Using Campinha-Bacote's process of cultural competence model to examine the relationship between health literacy and cultural competence

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

Comprehension of US Pharmacopeia and South African pictograms by sub-Saharan migrants who newly arrived in Europe

BACKGROUND

Patient understanding of health information is crucial for successful pharmaceutical care. Pharmaceutical pictograms enable communication of medication instructions to patients who may not share a common language or are illiterate. However, cultural factors can impact the accurate interpretation of these visual aids.

OBJECTIVES

This study aimed to assess and compare the comprehensibility of two sets of pictograms from different cultural backgrounds among sub-Saharan migrants recently arrived in Europe.

METHODS

In June 2022, a cross-sectional survey was conducted at the Migrant Temporary Stay Center in Melilla, Spain. Participants were randomly assigned to interpret 10 pictograms from either the U.S. Pharmacopeia or South African counterparts, with a minimum of 50 participants per group. Following the International Organization for Standardization's testing comprehensibility criterion, pictograms achieving a 66.7% correct interpretation rate were considered acceptable. Health literacy was measured using a culturally validated sub-Saharan version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Data analysis included Fisher's exact test or chi-square test (for qualitative variables) and the Mann-Whitney test (for quantitative variables).

RESULTS

A total of 106 participants were included (51 in the U.S. pharmacopeia group and 55 in the South African group). None of the assessed pictograms met the comprehensibility criterion, and both groups exhibited high nonresponse rates. The South African pictograms were better understood than the American ones for all intended messages, with a statistically significant difference in overall comprehension (p = 0.002). Additionally, the participants' country of birth was a statistically significant factor for comprehension (p = 0.019).

CONCLUSIONS

Our findings indicate that evaluated pharmaceutical pictograms cannot be validly used in newly arrived sub-Saharan immigrants in Europe. However, the significantly better comprehension of South African pictograms compared to North American ones highlights the importance of cultural alignment between pictograms and their prospective users for effective comprehensibility.

Association between cultural capital and health literacy during the COVID-19 pandemic among community residents in China: the mediating effect of social capital

Background

Health literacy is crucial for managing pandemics such as COVID-19 and maintaining the health of the population; our goal was to investigate the impact of cultural capital on health literacy during the COVID-19 pandemic among community residents and to further examine the mediating role of social capital in the relationship between cultural capital and health literacy.

Methods

A cross-sectional study was conducted among 1,600 community residents selected in Chongqing, China using a stratified random sampling method. Data were gathered through a questionnaire survey, including sociodemographic characteristics, cultural capital, social capital, and health literacy. Chi-square analysis, one-way ANOVA, t-test, and hierarchical linear regression were used to analyze the level of health literacy among community residents and the related elements; the structural equation model (SEM) was used to explore the influential mechanisms of health literacy and explore whether social capital acted as a mediator in the relationship between cultural capital and health literacy.

Results

Cultural capital, community participation, community trust, reciprocity, and cognitive social capital had a significant positive effect on health literacy. In addition, the results of SEM indicated that cultural capital not only directly influences health literacy (β = 0.383, 95% CI = 0.265-0.648), but also indirectly influences health literacy through three types of social capital (β = 0.175, 95% CI = 0.117-0.465; β = 0.191, 95% CI = 0.111-0.406; β = 0.028, 95% CI = 0.031-0.174); its mediating effect accounting for 50.7% of the overall effect.

Conclusions

Our results highlight the empirical link between cultural capital and health literacy, and suggest that social capital mediates this connection. These findings suggest that governments and communities should focus on the construction of community cultural capital and provide residents with better social capital to improve their health literacy to prepare for future pandemics.

Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature

OBJECTIVE

To assess the impact of cultural competence training for health professionals on patient outcomes.

METHOD

A systematic review of cultural competence training interventions for healthcare workers including papers published January 2010 to January 2021, identified through MEDLINE, CINAHL, ERIC and APA PsychINFO. Health conditions were not specified, however, only studies reporting patient outcomes were included. Training frameworks and delivery, measures of health professional cultural competence, and patient outcomes were reviewed.

