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