Measures Of Cultural Competence Research Articles

Moving the needle forward in health disparities: An education initiative

<abstract><sec> <title>Objective</title> <p>This paper sought to evaluate the impact of a year-long Health Equity Curriculum (HEC) on the knowledge of health disparities, cross-cultural humility, and empathy among physicians, trainees, and research staff.</p> </sec><sec> <title>Background</title> <p>There has been an increase in the inclusion of equity, cultural humility, and the social determinants of health into medical education at various levels. However, the frequency of this education is low and not well quantified or defined. The authors report the results of an education program, namely the HEC, on the knowledge of health disparities, cross-cultural humility, and empathy.</p> </sec><sec> <title>Materials and methods</title> <p>The HEC was delivered between March 2020 and May 2021. It included the following four modules: the social determinants of health, cultural humility, health literacy, and unconscious bias. The participants attended lectures and reviewed articles/videos using online modules and reflection assignments. The Jefferson Scale of Empathy (JSE) and the Cross-Cultural Competence Instrument for Health Care Professionals (CCCHP) were administered pre- and post-HEC. The results were statistically analyzed.</p> </sec><sec> <title>Results</title> <p>Of the 102 enrolled participants, 46 completed the entire course. The JSE showed a statistically significant improvement in the empathy scores from pre-HEC to post-HEC (p < 0.01). The CCCHP showed a significant improvement from pre-HEC to post-HEC total scores and in subcomponent scores of Motivation/Curiosity, Attitude, and Knowledge (p < 0.05). There were no significant differences in scores for the Skills and Emotions/Empathy subcomponents.</p> </sec><sec> <title>Conclusions</title> <p>Enrollment and completion in the HEC were associated with statistically significant improvements in the validated measures of cultural competence and empathy. Scaling this type of content and curriculum can educate professionals on equity and serving diverse communities. A further study is warranted.</p> </sec></abstract>

The Effectiveness of Peer Support to Improve Youth Refugee’s Mental Health

International geopolitical conflicts and climate change have expanded the international population and have produced an ever increasing number of refugees who are in need of help. However, the restrictive access and discriminatory treatment of refugees have contributed to poor mental and physical health. The lack of cultural competence and multicultural effectiveness (the ability to understand and navigate cross-cultural situations) contributes to worse outcomes with refugees, especially among refugee youth. The refugee youth population experience physical, mental, and emotional trauma while having to adjust to a foreign culture and language. The few current programs aimed at improving the health of refugee youth address most obstacles that refugee youth face, but do not address a key component in psychological wellbeing: social support from peers. An examination of the cultural competence of high school males (n=28) showed that scores were similar across ethnic groups and that scores just passed the midpoint (3.29, 3.21, 3.23), suggesting that students have some cultural competence but have areas of improvement. Future research should focus on more rigorous measures of cultural competence for youth populations. Efforts should be made to improve cultural competence among the non-refugee youth population.

Cultural Competency and Quality of Care of Nurses in a Public Hospital in Southern Philippines

Background: The inability of healthcare institutions to provide culturally sensitive care to patients with diverse cultures and beliefs correlates to poor nursing care and a decline in patient outcomes. In providing high-quality nursing care, nurses should be invaluable in demonstrating culturally competent caring behaviors to the diverse patient population. Objectives: This study aimed to determine the significant difference between the self-assessed cultural competency of nurses and the quality of care of nurses as perceived by the patients. Methods: A descriptive quantitative study was employed. Consecutive sampling was used to select the participants who met the inclusion criteria with a total of 98 respondents, 48 of them were nurse respondents and 40 were patient respondents. Questionnaires consist of the socio-demographic profile of the respondents, Patient Satisfaction with Nursing Care Quality Questionnaire, and Cultural Competence Self-Assessment Checklist. Descriptive statistics was used to analyze the data. Results: The results indicate that, on average, the nurse respondents rated themselves as "Pretty Well" in terms of their cultural competency based on awareness (x=3.15), knowledge (x=3.23), and skills (x=3.21). The overall total measure of cultural competence is x=3.20 which means that respondents have a generally positive perception of their overall cultural competency. As to the quality of care, the overall total measure of 4.14 and an SD of 0.48 indicates a Very Good perception of the overall quality of care nurses provide. Moreover, it was found that there is a significant difference in the cultural competency of nurses and the quality of care given to the patients. Conclusion: The study indicates that nurses’ cultural competence tends to affect patient outcomes and that the hospital needs training programs for nurses to increase their awareness of their behaviors and their influence on healthcare outcomes.