RESULTS

Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study.

CONCLUSION

Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes.

RESULTS

Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study.

CONCLUSION

Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes.

PRACTICE IMPLICATIONS

To ascertain the benefits of health professional cultural competence training on patient outcomes, research needs to address the issues of definition, theoretical frameworks and implementation approaches to training.

Developing a Theory of Norm-Criticism in Nursing Education

In this article, we explore the core concepts of norm-critical pedagogy developed in Sweden and only recently applied to nursing education praxis. These concepts, norms, power , and othering , are defined and demonstrated with exemplars from recent nursing education research. The theoretical model illustrates the ways in which these elements articulate in relationship to each other in nursing education praxis in ways that are dynamic, interlocking-like the gears of a clock-and resistant to interruption. We discuss the potential of a structurally oriented critical reflexivity-an equal and opposite force to the motion of the gears-to interrupt their motion.

Changing Perspectives of Local Therapists Eight Years after the Implementation of an Occupational Therapy Service in a Unique Himalayan Cross-Cultural Setting

Background. Whether concepts and principles of Occupational Therapy (OT) can successfully be applied to non-Western and cross-cultural settings is being intensively discussed. Aims/Objectives. We explored the changing perspectives of local occupational therapists (OTs) eight years after the implementation of an OT service in a Himalayan cross-cultural setting in terms of (1) treatment applied, (2) professional identity, and (3) cross-cultural interactions. Material and Methods. A qualitative study design was chosen, and semistructured interviews were conducted in all employed practitioners (a) during implementation and (b) eight years later (n = 7). Questions were carefully formulated in order to narrow down the intended issues but respecting crosscultural differences. The framework method was implemented for data analysis. Findings. Long-term empowering local OTs resulted in the successful development of a sustainable OT department in a unique Himalayan cross-cultural setting. Practitioners became aware of their therapeutic potentials, a clear sense of professional identity was developed, and it was recognised that sensitive cross-cultural practice is only achieved by an ongoing and intentional cultural learning process. Conclusions and Significance. Our findings suggest that OT can be applied to non-Western cross-cultural settings.

Telemedicine and eHealth Literacy in the Era of COVID-19: A Cross-Sectional Study in a Peripheral Clinic in Israel

The COVID-19 pandemic mandating isolation, quarantine, and social distancing has accelerated and expanded the use of telemedicine. This study examines the extent of the use of telemedicine and the relationship between eHealth literacy and satisfaction with using telemedicine during the pandemic. A total of 156 participants from a clinic in a peripheral community in southern Israel completed an online questionnaire. We found that 85% knew how to use the internet for health information, but only one third felt safe using it to make health decisions. Furthermore, 93% used the internet for technical needs, such as renewing prescriptions or making a doctor's appointment. Even lower use for telemedicine was found (38%) for consultation or treatment sessions. A positive association was found between eHealth literacy and satisfaction variables with using telemedicine (rp = 0.39, p < 0.001). Although respondents understood the benefits of telemedicine, they were not satisfied nor interested in online sessions after the epidemic's end, preferring a meeting involving personal interaction. Young people and academics benefit more from telemedicine, thereby creating usage gaps and potentially increasing existing inequality. We recommend developing intervention programs, especially among vulnerable populations, to strengthen eHealth literacy and remove barriers causing skepticism about the use of telemedicine during and after the pandemic.

Psychometric Properties of Nurse Cultural Competence Scale among Filipino Nurses

Purpose: Assessment of the cultural competence of nurses is becoming an important parameter in assessing the provision of quality care to patients especially in multicultural populations such as the Philippines. The study was conducted to assess the construct validity and internal consistency reliability of the Nurse Cultural Competence Scale (NCCS) among Filipino nurses. Methods: A methodological study was utilized and a convenience sample of 124 Filipino nurses were included in the study. An exploratory factor analysis was used to assess the construct validity of the instrument while internal consistency reliability was determined using Cronbach’s α coefficient and item-total correlations. Results: The 20-item NCCS was loaded on one dimension with factor loadings ranging from 0.72 to 0.95, explaining 79.19% of the total variance. Cronbach’s α was 0.986 which demonstrated high reliability and item-total correlations were between 0.811 and 0.929. Conclusion: The NCCS is a reliable and valid instrument for the measurement of cultural competencies among Filipino nurses. Keywords: Cultural competence, Filipino nurses, Reliability, Validity

