wow-inequalities/02-data/intermediate/wos_sample/a88160c7ed180d67506c35e826e78c7c-horvat-lidia-and-ho/info.yaml

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2023-09-28 14:46:10 +00:00
abstract: 'Background
Cultural competence education for health professionals aims to ensure
all people receive equitable, effective health care, particularly those
from culturally and linguistically diverse (CALD) backgrounds. It has
emerged as a strategy in high-income English-speaking countries in
response to evidence of health disparities, structural inequalities, and
poorer quality health care and outcomes among people from minority CALD
backgrounds. However there is a paucity of evidence to link cultural
competence education with patient, professional and organisational
outcomes. To assess efficacy, for this review we developed a
four-dimensional conceptual framework comprising educational content,
pedagogical approach, structure of the intervention, and participant
characteristics to provide consistency in describing and assessing
interventions. We use the term `CALDparticipants'' when referring to
minority CALD populations as a whole. When referring to participants in
included studies we describe them in terms used by study authors.
Objectives
To assess the effects of cultural competence education interventions for
health professionals on patient-related outcomes, health professional
outcomes, and healthcare organisation outcomes.
Search methods
We searched: MEDLINE (OvidSP) (1946 to June 2012); Cochrane Central
Register of Controlled Trials (CENTRAL, The Cochrane Library) (June
2012); EMBASE (OvidSP) (1988 to June 2012); CINAHL (EbscoHOST) (1981 to
June 2012); PsycINFO (OvidSP) (1806 to June 2012); Proquest
Dissertations and Theses database (1861 to October 2011); ERIC (CSA)
(1966 to October 2011); LILACS (1982 to March 2012); and Current
Contents (OvidSP) (1993 Week 27 to June 2012).
Searches in MEDLINE, CENTRAL, PsycINFO, EMBASE, Proquest Dissertations
and Theses, ERIC and Current Contents were updated in February 2014.
Searches in CINAHL were updated in March 2014.
There were no language restrictions.
Selection criteria
We included randomised controlled trials (RCTs), cluster RCTs, and
controlled clinical trials of educational interventions for health
professionals working in health settings that aimed to improve: health
outcomes of patients/consumers of minority cultural and linguistic
backgrounds; knowledge, skills and attitudes of health professionals in
delivering culturally competent care; and healthcare organisation
performance in culturally competent care.
Data collection and analysis
We used the conceptual framework as the basis for data extraction. Two
review authors independently extracted data on interventions, methods,
and outcome measures and mapped them against the framework. Additional
information was sought from study authors. We present results in
narrative and tabular form.
Main results
We included five RCTs involving 337 healthcare professionals and 8400
patients; at least 3463 (41\%) were from CALD backgrounds. Trials
compared the effects of cultural competence training for health
professionals, with no training. Three studies were from the USA, one
from Canada and one from The Netherlands. They involved health
professionals of diverse backgrounds, although most were not from CALD
minorities. Cultural background was determined using a validated scale
(one study), self-report (two studies) or not reported (two studies).
The design effect from clustering meant an effective minimum sample size
of 3164 CALD participants. No meta-analyses were performed. The quality
of evidence for each outcome was judged to be low.
Two trials comparing cultural competence training with no training found
no evidence of effect for treatment outcomes, including the proportion
of patients with diabetes achieving LDL cholesterol control targets
(risk difference (RD) -0.02, 95\% CI -0.06 to 0.02; 1 study, USA, 2699
``black{''''} patients, moderate quality), or change in weight loss
(standardised mean difference (SMD) 0.07, 95\% CI -0.41 to 0.55, 1
study, USA, effective sample size (ESS) 68 patients, low quality).
