The effectiveness of cultural-competence training for health professionals in community-based rehabilitation: a systematic review of literature

Evaluation of cross-cultural competence among German health care professionals: A quasi-experimental study of training in two hospitals

Sociocultural diversity in the German health care system is increasingly reflected in multicultural teams and the diversity of patients. To ensure successful collaboration in a multicultural environment and effective care to diverse patients the importance of cross-cultural competence training is growing. There is a lack of evidence-based training approaches for the German health care system, and it is unclear how the theoretical-conceptual promotion of cross-cultural competence can be achieved sustainably. The aim of the study is to evaluate the effectiveness of cross-cultural competence training for German health care professionals. A quasi-experimental evaluation study in two German hospitals was conducted. Cross-cultural competence was examined in an intervention and a control group (n = 196) using the self-reported instrument Cross-Cultural Competence of Healthcare Professionals (CCCHP) and analyzed with SPSS Statistics 25. Cross-cultural training had a cognitive level impact on knowledge, awareness, and attitudes and showed a highly significant reduction in social desirability. On an affective level, cross-cultural motivation and curiosity initially increased at t1 and decreased at t2. Cross-cultural emotion and empathy increased slightly. On a behavioral level, cross-cultural skills decreased after the training. For sustainable effects, cross-cultural training should focus more on practical skills in addition to theoretical content. Training interventions should be long-term. The results show that more needs to be done in the German health care sector to meet the increasing diversity and demands.

A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study

There is limited evidence regarding implementing organisational improvements in the cultural responsiveness of non-Aboriginal services. Using a pragmatic implementation process to promote organisational change around cultural responsiveness, we aimed to (i) identify its impact on the cultural responsiveness of participating services; (ii) identify areas with the most improvement; and (iii) present a program logic to guide cultural responsiveness. A best-evidence guideline for culturally responsive service delivery in non-Aboriginal Alcohol and other Drug (AoD) treatment services was co-designed. Services were grouped geographically and randomised to start dates using a stepped wedge design, then baseline audits were completed (operationalization of the guideline). After receiving feedback, the services attended guideline implementation workshops and selected three key action areas; they then completed follow-up audits. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to analyse differences between baseline and follow-up audits on three key action areas and all other action areas. Improvements occurred across guideline themes, with significant increases between median baseline and follow-up audit scores on three key action areas (median increase = 2.0; Interquartile Range (IQR) = 1.0-3.0) and all other action areas (median increase = 7.5; IQR = 5.0-11.0). All services completing the implementation process had increased audit scores, reflecting improved cultural responsiveness. The implementation process appeared to be feasible for improving culturally responsive practice in AoD services and may be applicable elsewhere.

Ethnocultural Minority Workers and Sustainable Return to Work Following Work Disability: A Qualitative Interpretive Description Study

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff

Background

Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care.

Objectives

To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels.

Design

Cross-sectional online survey in the form of a full census from May to November 2018.

Setting

Two organisations that run a total of 22 hospitals in Germany.

Participants

Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243].

Methods

Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features.

Results

The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff’s cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff’s assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001].

Conclusions

The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals.

Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses

PURPOSE

Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes?

METHOD

In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4.

RESULTS

Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus.

CONCLUSIONS

Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

Cultural Competence and Humility in Infectious Diseases Clinical Practice and Research

Infectious diseases as a specialty is tilted toward social justice, and practitioners are frequently on the front lines of the battle against health inequity in practices that are diverse and sometimes cross international borders. Whether caring for patients living with the human immunodeficiency virus, tuberculosis, or Ebola, infectious diseases practitioners often interact with those at the margins of societies (eg, racial/ethnic/sexual/gender minorities), who disproportionately bear the brunt of these conditions. Therefore, cultural barriers between providers and patients are often salient in the infectious diseases context. In this article, we discuss cultural competence broadly, to include not only the knowledge and the skills needed at both the organizational and the individual levels to provide culturally appropriate care, but also to include "cultural humility"-a lifelong process of learning, self-reflection, and self-critique. To enhance the quality and the impact of our practices, we must prioritize cultural competence and humility and be mindful of the role of culture in the patient-provider-system interactions, in our larger healthcare systems, and in our research agendas and workforce development.

Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics

Objective

The aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics.

Methods

We used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis.

Results

Three emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations.

Conclusion

For the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.

Evaluating a Programme for Intercultural Competence in Psychotherapist Training: A Pilot Study

Great cultural diversity among clients poses considerable challenges to mental health service providers. Therefore, staff in the mental health sector needs to be adequately trained. To date, however, there is little empirical evidence regarding such training. The present pilot study evaluates the effect of a standardised training programme to improve the intercultural competence of therapists.

Intercultural competence and therapeutic relationship were measured three times (pre, post and follow-up) in N = 29 psychotherapists. A control group of N = 48 therapists was included at pre-test to control for covariables.