Assessing cultural competence: a comparison of two measures and their utility in global learning experiences within healthcare education

ObjectivesThe purpose of this study was to investigate the relationship between two measures of cultural competence (CC), one more widely used, the other designed for healthcare students. It was hypothesized that there would be strong correlations allowing educators to forgo one measure for the other based on utility, resources, and sustainability. DesignExploratory, cross sectional design SettingOne US Doctor of Physical Therapy (DPT) academic program. Participants145 DPT students. Main outcome measuresIntercultural Development Inventory® (IDI) and Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV). ResultsThere were significant (negligible to low, rho = 0.16–0.28; p < 0.05) relationships between the IAPCC-SV total and three constructs with IDI Perceived Orientation scores, and the IAPCCSV total and two constructs with the IDI Developmental Orientation scores. There were significant (negligible to low, rho = 0.18–0.35; p < 0.05) relationships between IAPCC-SV total and construct scores with the IDI Acceptance and Adaptation orientation scores. Students with scores in an IDI DO of Acceptance or Adaptation were significantly more likely to have an IAPCC-SV score in the category of Culturally Competent (X2 = 3.70, p = 0.05). ConclusionsThe discordance of the two measures suggests that the instruments measure unrelated constructs (worldviews, attributes or skills) of cultural competence that are exclusive to each measure and context dependent. Context specific measures may not be generalized to a greater worldview, and visa versa. Multimodal assessment that triangulates data and supports student learning outcomes may be the most effective strategy to capture the impact of curriculum and/or a global learning experience on students’ development of cultural competence. Contribution of the Paper•The IDI and IAPCC-SV measure different aspects of CC and are not strongly related.•Any measure of CC specific to the healthcare setting should be used in combination with less contextually dependent measures of CC when learning objectives include skills that are expected to be generalized to a broader community or setting.•Triangulation of quantitative data and qualitative analysis of students’ work would result in a deeper understanding of students’ intercultural development across settings, allow students to set personal goals, and provide rich data for student learning outcomes and programmatic assessments.

Cultural Simulations, Authenticity, Focus, and Outcomes: A Systematic Review of the Healthcare Literature

BackgroundSimulation-based cultural competence training is core pedagogy in nursing education. With reference to the Healthcare Simulation Standards of Best PracticeTM, we sought toidentify strategies used to support culturally authentic experiences and the focus, theoretical framings, and outcomes of cultural simulations. MethodsWe searched 11 electronic databases and included empirical papers from any healthcare discipline reporting any type of simulation-based training and outcome measures of cultural competence. ResultsWe identified thirty papers and some evidence to support the efficacy of cultural simulations. However, we identified a low level of quality, inconsistent consideration of relevant standards, limited evidence of meaningful co-construction, some potentially negative cultural representations and a primary focus on cultural knowledge and skill. ConclusionMore robust designs that extend beyond a competency paradigm to examine the relative benefits of different simulation modalities and their impact on actual patient care are required. We recommend that researchers examine their own cultural lens, take cognizance of threats posed by oversimplifying the cultural experience, engage in inclusive partnerships and explicitly consider simulation best practice and reporting standards.

Cultural Awareness of Students in Communication Sciences and Disorders: A Mixed-Methods Study

Purpose This study used a mixed-methods design to assess changes in students' cultural awareness during and following a short-term study abroad. Method Thirty-six undergraduate and graduate students participated in a 2-week study abroad to England during the summers of 2016 and 2017. Quantitative data were collected using standardized self-report measures administered prior to departure and after returning to the United States and were analyzed using paired-samples t tests. Qualitative data were collected in the form of daily journal reflections during the trip and interviews after returning to the United States and analyzed using phenomenological methods. Results No statistically significant changes were evident on any standardized self-report measures once corrections for multiple t tests were applied. In addition, a ceiling effect was found on one measure. On the qualitative measures, themes from student transcripts included increased global awareness and a sense of personal growth. Conclusions Measuring cultural awareness poses many challenges. One is that social desirability bias may influence responses. A second is that current measures of cultural competence may exhibit ceiling or floor effects. Analysis of qualitative data may be more useful in examining effects of participation in a short-term study abroad, which appears to result in decreased ethnocentrism and increased global awareness in communication sciences and disorders students. Future work may wish to consider the long-term effects of participation in a study abroad for emerging professionals in the field.

