baseline cross-cultural competence of the providers is inadequate (N = 9 providers). Furthermore, a significant negative correlation was found between providers’ CCCS score and patients’ HbA1C (N = 49, P = 0.04). Phase 2 showed that cultural competence training significantly reduced providers’ self-perceived “un-preparedness” to care for patients of alternative cultures (N = 30 providers). Average diabetic health indices for all patients (N = 95) before and after the training were not significantly different. In the subset of patients with uncontrolled diabetes (HbA1C ≥ 7), SBP and HbA1C were significantly reduced after the training (P = 0.032 and P = 0.039, respectively). ConclusionsPharmacist-led cultural competence training had a positive impact on provider self-assessment and diabetic clinical outcomes in uncontrolled patients.

Cultural adaptation of CBT as a human rights issue: A UK study

Cognitive behaviour therapies have been used widely across the world and have been recommended as the first line of psychotherapeutic treatment for multiple mental health disorders. However, such blanket guidelines for use of Western-generated psychotherapies discount the socio-cultural determinants and aspects of mental health when recommended unadapted across ethnicities, eventually creating disparities in thequalityof care available to different populations. Examining the cultural relevance of these therapies for ethnic minority groups has therefore become an important avenue of inquiry.Recent decades have brought a revolution of cultural competency and adaptation research for such psychotherapies. Despite recent advances in cultural competency and adaptation research, the available body of literature in this domain remains limited and heterogenous. Furthermore, the lack of mandatory cultural competence training and the ineffectiveness of existing programmes increase the obvious discrepancy in the provision of mental healthcare services for certain minority groups, jeopardising equitable access and raising concerns about human rights protection.AimsThis study aimed to explore UK-based CBT therapists’ use of adaptations in their own practice, and understand what elements they tend to adapt, the impact and feasibility of their approaches, and the challenges faced by those who adapt and those who do not. The larger intention was to be able to gather information to recommend basic direction for policy and research to create plans for the benefit of ethnic minority groups for whom access to quality, tailored healthcare is currently largely overlooked.MethodThe study involved developing a survey informed by existing literature and distributing it to UK-based CBT therapists.ResultsThis study found that CBT therapists and their clients value cultural competency. It also found that therapists tend to believe that adapting CBT techniques and implementation and using culturally significant idioms and stories are impactful for their clients and practical to achieve as therapists. It further found that current barriers to adapting CBT for ethnic minority clients involves a lack of resources to study the efficacy of adaptations as well as a lack of well-established evidence-based adaptations in existing literature.ConclusionThe authors recommend that policymakers and service managers prioritise the regulation of cultural competence in psychotherapy and afford resources and incentive to researchers and clinicians that would eventually help to improve the effectiveness of their approaches and enhance mental health outcomes for ethnic minority groups. Future research could build on this study using qualitative methods or creating more robust surveys, using random sampling, and drawing larger sample sizes.

Encouraging Cultural Competence Among LIS Professionals via the Critical Incident Technique and Reflective Journaling

In a political climate in which intellectual freedom, particularly regarding Critical Race Theory (CRT) and other diversity, equity, and inclusion (DEI) concepts are under attack, courses with DEI content are especially relevant. Examining Library and Information Studies (LIS) curriculum within the United States, scholars have repeatedly found DEI content, despite being foundational to the LIS profession, is insufficient in preparing future LIS professionals. Scholars, throughout decades of research within LIS education, have explored various lines of inquiry, including multicultural LIS education (Carter, 1978), recruitment challenges that contribute to a lack of diversity (Childers and Adams, 1972), trainings, and professional development opportunities to better serve diverse populations (Simsova, 1980), and LIS curricula at institutions across the United States (Cohen, 1980). More recent scholarship has provided innovative efforts and approaches regarding recruitment, curriculum, and pedagogy, while also presenting the necessity to expand conceptions of diversity within LIS education (Adkins, Virden, & Yier, 2015; Jaeger et al., 2015; Roy, 2015). Despite extant literature and professional attention to DEI issues, the LIS education, and the profession at large, remains largely White (Bajjaly & Drulia, 2021) and can improve (Chancellor, 2019; DuMont, 1986; Jaeger et al., 2011; Mestre, 2010; Ndumu & Chancellor, 2021). The focus on these issues within LIS education is significant for the training of future LIS professionals as, once employed, opportunities for additional training are limited given the one-shot nature of many professional development opportunities.
 This presentation describes one attempt to effectively incorporate DEI content, specifically cultural competence, into a 4-week continuing education course in which participants can incorporate material into their professional activities via the critical incident technique and reflective journaling. After discussing existing scholarship regarding LIS education to establish the need for concerted efforts to implement useful and actionable approaches to DEI concepts, the presentation describes a continuing education course in which the critical incident technique and reflective journaling are offered as tools to effectively translate coursework into professional practice. A common, although not universal, approach to DEI and cultural competence training within LIS is one-off workshops, with many professional development opportunities limited by nature of their delivery. The present course’s emphasis on continual reflection via journaling and the critical incident technique addresses the limitations of many professional development opportunities.
 The presentation discusses a variety of topics pertinent to LIS curriculum. Instructional modality offers both opportunities and challenges, both of which this presentation addresses. As an online course, striking a balance between asynchronous content with synchronous meetings presents possibilities to check understanding and promote student engagement. As a continuing education course – a form of professional development – necessitates an understanding of educators that students’ schedules are full and, as working professionals, they have demands on their time that affect engagement. includes suggestions for professionals and educators to keep up to date with emerging research (e.g., the move from cultural competence to cultural humility within recent scholarship), incorporating course content into required LIS curriculum, and outlines avenues for future research.