The data show a significant increase in intercultural competence as well as an improvement in the therapeutic relationship. Interestingly, this positive outcome extends to non-immigrant clients.

The results confirm the assumption that culture is not limited to ethnic or national background but includes other dimensions such as age, gender and socioeconomic status which shape illness beliefs and expectations in the psychotherapeutic context. Therefore, intercultural competence can be considered a general therapeutic skill that can be taught in short interventions like the one developed in this study.

Mental health services and practitioners need to be able to respond appropriately to increasing cultural diversity.

Intercultural competence in psychotherapy can be enhanced by special training programmes.

These training programmes should focus on three components: intercultural knowledge, cultural awareness and culture-specific therapeutic skills.

Towards a culturally competent health professional: a South African case study

BACKGROUND

South Africa (SA) has a growing multilingual and multicultural population of approximately 55 million people, and faces service delivery challenges due to a shortage in skilled health professionals. Many health care facilities still depict distinct racial and ethnic characteristics that date back to the apartheid era, and there are reports of racial intolerance or preferential treatment at some facilities. There is limited literature in South Africa on cultural competence or on how to train health professionals to provide culturally competent care. This paper describes a study conducted to gain a better understanding of final year medical students' perceptions regarding concepts related to cultural and linguistic competence in the SA healthcare setting.

METHODS

An exploratory, cross-sectional, analytical study used a questionnaire to collect data from final year students at the medical school.

RESULTS

The demographic profile indicated considerable diversity in the respondents for languages spoken, ethnicity and religion. Responses indicated a level of cultural awareness and, according to the Cross Framework, a position of cultural pre-competence. This position was supported by the majority expressing high levels of agreement with the items deemed to indicate responsiveness: a desire for cultural competence to be promoted in the medical curriculum and for professional development to improve delivery of services and support to linguistically and culturally diverse groups. No significant association was found when analysing the latter item against demographic grouping variables. However, although not significant, a diminishing trend emerged in the rankings of monolingualism, bilingualism and multilingualism, suggesting that the ability to speak more than one language could possibly be a facilitating factor in acquiring cultural competence.

CONCLUSIONS

In response, it is recommended that specific learning objectives be included in the medical curriculum. Understanding of concepts related to both individual and institutional cultural competence would improve insights into their relevance in responding to the challenges related to culture in SA healthcare. Further research in teaching cultural competence is recommended. In order to respond to local needs, this should include research at a community level to analyse patients' perspectives and satisfaction with the cultural competence of healthcare providers and organisations serving the SA public.

Working With Clients With Limited English Proficiency: Mapping Language Access in Occupational Therapy

Nearly one in ten US residents have difficulty speaking and understanding English and are deemed to have limited English proficiency (LEP). Despite federal mandates for provision of interpreters and other language access services, individuals with LEP experience notable health disparities. Occupational therapists must be prepared to equitably serve this population, however there is a dearth of research evidence and practical recommendations about our profession's readiness to serve this growing population. This paper maps the current healthcare policy environment and existing language access research relevant to occupational therapy. Implications for the future of occupational therapy research, education and practice are discussed.

Improving Culturally Congruent Health Care for Children With Disabilities: Stakeholder Perspectives of Cultural Competence Training in an Interdisciplinary Leadership Training Program

INTRODUCTION

Racially/ethnically diverse children with disabilities experience increased risk for health care disparities when compared to non-Hispanic White children with disabilities or racially/ethnically diverse children without disabilities. The purpose of this study was to progress culturally congruent health care by exploring cultural competence (CC) for an interdisciplinary leadership training program designed to improve services for children with disabilities. The study also sought to bridge a gap in the literature by including the perspectives of diverse health care consumers.

METHOD

Q-methodology was used to support participant groups' sorting of CC training outcomes by importance to identify factors of CC.

RESULTS

Data collected from 51 participants were subjected to a by-person factor analysis that yielded six factors explaining 50% of variance.

DISCUSSION

Findings validate some common elements of existing CC models and provide new perspectives regarding potentially overlooked aspects of CC, with many new perspectives provided by racially/ethnically diverse parents of children with disabilities.

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study

Background

Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice.

Methods

We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers’ fieldwork reports, were coded and thematically analysed by each team using NPT.

Results

In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants’ needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP’s diagnoses and GPs reported a clearer understanding of migrants’ symptoms.

Conclusions

Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

BACKGROUND

People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce.

METHODS

The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome.

RESULTS

The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas.

DISCUSSION

Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world.

CONCLUSIONS

Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.

Cultural adaptations to augment health and mental health services: a systematic review

BACKGROUND

Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.

METHODS

MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.

RESULTS

Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider's behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.

CONCLUSIONS

Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.