Exploring the Impact of Health Care Provider Cultural Competence on New Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers.

Introduction:New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most.Methodology:Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment.Results:Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p < .001) and its psychological (β = −.318; p < .001), social (β = −.177; p = .048), and environmental (β = −.408; p < .001) domains.Discussion:Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners’ values and biases.

IMoCC – Measure of cultural competence among medical students in the Malaysian context

Cultural beliefs and practices impact heavily on health outcomes of patients. Doctors’ ability to deal with such issues in clinical practice, i.e. cultural competence, is widely studied in the west. It has yet to be given due importance in non-western contexts. This study aimed to develop a valid and reliable measure of cultural competence in the Malaysian cultural context and to assess cultural competence among Malaysian medical students. Thirty-five cultural issues faced by Malaysian doctors were identified with a series of interviews to develop a preliminary tool. The responses of students to these cultural issues were evaluated against the extent of inquiry and advocacy based on a theoretical framework of cultural competence. The responses were subjected to statistical analysis to determine the internal structure of the tool and to reduce the number of items in the tool. The final tool (IMU Measure of Cultural Competence – IMoCC) comprised of 22 issues, which deemed to be reliable in the second round of testing. In both tools, student cohorts demonstrated an acceptable level of cultural competence with room for improvement. However, they appeared to learn how to deal with cultural issues primarily through informal means and not in the formal curriculum.

The construction of the cultural niche: A biocultural model.

Objective of the study is to develop a more precise model of culture as an evolutionary niche for the human species. Culture is encoded in cultural models and can be decomposed into three basic components: shared knowledge and understanding, referred to as cultural competence; alternate configurations of shared understanding, referred to as residual agreement; and social practice, referred to as cultural consonance. Individuals are thus located in a cultural Euclidean space of shared understanding, patterned divergence from that understanding, and social practice. A follow-up sample (n = 64) of a larger survey sample was interviewed to collect data on cultural competence, residual agreement, and cultural consonance in five cultural domains. Nonmetric multidimensional scaling was used to examine dimensional structure. Cluster analysis was used to group respondents along these dimensions. The association of cluster membership with depression was examined using dummy variable regression analysis. Multidimensional scaling was consistent with a three-dimensional structure. Based on measures of cultural competence, residual agreement, and cultural consonance, respondents clustered into three groups: the culturally proficient, the culturally knowledgeable, and the culturally distal. Individuals in the culturally proficient and knowledgeable groups reported fewer depressive symptoms than the culturally distal. These results suggest a three-dimensional Euclidean structure of culture in which knowledge is shared, contested, and acted upon. Such a cultural niche likely emerged early in human evolution because of the enhanced survival value of shared and contested knowledge, verifiable through practice.

Development of the Cultural Competence Scale for Registered Nurses (CCS-RN)

Purpose: This study is to develop the Cultural Competence Scale for Registered Nurses (CCS-RN) and to examine its validity and reliability. Methods: The item pool was generated based on related scales, a wide review of the literature, and in-depth interviews with nurses according to Purnell’s cultural competence model. Content validity was verified by nursing experts. Construct validity using exploratory factor analysis, convergent validity using correlation coefficients, discriminant validity, internal consistency reliability, and test-retest reliability were examined. Results: The CCS-RN consists of a 35-item/7-factor solution with 54.1% of the total variance explained. The convergent validity of CCS-RN was supported. Cronbach’s ⍺ was .94 for the total scale and ranged from .77 to .90 for the seven factors. Test-retest reliability was moderate. Conclusion: The evaluation of the psychometric properties of the CCS-RN shows that this scale is expected to be a valid and reliable measure of cultural competence among nurses. This scale may be useful for assessing nurses’ own cultural competence and thus contribute to strengthening cultural competence.

Assessment of Psychometric Properties of an Oral Health Care Measure of Cultural Competence Among Dental Students Using Rasch Partial Credit Model.