Nurse Cultural Competence-cultural adaptation and validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results

Introduction

Measuring nurses’ cultural competence is an important aspect in monitoring the acceptable quality in multicultural populations, and is a means for efficient modification of the educational process of nurses based on this assessment.

Purpose

The goal of this article is to offer a preliminary assessment of the cultural competence of nurses based on a Polish-language and -culture version of the Nurse Cultural Competence Scale (NCCS).

Research method

An adaptive and diagnostic cross-disciplinary concept was used in the research. Two hundred thirty-eight professionally active nurses in the southeast region of Poland took part in this study. The NCCS-Polish version (NCCS-P) questionnaire was used after linguistic adaptation and analysis of psychometric properties.

Results

Moderate levels of competence in the Cultural Knowledge Subscale (M = 3.42) were found in the group of nurses studied. The results indicate lowest competency levels in the Cultural Skill Subscale (M = 3.14). The highest values were obtained for the Cultural Awareness Subscale (M = 3.98) and the Cultural Sensitivity Subscale (M = 3.72). The Cronbach's alpha reliability coefficient for the NCCS-P scale was 0.94, with the subscale values ranging from 0.72 to 0.95. Factor validity analysis of the Polish adaptation of the NCCS-P scale pointed to its four-factor structure. The Kaiser-Mayer-Olkin sampling adequacy test was 0.905, and the Bartlett test of sphericity result was χ2 = 5755.107; df = 820; p<0.001. The four-factor structure is affirmed by the Kaiser criterion and the scree test result.

Conclusions

The NCCS-P psychometric properties were highly reliable and significant because of the opportunity for using them for research in Poland.

Practical implications

The scale can be used in intercultural research for comparing cultural competence of nurses, including Polish ones. This scale facilitates the precise monitoring of cultural competence among nurses and nurse managers, which may help in developing nursing policies geared toward a commitment to expanding cultural competence.

Psychometric properties of instruments used to measure the cultural competence of nurses: A systematic review

BACKGROUND

Cultural competence is a key component of culturally congruent nursing care. In order to reduce healthcare inequalities and to identify potentials for improvement in nursing practice, researchers need to be able to assess cultural competence properly. Although many instruments for the assessment of cultural competence have been developed, their measurement properties have not yet been reviewed systematically. Such an overview of existing instruments, however, would allow researchers to identify the most valid and reliable instrument for nursing practice.

OBJECTIVE

The purpose of conducting this review is to identify and critically appraise the psychometric properties of instruments used to measure the cultural competence of nurses.

METHODS

A systematic literature search was performed in November 2019 in the following electronic databases: Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO and PubMed. Studies that were conducted to assess any measurement property of instruments used to measure the cultural competence of nurses were included. Two reviewers independently screened the articles and assessed the risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The quality of included instruments was assessed on the basis of the updated criteria for good measurement properties, and the quality of the summarised results was graded based on the principles of Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

In total, 44 studies describing 21 instruments were included in this study. We found that most instruments were tested for at least some forms of validity, but seldom for reliability. The quality of the psychometric properties was evaluated using the criteria for good measurement properties for the following: content validity, structural validity, internal consistency, reliability, measurement error and construct validity. No studies were found in which cross-cultural validity, criterion validity, or the responsiveness of the included instruments were evaluated. The Transcultural Self-Efficacy Tool, the Cultural Competence Assessment, and the Cultural Competence Health Practitioner Assessment showed sufficient levels of quality for psychometric properties and can be recommended for the assessment of cultural competence in nurses.

