Cultural Competency Training Research Articles

Denial of medical care: the example of blood transfusion refusal for religious reasons under the view of the cultural competence of health professionals

The relationship developing between Human Rights and health is dynamic, two-way, interdependent and in some cases conflicting. The challenges within health professionals in health care in a multicultural society are inevitable, as health users "carry" different cultures. The refusal of health users to perform medical procedures vital to their health, mainly for religious reasons, raises both legal and moral issues as well as practical ones. The refusal to transfuse blood for religious reasons must, on the one hand, follow the ethical principles governing health professionals and, on the other, the content of the relevant rights of health users, in order to avoid induced moral, legal and practical conflicts on both sides. To this end, based on the literature review, the application and enjoyment of the rights of the members involved under the cultural perspective of health professionals are considered of primary importance. The cultural competence training of health professionals will be a key element of individualization and holistic approach to managing the challenges, as well as removing the inequalities required by health care in a multicultural society.

Implementing the Cultural Formulation Interview in a Community Clinic to Improve Appointment Retention: A Pilot Study.

Despite consensus that clinicians should receive cultural competence training to reduce mental health disparities among racial-ethnic minority groups, few studies have evaluated training in community settings. This column delineates implementation of the DSM-5 Cultural Formulation Interview (CFI) at a community hospital. Participating clinicians were able to implement the CFI after a single training session and offer administrative support and instructions on customizing care with lower- and middle-income, racially and ethnically diverse patients.

Cultural Responsiveness Curriculum for Behavior Analysts: A Meaningful Step Toward Social Justice.

Clients of applied behavior analysis (ABA), specifically Black, Indigenous, and people of color receiving treatment for autism spectrum disorder (ASD), regularly experience the effects of systemic racism via biases in the health care system. ABA as a science offers the necessary tools to support immediate, concrete actions to bring about social justice. This article offers a brief conceptual framework of critical race theory (CRT); cultural competence, responsiveness, and humility; and social justice concepts. Applications to health care are offered, addressingincluding systemic racism and implicit bias, along with points of personal reflection. These conceptual frameworks are synthesized in support of a cultural responsiveness curriculum, rooted in the tenets of CRT and cultural competence trainings in neighboring disciplines, that we offer as an immediate, actionable step that Board Certified Behavior Analysts can take today to broaden their perspective and proficiency. The prospective benefits of this work include effecting change in access to and outcomes of behavior-analytic services, particularly for the treatment of ASD in marginalized communities.

Facilitating an encounter with a new sexuality discourse: the role of civic communicators in building sexual health literacy among newly arrived migrants

Language and different sexual health discourses constitute barriers to the uptake of information on sexual and reproductive health and rights among migrants. Challenges remain with regards to the design and implementation of culturally appropriate programmes and interventions. This study explored the role of civic communicators in increasing access to sexual health information among migrants resettling in Sweden. Twenty in-depth interviews were conducted and analysed using qualitative content analysis. Findings illustrate the potential role of civic communicators in identifying sexual health needs, deconstructing misinformation and providing a space for reflective dialogue. Training in adult pedagogy, leadership, cultural competence and subject knowledge, and allocating sufficient time to cover themes that are culturally different, sensitive and politicised, are essential for good quality implementation and promoting rights-based sexual health.

Measuring the Cultural Competence of Latinx Domestic Violence Service Organizations.

