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

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
type: article
unique-id: WOS:000336657000018
usage-count-last-180-days: '5'
usage-count-since-2013: '105'
web-of-science-categories: Medicine, General \& Internal
year: '2014'