Reliability, validity, and feasibility of the only validated oral health care measure of cultural competence, the Knowledge, Efficacy, and Practices Instrument (KEPI), have been confirmed. However, the instrument's psychometric properties including item and person reliability, category response functioning, and scale targeting, as well as differential scale functioning for subgroups, have not yet been examined. The aim of this study was to test the psychometric properties of KEPI among dental students using Rasch Partial Credit Model to determine if this model provided broader valid information that cannot be demonstrated according to Classical Test Theory. A total 1,290 dental students in the first or final semester at four U.S. dental schools were invited to participate in the study in 2016. Of those, 1,231 individuals completed the survey, for a 95.4% response rate. The participants were 613 males and 618 females and 889 non-underrepresented minority (URM) and 342 URM students. The Rasch Partial Credit Model assessed the psychometric properties of KEPI's 20 items/three subscales. Differential scale functioning was found in the Culture-Centered Practice and Efficacy of Assessment subscales. Four items were endorsed differentially by gender; four items were endorsed differentially by URM/non-URM students. This study examined the psychometric properties of the KEPI using Rasch analysis to assess differential item functioning by dental student gender and race. The results provided valid evidence for the high internal reliability, measurement properties, and unidimensionality for the KEPI domains, ideal targeting, and well response category functioning, showing that the KEPI is a reliable instrument for measuring the subscales Knowledge of Diversity, Culture-Centered Practice skills, and Efficacy of Assessment for health care providers.

Factor Structure of the Cultural Competence Items in the National Home and Hospice Care Survey.

There is a need for validated measures of cultural competency practices in home health and hospice care (HHHC). To establish the factor structure of the cultural competency items included in the agency-component of the 2007 public-use National Home and Hospice Care Survey file. We used weighted survey data from 1036 HHHC agencies. We used exploratory factor analyses to identify a preliminary factor structure, and then performed confirmatory factor analysis to provide further support for identified factor structure. We examined 9 cultural competency items. Exploratory factor analyses suggested an interpretable 2-factor solution: (1) the provision of mandatory cultural competency training; and (2) the provision of cultural competency communication practices. Each factor consisted of 3 items. The remaining 3 items did not load well on these factors. A similar, but more restrictive, confirmatory factor analysis model without cross-loadings supported the 2-factor model: (Equation is included in full-text article.)=9.50, P=0.30, root mean square error of approximation (RMSEA)=0.01, comparative fit index (CFI)=0.99, Tucker-Lewis Index (TLI)=0.99. Two constructs with 3 items each appeared to be internally valid measures of cultural competency in this nationally representative survey of HHHC agencies: cultural competency training and cultural competency communication practices. These measures could be used by HHHC managers in quality improvement efforts and by policy makers in monitoring cultural competency practices.

Cultural competence and social desirability among practitioners: A systematic review of the literature

There is increased awareness that practitioners (e.g., teachers, school counselors, social workers, and school psychologists) need additional training to work effectively with diverse populations. However, there has been limited consideration of measurement challenges related to assessing this type of competence. Specifically, there are growing concerns that self-report measures of cultural competence may be biased by social desirability. To address these gaps, we conducted a systematic review of the literature on cultural competence and social desirability bias. We identified 15 studies focused on issues related to cultural competence and social desirability bias that met our search criteria. Our review and analysis of these studies suggested that cultural competence is positively correlated with social desirability bias, but the strength of this association varies as a function of the cultural competence scale used. Furthermore, race, gender, sexual orientation, years of experience, and training experiences were also significantly associated with cultural competence and/or social desirability. Implications for future research and professional development related to cultural competence are discussed.

Developing and Testing the Short‐Form Knowledge, Efficacy, and Practices Instrument for Assessing Cultural Competence

The importance of educating dental students in cultural competence has been widely emphasized, but there is a need to assess cultural competence in a consistent and reliable way. The aims of this study were to determine latent constructs for the initial measure of cultural competence for oral health providers, the Knowledge, Efficacy, and Practices Instrument (KEPI), and to determine how well these factors related to previously identified latent constructs. Data were collected in surveys of dental students and from dental hygiene, dental assisting, and dental faculty members in 44 academic dental institutions from 2012 to 2015. There were a total of 1,786 respondents to the surveys; response rates to individual surveys ranged from 35% to 100%. There were 982 (55%) female and 804 (45%) male respondents, 286 (16%) underrepresented minority (URM) and 1,500 (84%) non-URM respondents, and 339 (19%) faculty and 1,447 (81%) student respondents. Three latent constructs were identified. Female respondents scored significantly higher on the culture-centered practice and efficacy of assessment factors, while URM respondents had significantly higher scores on all three of the KEPI factors. Measurements indicated that the long-form KEPI could be shortened by ten questions and still have three meaningful measurements. Continued research in assessing other health care providers' cultural competence is needed to expand the KEPI to measure providers' cultural competence with patients with minority sexual orientation and gender identity issues and those with physical disabilities, mental illness, and autism to advance patient-centric communication.