Domestic violence (DV) represents a significant public health concern in the United States, including among Latinx populations. Despite the negative consequences associated with experiencing DV, research has shown that Latinx DV survivors may be less likely than others to utilize important services. One potential barrier is cultural competence (CC) in the provision of services specific to Latinx survivors among DV organizations. Thus, a beneficial addition to the field of DV service provision for such survivors is a better understanding and measurement of CC for this unique population. The exploratory, cross-sectional study herein presents the development and evaluation of a novel instrument for measuring the CC of DV organizations. Exploratory factor analysis was used on a purposive sample of 76 organizations in North Carolina who completed a comprehensive survey on their characteristics, practices, norms, and values. Psychometric results found best support for a 29-item, 4-factor bifactor model with both a general CC factor as well as three sub-factors. The general scale was named “General Cultural Competence,” while the three sub-scales were named “Organizational Values and Procedures,” “Latinx Knowledge and Inclusion,” and “Latinx DV Knowledge.” The final measure also demonstrated convergent validity with key organizational characteristics. Overall, higher CC scores were associated with organizations having more DV services in Spanish, a higher percentage of staff attending CC training, a higher percentage of staff attending Latinx service provision training, and a medium or greater presence in the Latinx community, and a moderate or stronger relationship with the Latinx community. The development of this measure is particularly useful in addressing knowledge gaps regarding the measurement of CC for Latinx DV services. Implications have importance for both the measurement of organizational CC and the scope of the measure’s associations with organizational, provider, and client outcomes.

Culturally safe dementia care: Building nursing capacity to care for First Nation Elders with memory loss.

Nursing staff require culturally relevant and dementia-specific education to care for the increasing number of First Nation Elders experiencing memory loss. The culturally safe dementia care (CSDC) research team, composed of researchers, decision makers and Secwepemc Elders, was formed to address this. To increase the capacity of nurses to care for First Nations Elders with memory loss in a culturally safe way. Our community-based research used purposive sampling and mixed methods to create, implement and evaluate an education programme for nurses. Thirty-four Elders from six Secwepemc communities participated in roundtables to share views and stories of dementia and nursing care. These data were used to create four teaching stories for the storytelling sessions and talking circles with Elders which, together with the Indigenous Cultural Competency (ICC) training, comprised the CSDC education programme. Thirty-eight nurses (healthcare aides, licensed practical nurses and registered nurses) working in Central British Columbia began the CSDC study and 15 nurses took part in the education programme, evaluated the storytelling session and completed the three pre- and post-measures (Approaches to Dementia Questionnaire (ADQ), ICC knowledge quiz and self-assessment, and Care Plans). The pre- and post-tests were scored, and the data were analysed statistically. The data from the roundtables and talking circles were analysed thematically through a collaborative process. The scores for the ADQ Hope sub-scale, the ICC knowledge quiz and the Care Plans increased from pre- to post-test. All nurse participants judged the storytelling session to be effective and their learning outcomes reflected culturally safe dementia care. This programme can improve the knowledge, skills and values of nurses to provide culturally safe dementia care.

The association between students' emotional intelligence, cultural competency, and cultural awareness

IntroductionEmphasis has been placed on health professionals' employment of social and behavioral skills to negotiate complex patient-clinician relationships. One example is a professional's ability to provide culturally appropriate care. This study evaluated the relationship between pharmacy students' cultural awareness, emotional intelligence, and their ability to engage in appropriate cross-cultural interactions as measured by a cultural competency scale. MethodsA cross-sectional study was conducted in first-year pharmacy students using three distinct survey instruments to measure cultural awareness, emotional intelligence, and cultural competence. Demographic characteristics assessed included gender, race, ethnicity, and previous cultural competency training. Descriptive statistics were used to characterize performance on each survey instrument. Pearson's correlation was used to evaluate the statistical significance of associations observed between the variables measured within the study. ResultsForty-four students responded, of which 34% had previous cultural competency training. No statistically significant associations were observed between overall cultural competence, emotional intelligence, or cultural awareness. The self-cultural scale (part of the cultural awareness scale) was significantly related to higher overall emotional intelligence scores (P = .02). Previous cultural competency training was associated with significantly higher scores on the cultural competence scale (P = .004). Previous cultural competency training was also associated with enhanced ability to perceive one's own emotions as measured by the emotional intelligence scale (P = .02). ConclusionsPrevious exposure to cultural competency training impacts cultural competence scores most significantly.

Mind the Gate: General Practitioner's Attitudes Towards Depressed Patients with Diverse Migration Backgrounds.