CONCLUSION

Given the broad availability of self-administered instruments to assess cultural competence, the development of new instrument is not recommended. A particular need was identified to conduct further psychometric evaluation studies on existing instruments and to adapt them accordingly, and especially on less frequently evaluated properties, such as reliability, measurement error and responsiveness.

Medication self-management support for people with diabetes and low health literacy: A needs assessment

INTRODUCTION

An adequate level of health literacy is regarded as a prerequisite for adequate medication self-management. Low health literacy skills are relatively more common in people with Diabetes Mellitus type 2. The aim of this study was to explore the needs regarding medication self-management of people with type 2 diabetes and low (functional, communicative and critical) health literacy, and their preferences for medication self-management support.

MATERIALS AND METHODS

A two-stage qualitative needs assessment study was performed using in-depth individual interviews and focus groups.

RESULTS

The participants preferred to be supported with reliable and easily understandable information, adequate interactive communication with health care professionals and fellow people with diabetes and tools for medication self-management support.

DISCUSSION

Future interventions should be created in co-creation with people with low health literacy and fulfill the expressed needs on information, communication and tools to improve self-management.

A qualitative study of cancer care professionals' experiences of working with migrant patients from diverse cultural backgrounds

OBJECTIVES

To improve the experiences of people from diverse cultural backgrounds, there has been an increased emphasis on strengthening cultural awareness and competence in healthcare contexts. The aim of this focus-group based study was to explore how professionals in cancer care experience their encounters with migrant cancer patients with a focus on how they work with cultural diversity in their everyday practice, and the personal, interpersonal and institutional dimensions therein.

DESIGN

This paper draws on qualitative data from eight focus groups held in three local health districts in major metropolitan areas of Australia. Participants were health professionals (n=57) working with migrants in cancer care, including multicultural community workers, allied health workers, doctors and nurses. Focus group discussions were audio recorded and transcribed in full. Data were analysed using the framework approach and supported by NVivo V.11 qualitative data analysis software.

RESULTS

Four findings were derived from the analysis: (1) culture as merely one aspect of complex personhood; (2) managing culture at the intersection of institutional, professional and personal values; (3) balancing professional values with patient values and beliefs, and building trust and respect; and (4) the importance of time and everyday relations for generating understanding and intimacy, and for achieving culturally competent care.

CONCLUSIONS

The findings reveal: how culture is often misconstrued as manageable in isolation; the importance of a renewed emphasis on culture as interpersonal and institutional in character; and the importance of prioritising the development of quality relationships requiring additional time and resource investments in migrant patients for enacting effective intercultural care.

Australian nursing and midwifery educators delivering evidence-based education in Tanzania: A qualitative study

Since 2011, Western Australian nursing and midwifery educators have been providing evidence-based continuing education to Tanzanian health professionals. Despite thorough preparation before departure, differences in local resource levels and available facilities have necessitated impromptu adaptation of curriculum content and delivery methods to ensure an effective program was delivered. This study explored the personal, cultural and teaching strategies utilised by Western Australian nursing and midwifery educators in Tanzania and examined if the transferability of education packages was influenced by the educators' cultural competence. Using a qualitative exploratory approach, data was collected from 15 Western Australian nursing and midwifery educators using a demographic survey and in-depth individual semi-structured interviews. The core themes identified from the analysis were Determination to learn, Assessing needs, Communication skills and Greater understanding. These findings are described using the conceptual framework of Campinha-Bacote's The Process of Cultural Competence in the Delivery of Healthcare Services. With appropriate levels of cultural competence, international health professionals can be effective at providing ongoing professional development to colleagues in developing country contexts, which may help address difficulties with retention and motivation of staff. It is essential that prior to departure cultural competence training is provided to educators to enhance their teaching capacity and effectiveness in international settings.