Assessing Cultural Competence in a BSW Student Population

Bachelor’s level social workers serve a population that is becoming more diverse. Social work educators must respond with adapted teaching methods, theories, and exercises to reflect the growing need for cultural competence in our practitioners. The 2015 Educational Policy and Accreditation Standards (EPAS) outline the knowledge, value, and skills competencies central to social work education. These competencies include thorough integration of cultural competence in social work education; the ways in which this content is taught likely vary greatly between programs. This study assessed whether students gained competence as a result of taking a bachelor’s level social work (BSW) course in cultural diversity at a mid-sized public university. Furthermore, the study assessed whether their level of competence was related to student demographics, such as being from an urban or rural community. One hundred twenty-three students completed the California Brief Multicultural Competence Scale (CBMCS) at the beginning and end of a course specifically dedicated to cultural competence. Results indicate that the course itself is effective in increasing significantly student’s self-reported cultural competence. Study results lay the foundation for future research that will (1) assess more broadly the implications of a specific cultural competence course and (2) aid in the development of a social work-specific measure of cultural competence.

Relationships Among the Knowledge, Efficacy, and Practices Instrument, Color‐Blind Racial Attitudes Scale, Deamonte Driver Survey, and Defining Issues Test 2

Concordance studies indicate the degree to which instruments measure the same or similar constructs or something different. The aims of this study were to identify the factor structure of the Deamonte Driver Survey and determine the relationship between the Deamonte Driver (a measure of social class stereotyping), the Defining Issues Test 2 (DIT2; a measure of ethical sensitivity), the Color-Blind Racial Attitudes Scale (CoBRAS; a measure of racial stereotyping), and the Knowledge, Efficacy, and Practices Instrument (KEPI; a measure of cultural competence). The results showed a three-factor solution for the Deamonte Driver Survey and significant relationships between CoBRAS and DIT2 subscales and between CoBRAS and Deamonte Driver subscales. Significant relationships between the measures and exploratory variables, underrepresented minority status, age, citizenship, marital status, political stance, English as a first language, and gender were found. The lack of a significant relationship between the KEPI and Deamonte Driver, DIT2, or CoBRAS subscales suggests that the KEPI is measuring a unique construct. These findings showed how these scales contributed to the assessment of cultural competence among dental students and faculty.

Culture and Cultural Competence in Nursing Education and Practice: The State of the Art.

The concept of cultural competency has developed a substantial presence in nursing education and practice since first attracting widespread attention in the 1990s. While several theories and corresponding measures of cultural competency have been advanced and tried, much work remains, as many nursing professionals continue to call for greater evidence-based research and attention to patient perspectives and outcomes. Using a method provided by Hawker et al. to appraise articles, this paper compares nine recent (2008-2013) studies (including two composite studies) related to cultural competency, undergraduate curricula, and teaching strategies in nursing to assess the state of the art in this important area of care. The studies applied phenomenological, study abroad, online, and service learning strategies, four of which relied on some version of Campinha-Bacote's IAPCC© model. These studies reported a general improvement in competency among students, though generally only to a level of cultural awareness, and admitted being constrained by several common limitations. Improved results and more realistic expectations in this area may require a closer understanding of the nature of the "culture" that underlies cultural competence. Harkess Kaddoura.

The Developmental paradigm for intercultural competence research

The purpose of this study was to investigate the relationship between two measures of cultural competence (CC), one more widely used, the other designed for healthcare students. It was hypothesized that there would be strong correlations allowing educators to forgo one measure for the other based on utility, resources, and sustainability.Exploratory, cross sectional designOne US Doctor of Physical Therapy (DPT) academic program.145 DPT students.Intercultural Development Inventory® (IDI) and Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV).There were significant (negligible to low, rho = 0.16–0.28; p < 0.05) relationships between the IAPCC-SV total and three constructs with IDI Perceived Orientation scores, and the IAPCCSV total and two constructs with the IDI Developmental Orientation scores. There were significant (negligible to low, rho = 0.18–0.35; p < 0.05) relationships between IAPCC-SV total and construct scores with the IDI Acceptance and Adaptation orientation scores. Students with scores in an IDI DO of Acceptance or Adaptation were significantly more likely to have an IAPCC-SV score in the category of Culturally Competent (X2 = 3.70, p = 0.05).The discordance of the two measures suggests that the instruments measure unrelated constructs (worldviews, attributes or skills) of cultural competence that are exclusive to each measure and context dependent. Context specific measures may not be generalized to a greater worldview, and visa versa. Multimodal assessment that triangulates data and supports student learning outcomes may be the most effective strategy to capture the impact of curriculum and/or a global learning experience on students’ development of cultural competence.•The IDI and IAPCC-SV measure different aspects of CC and are not strongly related.•Any measure of CC specific to the healthcare setting should be used in combination with less contextually dependent measures of CC when learning objectives include skills that are expected to be generalized to a broader community or setting.•Triangulation of quantitative data and qualitative analysis of students’ work would result in a deeper understanding of students’ intercultural development across settings, allow students to set personal goals, and provide rich data for student learning outcomes and programmatic assessments.