This study aims to examine (a) whether there are differences in general practitioners' (GPs) attitudes towards native Belgian patients, patients of foreign descent and asylum seeking patients who all express symptoms of major depression, and (b) whether these differences depend on GPs' experience with cultural competency training and interethnic contact. Using a video vignette study among 404 Flemish (Belgium) GPs, we find evidence of a provider bias. While GPs regard a patient of foreign descent as less trustworthy and less able to adhere to medical recommendations than a native Belgian patient, they also hold more pessimistic views on a potential recovery of an asylum seeking patient. In addition, we find that cultural competency training might alter GPs' attitudes of asylum seeking patients in a positive way. Summarized, our research highlights the need to target stereotypes among GPs for interventions designed to reduce migration-based disparities in healthcare use and health status.

Exploring the Impact of Religion, Superstition, and Professional Cultural Competence on Access to HIV and Mental Health Treatment Among Black Sub-Sahara African Communities in the English City of Birmingham.

HIV and mental health are sensitive subjects among Black Sub-Saharan African (BSSA) communities despite the disproportionate impact of HIV among this population and high comorbidity between HIV and mental disorders. This study explored the impact of religion, superstition, and professional cultural competence on access to HIV and mental health services among BSSA communities in the English city of Birmingham. Researchers utilised explorative qualitative methods. Specifically, 12 focus groups were conducted followed by a semi-structured interview with a member from each focus group. Data were analysed using a thematic approach guided by the four phases of the silences framework. Results suggest that religion, superstition, and professional cultural competence affect access to HIV and mental health services among BSSA communities. Findings indicate a need to educate religious leaders on the impact of HIV and mental health stigma as well as a need for cultural competence training among health professionals.

“Making time to make a difference”: Program Effects of a Cultural Competency Training

By the year 2044, more than half the United States population will be non-white. Extension is faced with the challenge of being inclusive in our multicultural world; thus, it is important that Extension educators receive cultural competency training. Cultural competency training based on and informed by intercultural theory and practice leads to increased awareness and knowledge and changes in professional practices. This paper presents qualitative evaluation results to document outcomes of an 18-hour cultural competency training for Extension and outreach professionals. The study focused on two research questions: Does cultural competency training impact professional practice of Extension and outreach professionals? What factors facilitate or inhibit the practice of new interculturally appropriate behaviors? An evaluation protocol was intentionally designed to test participants’ knowledge, skills, and professional practice changes. Previous work showed changes in knowledge and skills at post-training, as well as at six-month follow-up. Our findings in this study reflect that participants did make changes in some significant professional practices. It is possible to provide professionals with the knowledge and skills to make real change in their practices to better serve their communities

Promoting cultural awareness, professionalism, and communication skills in medicine through anatomy: The Deaf culture session.

The anatomy curriculum is a place where professionalism can be learned and practiced, including training in cultural competence and communication skills for working with diverse populations. One population that has received little attention in terms of medical education are d/Deaf and hard of hearing (d/DHH) patients, although there is much evidence to support health care disparities in this population. Several major contributing factors include differing views of deafness between medical professionals and those who are culturally Deaf, a lack of understanding of Deaf culture and American Sign Language (ASL) by medical professionals, a lack of educational resources in ASL, and poor experiences in health care. To address this need, a Deaf Culture Applied Anatomy session was incorporated into the first-year curriculum at Morehouse School of Medicine while medical students were studying anatomy of the ear and hearing. Panelists, who were culturally Deaf, hard of hearing, and hearing children of deaf adults, shared their experiences in healthcare, including challenges they faced with communication and care. Surveys were provided to students before and after the panel session. Surveys indicated a lack of knowledge prior to this session, while also demonstrating that this 90-min session improved students' understanding of effective communication with future patients and issues related to deafness. Qualitative feedback also suggested that the students found the session to be personally and professionally beneficial. Implementing the Deaf Culture session was an effective means for introducing students to Deaf culture and working with d/DHH patients.