Health behaviour (client concordance with attendance) improved
significantly among intervention participants compared with controls
(relative risk (RR) 1.53, 95\% CI 1.03 to 2.27, 1 study, USA, ESS 28
women, low quality). Involvement in care by ``non-Western{''''} patients
(described as ``mainly Turkish, Moroccan, Cape Verdean and Surinamese
patients{''''}) with largely ``Western{''''} doctors improved in terms of
mutual understanding (SMD 0.21, 95\% CI 0.00 to 0.42, 1 study, The
Netherlands, 109 patients, low quality). Evaluations of care were mixed
(three studies). Two studies found no evidence of effect in: proportion
of patients reporting satisfaction with consultations (RD 0.14, 95\% CI
-0.03 to 0.31, 1 study, The Netherlands, 109 patients, low quality);
patient scores of physician cultural competency (SMD 0.11 95\% CI -0.63
to 0.85, 1 study, USA, ESS 68 ``Caucasian{''''} and ``non-Causcasian{''''}
patients (described as Latino, African American, Asian and other, low
quality). Client perceptions of health professionals were significantly
higher in the intervention group (SMD 1.60 95\% CI 1.05 to 2.15, 1
study, USA, ESS 28 ``Black{''''} women, low quality).
No study assessed adverse outcomes.
There was no evidence of effect on clinician awareness of ``racial{''''}
differences in quality of care among clients at a USA health centre (RR
1.37, 95\% CI 0.97 to 1.94. P = 0.07) with no adjustment for clustering.
Included studies did not measure other outcomes of interest. Sensitivity
analyses using different values for the Intra-cluster coefficient (ICC)
did not substantially alter the magnitude or significance of summary
effect sizes.
All four domains of the conceptual framework were addressed, suggesting
agreement on core components of cultural competence education
interventions may be possible.
Authors'' conclusions
Cultural competence continues to be developed as a major strategy to
address health inequities. Five studies assessed the effects of cultural
competence education for health professionals on patient-related
outcomes. There was positive, albeit low-quality evidence, showing
improvements in the involvement of CALD patients. Findings either showed
support for the educational interventions or no evidence of effect. No
studies assessed adverse outcomes. The quality of evidence is
insufficient to draw generalisable conclusions, largely due to
heterogeneity of the interventions in content, scope, design, duration,
implementation and outcomes selected.
Further research is required to establish greater methodological rigour
and uniformity on core components of education interventions, including
how they are described and evaluated. Our conceptual framework provides
a basis for establishing consensus to improve reporting and allow
assessment across studies and populations. Future studies should measure
the patient outcomes used: treatment outcomes; health behaviours;
involvement in care and evaluations of care. Studies should also measure
the impact of these types of interventions on healthcare organisations,
as these are likely to affect uptake and sustainability.'
affiliation: 'Horvat, L (Corresponding Author), Dept Hlth, Qual \& Rural Hlth Branch,
Sect Performance, Melbourne, Vic, Australia.
Horvat, Lidia, Dept Hlth, Qual \& Rural Hlth Branch, Sect Performance, Melbourne,
Vic, Australia.
Horvat, Lidia; Kis-Rigo, John, La Trobe Univ, Sch Publ Hlth \& Human Biosci, Cochrane
Consumers \& Commun Review Grp, Bundoora, Vic, Australia.
Horey, Dell, La Trobe Univ, Fac Hlth Sci, Bundoora, Vic, Australia.
Romios, Panayiota, Australian Red Cross Soc, Carlton, Vic, Australia.'
article-number: CD009405
author: Horvat, Lidia and Horey, Dell and Romios, Panayiota and Kis-Rigo, John
author-email: lidia.horvat@health.vic.gov.au
author_list:
- family: Horvat
given: Lidia
- family: Horey
given: Dell
- family: Romios
given: Panayiota
- family: Kis-Rigo
given: John
da: '2023-09-28'
doi: 10.1002/14651858.CD009405.pub2
eissn: 1361-6137
files: []
issn: 1469-493X
journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
keywords-plus: 'INTERCULTURAL COMMUNICATION; PROMOTION PROGRAM; CONTROLLED-TRIAL;
DIABETES CARE; LOW-INCOME; INTERVENTION; ETHNICITY; OUTCOMES; RACE;
DISPARITIES'
language: English
number: '5'
number-of-cited-references: '113'
orcid-numbers: Horey, Dell/0000-0001-7594-7694
papis_id: 253eaaaf96854e66c3afbcb2c81ca5ff
ref: Horvat2014culturalcompetence
researcherid-numbers: Horey, Dell/AAE-1918-2021
tags:
- review
times-cited: '241'
title: Cultural competence education for health professionals
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000336657000018
usage-count-last-180-days: '5'
usage-count-since-2013: '105'
web-of-science-categories: Medicine, General \& Internal
year: '2014'