Developing cultural competence in general practitioners: an integrative review of the literature

Background

Cultural competence is a broad concept with multiple theoretical underpinnings and conflicting opinions on how it should be materialized. While it is recognized that cultural competence should be an integral part of General Practice, literature in the context of General Practice is limited.

The aim of this article is to provide a comprehensive summary of the current literature with respect to the following: the elements of cultural competency that need to be fostered and developed in GPs and GP registrars; how is cultural competence being developed in General Practice currently; and who facilitates the development of cultural competence in General Practice.

Methods

We conducted an integrative review comprising a systematic literature search followed by a synthesis of the results using a narrative synthesis technique.

Results

Fifty articles were included in the final analysis. Cultural competence was conceptualized as requiring elements of knowledge, awareness/attitudes and skills/behaviours by most articles. The ways in which elements of cultural competence were developed in General Practice appeared to be highly varied and rigorous evaluation was generally lacking, particularly with respect to improvement in patient outcomes. Formal cultural competence training in General Practice appeared to be underdeveloped despite GP registrars generally desiring more training. The development of most aspects of cultural competence relied on informal learning and in-practice exposure but this required proper guidance and facilitation by supervisors and educators. Levels of critical and cultural self-reflection amongst General Practitioners and GP registrars varied and were potentially underdeveloped. Most standalone training workshops were led by trained medical educators however the value of cultural mentors was recognised by patients, educators and GP registrars across many studies.

Conclusions

Cultural competency development of GP registrars should receive more focus, particularly training in non-conscious bias, anti-racism training and critical self-reflectiveness. There is a need for further exploration of how cultural competence training is delivered within the GP training model, including clarifying the supervisor’s role.

It is hoped this discussion will inform future research and training practices in order to achieve quality and respectful care to patients across cultures, and to remove health inequities that exist between cultural groups.

Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review

PURPOSE

This article describes the characteristics and reviews the methodological quality of interventions designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA.

DATA SOURCES

A total of 17 electronic databases and 13 websites for the period of 2002-13.

STUDY SELECTION

Studies were included if they evaluated an intervention strategy designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, the USA or Canada.

DATA EXTRACTION

Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools.

RESULTS OF DATA SYNTHESIS

Sixteen published evaluations of interventions to improve cultural competency in health care for Indigenous peoples were identified: 11 for Indigenous peoples of the USA and 5 for Indigenous Australians. The main types of intervention strategies were education and training of the health workforce, culturally specific health programs and recruitment of an Indigenous health workforce. Main positive outcomes reported were improvements in health professionals' confidence, and patients' satisfaction with and access to health care. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Particular problems included weak study designs, low or no reporting of consent rates, confounding and non-validated measurement instruments.

CONCLUSION

There is a lack of evidence from rigorous evaluations on the effectiveness of interventions for improving cultural competency in health care for Indigenous peoples. Future evaluations should employ more rigorous study designs and extend their measurement of outcomes beyond those relating to health professionals, to those relating to the health of Indigenous peoples.

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Background

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

Methods

A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong.

Results

Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes.

Conclusion

This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs.

Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department

INTRODUCTION

Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs.

AIM

To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people.

METHOD

One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer.

RESULTS

The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group.

CONCLUSION

Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions.

Cultural Competence Training for Clinical Staff

In an environment of changing demographics and health care disparities, it is essential that nurses continue to develop competence in providing care across cultures. This article presents the findings of a pilot project to measure and compare self-reported cultural competence scores before and after participation in one of the core classes of a cultural competence curriculum. Cultural competence of the staff of a patient care unit ( N = 98) was assessed prior to the class, at 3 months, and at 6 months posteducation using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals–Revised. The results demonstrated that following an educational intervention the participants self-reported a statistically significant increase ( p = .03) in cultural competence within the category range of cultural awareness. Providing cultural competence education may better equip nurses to care for patients from diverse cultures.

The effectiveness of cultural competence programs in ethnic minority patient-centered health care--a systematic review of the literature

PURPOSE

To examine the effectiveness of patient-centered care (PCC) models, which incorporate a cultural competence (CC) perspective, in improving health outcomes among culturally and linguistically diverse patients.

DATA SOURCES

The search included seven EBSCO-host databases: Academic Search Complete, Academic Search Premier, CINAHL with Full Text, Global Health, MEDLINE with Full Text, PsycINFO PsycARTICLES, PsycEXTRA, Psychology and Behavioural Sciences Collection and Pubmed, Web of Knowledge and Google Scholar.

STUDY SELECTION

The review was undertaken following the preferred reporting items for systematic reviews and meta-analyses, and the critical appraisals skill program guidelines, covering the period from January 2000 to July 2011. Data extraction Data were extracted from the studies using a piloted form, including fields for study research design, population under study, setting, sample size, study results and limitations.