Increasing underrepresented minority cancer patient enrollment into cancer clinical trials: A systematic review.

e18574 Background: Minorities continue to be underrepresented in clinical trials despite the National Institute of Health’s Revitalization Act, passed in 1993, mandating the representation of women and underrepresented minority groups in clinical trials. Studies have shown that although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates in are disproportionately low at 4-6% and 3-6% respectively. We conducted a systematic review exploring interventions aimed at improving clinical trial enrollment for racial and ethnic minorities. Methods: A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies of humans since 1993. Inclusion criteria included peer-reviewed, U.S.-based studies with interventions aimed to recruit underrepresented minority adult cancer patients into cancer clinical trials. We defined underrepresented minority groups as Black, Hispanic/Latino, Asian, American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Results: A total of 2471 titles and abstracts were identified and 2324 were excluded based on the eligibility criteria. A full text review was conducted of the remaining 147 articles, of which only 9 met criteria for our review. The interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1) and cultural competency training for providers (n = 1). Studies were conducted in a variety of practice settings including national cancer institutes and community practices. The quality of evidence was limited by the heterogeneity of study methods, patient representation and bias. Several studies had a homogeneous population of Black patients. Most studies (n = 7) were single arm trials that compared results to either historical controls or those cited in the existing literature; two studies were randomized controlled trials. A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos, the institutional research infrastructure change and the relationship building and social marketing recruitment model. The common threads to many of these successful interventions were support through the cancer care continuum, cultural congruency of research staff and culturally catered clinical trial educational materials. Conclusions: This systematic review illustrates several mechanisms by which to increase cancer clinical trial recruitment for cancer patients of underrepresented minority backgrounds in a variety of clinical settings. Randomized controlled trials with representation of multiple races/ethnicities are needed to further explore the benefits of these interventions.

First data from OUT: The National Cancer Survey of LGBTQ+ survivors.

e18544 Background: Cultural barriers that inhibit LGBTQ cancer care are a public health crisis. Although LGBTQ cultural competency trainings are rapidly becoming the norm, patient-centered information is lacking for healthcare professionals in cancer care. The purpose of OUT: The National Cancer Survey is to understand the experiences of LGBTQ cancer survivors in order to make cancer care a safer and more welcoming place for survivors and their support teams. Methods: Individuals age 18 or older currently living in the United States who have been previously diagnosed with cancer and who identify as LGBTQ+ were recruited via community partnerships and targeted paid social media advertisements with an oversample of media outreach to Black Indigenous and People of Color (BIPOC). Participants completed a cross-sectional web-based survey of their cancer care experiences. This resulted in a final sample of [1,600+] survivors, the largest known sample of LGBTQ+ cancer survivors in the world. The sample was weighted to adjust for U.S. sex assigned at birth and racial/ethnic demographics. Descriptive statistics were used to summarize participant responses, crosstabs were used to compare responses across demographic categories, and excerpted responses are used to highlight qualitative themes. Results: Participants ranged in age from X to X years (median X). X% of the sample identified as either gay or lesbian, X% as bi, and X% as trans or gender nonconforming. X% of the sample identified as White only, followed by X% as Latine, X% as Black and X% as other or mixed race. Most common cancer types included XYZ. When asked about welcoming care, X% of the sample reported they specifically sought an LGBTQ+ welcoming provider after diagnosis. Most common methods for finding such a provider included: X, X, and X. Most common cues that helped patients identify welcoming providers included X, X, and X. Overall X% reported receiving care in an LGBTQ+ welcoming environment but X% did not. Of those who did not receive care in a welcoming environment, they were more likely to be X, X, and X. Overall, X% of patients were out to their providers, but this varied by X, X, and X. The most common ways of coming out included X, X, and X. When asked what they wanted to tell health care providers to ensure better care, participants highlighted several themes, including: X, X, and X. These findings provide patient driven insights into how cancer care varies within the LGBTQ+ population by different demographic factors and specific strategies providers can take to enhance care for LGBTQ+ people.