LGBTQ+ cultural competency of Irish mental health professional students

Introduction The LGBTQ+ community is often discriminated against and stigmatized resulting in greater psychological and emotional stress compared to heterosexual and cisgender people. Consequently, poorer mental health is often observed in this community. To alleviate these disparities, mental health professionals need to be culturally competent. Therefore, LGBTQ+ cultural competency was explored in a sample of Irish mental health professional students. Methods A questionnaire was circulated among Irish students in mental health programmes. Out of approximately 700 students, 66 competed the survey, of which 23 identified as LGBTQ+. Results In terms of cultural competency, participants reported significantly higher attitudinal awareness compared to basic knowledge and clinical preparedness. Further, cultural competency was lower for transgender clients. LGBTQ+ patient education significantly predicted cultural competency when controlling for demographic variables. Three themes were generated from the open answers: experiences of cultural competency training, affirmative but uninformed, and recommendations for implementing training. Conclusion To provide adequate, affirmative care, cultural competency training should be a mandatory component of all mental health professional programmes.

Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study.

First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non-First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients' experiences with health care systems and identify solutions. Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. Patients' (n = 10) and community health care providers' (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients' overall health. Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.

Theory-Informed Teaching and Mentoring Strategies for Enhancing Cultural Competence in Sport Psychology With “How-To” Examples

Cultural competence and diversity, equity, and inclusion (DEI) have become fundamental learning objectives in sport psychology training, yet the literature lacks theory-informed strategies that support relevant teaching and mentoring efforts. Using two evidence-based instructional strategies—cooperative learning and scaffolding, we present how to apply strengths-based and cultural humility frameworks and activities to promote cultural competence through teaching or group mentorship. We also discuss how to modify these activities based on the modality, group size, and time available. Additionally, we share student feedback and our reflections on the successes, lessons learned, and recommendations for enhancing students’ cultural competence and DEI training.

LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial.

Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face-to-face, multi-level (administrators and therapists) and multi-strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training-the Sexual and Gender Diversity Learning Community (SGDLC)-was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self-Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0-1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self-efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self-reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self-efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational- and therapist-level changes that may benefit LGBTQ+ clients.

An exploration of cultural competency training and genetic counselors' racial biases.

Research shows genetic counselors generally have pro-White implicit biases-both prejudice and stereotyping. Cultural competency training aims to foster equitable beliefs, behaviors, and attitudes in cross-cultural genetic counseling sessions, including those that are racially discordant (genetic counselors and patients are from different racial backgrounds). Therefore, cultural competency training has the potential to mitigate bias and reduce disparities. Here, we report the prevalence of cultural competency training among genetic counselors and associations between recency of training and counselors' racial biases. We conducted an online survey of genetic counselors and trainees in fall 2021. The survey assessed four types of bias (implicit/explicit prejudice and implicit/explicit stereotyping), time since last cultural competency training, time since last communication skills training, and frequency of clinic sessions with Black patients. Multiple linear regressions modeled associations between cultural competency training and different types of bias, adjusting for communication skills training, frequency of encounters with Black patients, and counselor race (White vs. non-White). Two hundred fifteen participants (107 genetic counselors and 108 trainees) responded, and 205 reported whether they had prior cultural competency training. Of these, 187 (91%) reported ever having cultural competency training, most (53%) of participants who had training had it within 6 months prior to survey completion. We found no clear pattern of associations between cultural competency training and racial biases (implicit or explicit) in adjusted analyses. Participants who had cultural competency training four or more years prior demonstrated less negative implicit stereotyping toward Black individuals compared with those having more recent training; but no statistically significant effect was found for participants who reported never having cultural competency training, compared with those having training more recently than 4 years prior. Overall, our findings do not support that cultural competency training is negatively associated with, or mitigates, Black/White racial prejudices and stereotypes against Black patients. These findings suggest more effective interventions are needed to reduce racial biases.

Perceived impact of ethnocultural competency training on genetic counselors' clinical interactions.