The Effects of Work Characteristics, Supervision, and Cultural Competence on Nurses’ Burnout

This study examines the effects of work characteristics, superior supervision, and cultural competence on nurses’ burnout. Controlling the effects of work characteristics and supervision, this study focuses on the effects of cultural competence influencing nurses’ burnout. Participants in the study are nurses who are working at six small- and medium-size hospitals under 400 beds, which multicultural patients usually use, located in Seoul and Gyeonggi-do. The data were collected by the measure of cultural competence developed in Korea, and the standardized measures of burnout, workload, role ambiguity, and superior supervision. The statistical analyses include descriptive statistics of respondents’ general characteristics, correlation analysis of relationships between variables, and hierarchical regression analysis of the effects of precedent variables on work burnout. The result of hierarchical regression shows that role ambiguity, subcategory of work characteristics, is positively related to burnout, and that supervision has no impact on burnout. In addition, it indicates that cultural competence (cultural knowledge and skill, cultural awareness, cultural attitude) is a statistically significant variable predicting burnout, and that the effect of cultural attitude is the largest among subcategories of cultural competence. The significance of this study is that it lays the foundation for nurses’ cultural competence by examining the effects of nurses’ cultural competence on burnout. Since work-related competence is not a choice but a must, more diverse education should be provided to improve nurses’ cultural competence for multicultural patients.

Cultural consultation as a model for training multidisciplinary mental healthcare professionals in cultural competence skills: preliminary results

Lack of cultural competence in care contributes to poor experiences and outcomes from care for migrants and racial and ethnic minorities. As a result, health and social care organizations currently promote cultural competence of their workforce as a means of addressing persistent poor experiences and outcomes. At present, there are unsystematic and diverse ways of promoting cultural competence, and their impact on clinician skills and patient outcomes is unknown. We developed and implemented an innovative model, cultural consultation service (CCS), to promote cultural competence of clinicians and directly improve on patient experiences and outcomes from care. CCS model is an adaptation of the McGill model, which uses ethnographic methodology and medical anthropological knowledge. The method and approach not only contributes both to a broader conceptual and dynamic understanding of culture, but also to learning of cultural competence skills by healthcare professionals. The CCS model demonstrates that multidisciplinary workforce can acquire cultural competence skills better through the clinical encounter, as this promotes integration of learning into day-to-day practice. Results indicate that clinicians developed a broader and patient-centred understanding of culture, and gained skills in narrative-based assessment method, management of complexity of care, competing assumptions and expectations, and clinical cultural formulation. Cultural competence is defined as a set of skills, attitudes and practices that enable the healthcare professionals to deliver high-quality interventions to patients from diverse cultural backgrounds. Improving on the cultural competence skills of the workforce has been promoted as a way of reducing ethnic and racial inequalities in service outcomes. Currently, diverse models for training in cultural competence exist, mostly with no evidence of effect. We established an innovative narrative-based cultural consultation service in an inner-city area to work with community mental health services to improve on patients' outcomes and clinicians' cultural competence skills. We targeted 94 clinicians in four mental health service teams in the community. After initial training sessions, we used a cultural consultation model to facilitate 'in vivo' learning. During cultural consultation, we used an ethnographic interview method to assess patients in the presence of referring clinicians. Clinicians' self-reported measure of cultural competence using the Tool for Assessing Cultural Competence Training (n = 28, at follow-up) and evaluation forms (n = 16) filled at the end of each cultural consultation showed improvement in cultural competence skills. We conclude that cultural consultation model is an innovative way of training clinicians in cultural competence skills through a dynamic interactive process of learning within real clinical encounters.