An Exploration into the Experiences of Female Veterans Who Attended Higher Ground Military Programming

Female veterans are the fastest growing military group, yet they are largely underrepresented in research (Hawkins & Crowe, 2018a, 2018b; Lundberg et al., 2016). There is a gap in the literature regarding the lived experiences of female veterans. The purpose of this qualitative phenomenological study was to understand female veterans’ experiences while participating in Higher Ground’s military program (HGMP), utilizing semi-structured interviews. Qualitative analysis yielded four themes: 1) transformative experiences, 2) empathetic staff, 3) staff connection to the military, and 4) resources after HGMP. The study’s findings highlight the need for trauma-informed care, cultural competency training for practitioners working in programs that serve female veterans, and offering continued resources after the conclusion of a program. Findings also indicate that participants had transformative experiences during the program. Further research is needed to examine programming elements in other outdoor recreational therapy programs to determine their effectiveness as therapeutic tools.

Virtual patients reflecting the clinical reality of primary care \u2013 a useful tool to improve cultural competence

BackgroundVirtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context.MethodsThree virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis.ResultsThe analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one’s own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants.ConclusionsVirtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.

Strengthening Culturally Competent Health Communication

Vulnerable refugee communities are disproportionately affected by the ongoing COVID-19 pandemic; existing longstanding health inequity in these communities is exacerbated by ineffective risk communication practices about COVID-19. Culturally and linguistically appropriate health communication following health literacy guidelines is needed to dispel cultural myths, social stigma, misinformation, and disinformation. For refugee communities, the physical, mental, and social-related consequences of displacement further complicate understanding of risk communication practices grounded in a Western cultural ethos. We present a case study of Clarkston, Georgia, the "most diverse square mile in America," where half the population is foreign born and majority refugee. Supporting marginalized communities in times of risk will require a multipronged, systemic approach to health communication including: (1) creating a task force of local leaders and community members to deal with emergent issues; (2) expanding English-language education and support for refugees; (3) including refugee perspectives on risk, health, and wellness into risk communication messaging; (4) improving cultural competence and health literacy training for community leaders and healthcare providers; and (5) supporting community health workers. Finally, better prepared public health programs, including partnerships with trusted community organizations and leadership, can ensure that appropriate and supportive risk communication and health education and promotion are in place long before the next emergency.

Successful Partnerships in Emerging Markets: The Moderating Role of Operational Performance

Purpose – With the reported high failure rate among Small and Medium-sized Enterprises (SMEs) in the professional service sector of emerging markets, coalescing their resources via strategic partnerships to effectively compete in the market place is seen as crucial to their growth and survival. This paper investigates the impact of attributes of partnership, communication behaviour and collaborative conflict resolution on partnership success among Professional Service Firms (PSFs) in emerging markets. It further contributes to the body of knowledge by exploring the moderating role of operational performance in the hypothesised relationships. Design/methodology/approach – Relying on a positivistic paradigm, 300 small and medium-sized PSFs were surveyed, yielding a 79% response rate. Descriptive statistics, hierarchical regression and exploratory factor analysis were used to analyse the collected data. Findings – A positive significant relationship was found between two of the three dimensions of attributes of partnership (commitment and coordination) and the success of partnerships. Despite their importance for partnerships, trust and information sharing negatively impacted partnership success in this study. A positive significant impact was however realised for trust and information sharing when operational performance moderated the relationship. Practical implications – PSFs must develop innovative and workable tools to effectively monitor their operational performance given its significant influence on the relationship between attributes of partnership, communication behaviour and partnership success. Social and cultural competence training is needed for staff to improve the relationship bond, trust and collective goals of partnerships. Originality/value – This paper introduces operational performance as a moderating variable to investigate the hypothesised relationships. It offers insights into how PSFs can manage the pertinent issues critical to the effective management of partnerships in emerging markets.

Midwives\u2019 experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project

BackgroundThe number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project.MethodsCultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA project.ResultsA significant improvement of the median score pre to post-test was observed for midwives’ knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010).Exploration of midwives’ experiences of the training revealed themes of “appropriate and applicable”, “made a difference” and “training gaps” and data from ORAMMA project experiences identified three further themes; “supportive care”, “working alongside peer supporters” and “challenges faced”.ConclusionsThe training improved midwives’ knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters’ roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions

ABSTRACT This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013–2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.

‘I’m Not Afraid of the Dark’

‘I’m Not Afraid of the Dark’