For genetic counselors to effectively meet the needs of an ever-diversifying multicultural patient population, it is vital that their genetic counseling programs (GCPs) equip future genetic counselors to recognize the impact of a patient's ethnocultural background on clinical interactions (Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed (p. 28). CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989). Concerns about genetic counseling cultural competency training (CCT) including content and delivery have been brought up by GCP students who identify as racial and ethnic minorities (Journal of Genetic Counseling, 29, 303-314). Though GCPs must meet the Accreditation Council of Genetic Counselors' (ACGC) accreditation criteria, there is a gap in knowledge regarding the focus, type, and methods of delivery that GCPs have chosen to incorporate into their CCT, as ACGC does not dictate the exact focus, delivery, or format of training curricula. This quantitative study aimed to (1) characterize the current focus, type, and delivery of ethnocultural competency training in GCPs as perceived by second-year genetic counseling students and recent graduates and (2) highlight their perception of its impact on their levels of preparedness and comfort when interacting with ethnoculturally diverse patients. One hundred and one survey responses were analyzed using descriptive statistics, chi-square analyses, two-sample Wilcoxon rank-sum, and Fisher's exact tests. The results reveal significant variability in the format, type, and delivery of CCT provided by GCPs. Participants perceive that CCT focusing on specific traditions, medical considerations, and systemic healthcare disparities (taught to 74%, 61%, and 94% of students, respectively) related to ethnoculturally diverse patients was more likely to increase their self-reported levels of preparedness and comfort for clinical interactions than training focused on racial or ethnic stereotypes and generalizations (taught to 88% of students). Although 94% of participants perceived their CCT as helpful, 61% reported they received an insufficient amount. In light of these results, we provide suggestions for the improvement of ethnocultural CCT and highlight future opportunities for more intentional and fruitful CCT in GCPs.

LGBTQ + cultural competency training for health professionals: a systematic review

BackgroundHealth disparities experienced by LGBTQ + individuals have been partially attributed to health professionals’ lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes.MethodsIncluded studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting.Results75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest–posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 – 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 – 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 – 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 – 1.11).ConclusionsThe findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals’ cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.

Veteran Cultural Competence Training: Initial Effectiveness and National-Level Implementation.

Because service professionals often lack cultural competence in working with veterans, veterans often perceive such professionals as "not understanding." The authors developed, evaluated, and implemented Veteran Cultural Competence Training (VCCT), combining educational and experiential components in an in-person training focused on building awareness, knowledge, and skills to better work with veterans. Study 1 was a type 1 effectiveness-implementation hybrid trial examining VCCT effectiveness in a sample of social service professionals (N=41) compared with a matched comparison group (N=41) via the Multicultural Counseling Self-Efficacy Scale-Veteran Form (MCSE-V) instrument. In study 2, the authors used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to conduct a type 2 effectiveness-implementation hybrid trial and implemented VCCT with an expanded population (N=312) during eight training sessions in three U.S. states. Results from study 1 indicated that VCCT significantly increased self-efficacy of trainees in veteran cultural competence compared with the matched group (p<0.001). In study 2, the RE-AIM framework highlighted the importance of building coalitions and utilizing implementation facilitation to maintain fidelity. The within-group effectiveness of VCCT was statistically significant and maintained across settings and professions (p<0.001), and trainees were satisfied with VCCT. Maintenance analysis revealed expansion of VCCT after implementation in terms of the number of training sessions (N=9), regions hosting the training (N=5), staff hired (N=13), and trainee applications (N=1,018). VCCT effectively increases self-efficacy in veteran cultural competence. Gains appeared across different professions, demographic characteristics, and locations. Participation in VCCT may increase professionals' competence in understanding veteran culture, thereby potentially improving veteran services.

Perspectives on Human Papilloma Virus Vaccination Barriers, Knowledge and Beliefs, and Practices: Providers Serving Arab-American Populations.

Little is known of HPV vaccination (HPVV) recommendation practices among healthcare providers who treat the Arab American community. Evidence indicates that HPVV patient uptake is low in this population. A survey was administered to healthcare providers (N = 46, 63% response rate) who treated ≥ 5% Arab American patients aged 9-26 years in areas of New York City and New Jersey with large Arab American populations. They were asked about barriers to HPVV recommendation and uptake among their Arab American patients. Providers (Doctors of Medicine and Osteopathy, Nurse Practitioners, and Physician Assistants) mostly worked in pediatrics (41%), primary care/internal medicine (26%), obstetrics/gynecology (20%), and family medicine (15%). Most (91%) were confident in their ability to effectively counsel their patients on HPVV. The most frequent provider-reported barriers to administering the HPVV to Arab American patients were patient cultural/religious practices (reported by 67%) and patient and provider difficulties with insurance reimbursement (44%). Most providers (84%) agreed that organizations/programs to increase HPVV uptake among Arab American patients were needed. Providers felt that HPVV uptake could be increased with educational materials in the patients' native languages ("very useful," 81%) and provider cultural competency training ("very useful," 65%). In responses to open-ended questions, cultural and religious HPVV barriers were a salient topic, as were linguistic barriers and provider burdens related to HPVV costs and regulations. HPVV uptake could potentially be improved with Arabic language education materials, provider education that is culturally and linguistically tailored to the Arab American community, and policies to address HPVV financial and regulatory burdens.