Mentorstvo tujim študentom zdravstvene nege: študija primera

Uvod: Multikulturalizem, globalizacija in internacionalizacija predstavljajo neizogiben dejavnik razvoja, ki so mu izpostavljeni tako visokošolski prostor kot klinična okolja. Raziskave kažejo, da klinični mentorji nimajo dovolj multikulturnih kompetenc. Namen raziskave je bil proučiti izkušnje kliničnih mentorjev in visokošolskih učiteljev z mentorstvom tujim študentom. Metode: S kvalitativnim pristopom – študijo primera so bile raziskane izkušnje kliničnih mentorjev in visokošolskih učiteljev z mentorstvom tujim študentom zdravstvene nege enega od visokošolskih zavodov. Podatki so bili zbrani januarja 2014, s tehniko skupinskega intervjuja, uporabljen je bil polstrukturiran vprašalnik. V vzorec je bilo vključenih šest kliničnih mentorjev in visokošolskih učiteljev. Pogovori so bili transkribirani in besedilo podrobno analizirano s pristopom indukcije. Rezultati: Odgovori so bili strnjeni v pet glavnih tem: kulturno zavedanje, poznavanje kultur, kulturne spretnosti, medkulturni stiki in želja po kulturni osveščenosti. Kategorije opisujejo izkušnje intervjuvancev v novih kulturah, posebnosti mentorstva, željo po kulturni osveščenosti in jezikovne ovire. V želji po kulturni osveščenosti ugotavljamo vpliv kulture na kakovost zagotavljanja zdravstvene nege, željo po novih znanjih in pozitiven odnos do internacionalizacije praktičnega usposabljanja. Diskusija in zaključek: Intervjuvanci navajajo, da je pomembno medsebojno spoštovanje različnih kultur. Izražajo željo po razumevanju drugačnosti, ne navajajo posebnih priprav na izmenjavo tujih študentov. Jezikovna ovira in strah se ob vsakodnevnem stiku s tujimi študenti zmanjša. Raziskava prispeva k boljšemu razumevanju razmer v procesu mentorstva tujih študentov zdravstvene nege.

Impact of nurses' cross-cultural competence on nursing intellectual capital from a social cognitive theory perspective

AIMS

To understand the relationships among certain key factors such as organizational climate, self-efficacy and outcome expectation on registered nurses, with regard to the development of registered nurses' cross-cultural competence. The focus is specifically on the use of a social cognitive framework for nurses for providing intercultural nursing care to international patients. This study also aims to examine the relationship between nurses' cross-cultural competence and nursing intellectual capital.

BACKGROUND

Given the influence of globalization on healthcare services, healthcare providers need to have enough cross-cultural competence to effectively care for patients from different cultures. Thus, the development of cross-cultural competence in nursing care has become an important issue.

DESIGN

A quantitative method and a cross-sectional design were employed in this study.

METHODS

Data were collected from 309 RN working in 16 healthcare institutions in Taiwan from May to August 2013. Structural equation modelling, in combination with the smart partial least squares method, was used to measure the relationships in the research model.

RESULTS

The results show that outcome expectation has a stronger impact on nurses' cross-cultural competence than self-efficacy. In addition, it was found that the cross-cultural competence of nurses has a positive impact on nursing intellectual capital.

CONCLUSION

Nursing supervisors should promote a higher level of outcome expectation on nurses to enhance the improvement of their cross-cultural competence. Raising the cross-cultural competence of nurses will aid in the accumulation of nursing intellectual capital.

The Impact of Cultural Competence Education on Short-Term Medical Mission Groups

Background: There are large numbers of short-term medical mission (STMM) groups traveling yearly from the United States to underdeveloped countries. Medical professionals educated in the Western biomedical model of treatment have an ethnocentric view of how to treat illness. Purpose: The purpose of this pilot study was to demonstrate that a 2-hour culturally sensitive educational program administered to medical professionals travelling to Haiti on a STMM could raise their cultural competency as measured by a specific tool. Method: The participants were invited to a short educational program designed to help them understand their own biases and make better treatment decisions for their patients based on the five constructs of Dr. Campinha-Bacote’s cultural competence model. Findings: Following an evidence-based educational program, the members of the STMM groups demonstrated improved levels of cultural competency. Implications: This program could provide an appropriate way to raise the cultural competency of medical mission health care providers.