RESULTS OF DATA SYNTHESIS

The initial search identified 1450 potentially relevant studies. Only 13 met the inclusion criteria. Of these, 11 were quantitative studies and 2 were qualitative. The conclusions drawn from the retained studies indicated that CC PCC programs increased practitioners' knowledge, awareness and cultural sensitivity. No significant findings were identified in terms of improved patient health outcomes.

CONCLUSION

PCC models that incorporate a CC component are increased practitioners' knowledge about and awareness of dealing with culturally diverse patients. However, there is a considerable lack of research looking into whether this increase in practitioner knowledge translates into better practice, and in turn improved patient-related outcomes. More research examining this specific relationship is, thus, needed.

Ethical Concerns in Voluntourism in Speech-Language Pathology and Audiology

There is growing interest in short-term volunteering (i.e., volunteer tourism) to contribute to the development of speech-language pathology (SLP) and audiology (AUD) in global contexts. While this is exciting, professionals and students must be properly prepared for such trips to ensure cultural safety and avoid potential ethical concerns and pitfalls of neo-colonialist perspectives in working in resource-poor contexts. There is a burgeoning literature on volunteer tourism and medical tourism that can be used to assist us in planning and preparing for such work. Some examples from the first author's experiences in Malawi, Tanzania, and Kenya are used to illustrate some of the ethical concerns in SLPs' and AUDs' voluntourism. This article suggests that we attend to the motivations of volunteers, conduct training to ensure culturally safe and sustainable practices, and assist volunteers in coping with culture shock and re-entry shock. Research is needed to understand best practices in assessment and treatment in global contexts and best practices in pre- and post-trip training for SLP/AUD volunteers and students.

Working with immigrant families raising a child with a disability: challenges and recommendations for healthcare and community service providers

PURPOSE

Although providing culturally sensitive care is an important element of family-centered rehabilitation very is little known about providers' experiences working with immigrant families in pediatric settings. The purpose of this study is to develop a better understanding of the experiences of service providers working with immigrant families raising a child with a physical disability.

METHOD

We draw on a qualitative approach involving in-depth interviews and focus groups with healthcare and community service providers (n = 13) in two multi-cultural Canadian cities.

RESULTS

The findings indicate that healthcare and community service providers encounter several challenges in providing care to immigrant families raising a child with a disability. Such challenges include the following: (1) lack of training in providing culturally sensitive care; (2) language and communication issues; (3) discrepancies in conceptualizations of disability between healthcare providers and immigrant parents; (4) building rapport; and (5) helping parents to advocate for themselves and their children. Service providers also have several recommendations for improving services to better meet the needs of immigrant families.

CONCLUSION

Clinicians should be cognizant of how culture influences the care they provide to clients. More training opportunities are needed for enhancing culturally sensitive care.

IMPLICATIONS FOR REHABILITATION

• Pediatric rehabilitation providers working with immigrant families raising a child with a disability should engage in training and education around culturally sensitive care to better meet the needs of these clients. • More time is needed when working with immigrant families to build trust and rapport. • Clinicians need to be sensitive around gender issues and try to involve both parents in the decision making around the care for their child. • Healthcare providers should help clients to become more aware of the resources available to them in the hospital and in the community.

Indigenous cultural training for health workers in Australia

PURPOSE

Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia.

DATA SOURCES

CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest.

STUDY SELECTION

The review focuses on the conceptual and empirical literature on indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations.

RESULTS OF DATA SYNTHESIS

Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect.

CONCLUSION

This review shows that the evidence for the effectiveness of indigenous cultural training programmes in Australia is poor. Critiques of cultural training from indigenous and non-indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for indigenous Australians.

Improving cross-cultural care and antiracism in nursing education: a literature review

PURPOSE

To appraise through literature review the available research evidence to guide teaching and learning regarding cross-cultural care for nursing students. Cross-cultural education of nurses with a focus on both culture and antiracism is one way of promoting ethical and effective cross-cultural health systems for people from culturally diverse backgrounds. Although cross-cultural care has long been recognised as necessary to nursing education there is no clear consensus regarding how it is to be taught or which theoretical perspectives should underpin this teaching.

FINDINGS

Current literature supports the effectiveness of cross-cultural teaching interventions in promoting cultural competence and in facilitating attitudinal and belief changes in nursing students. The literature further suggests that racism persists in some students following participation in cross-cultural education and that there is a paucity of theory, teaching interventions and evaluations addressing antiracism.

CONCLUSIONS

Cross-cultural education alone is insufficient to combat racism. Cross-cultural education focused on both cultural competence and antiracism is necessary to promote effective cultural care in nursing students.

Psychoeducation to address stigma in black adults referred for mental health treatment: a randomized pilot study

Forty-two Black clients referred for outpatient treatment were randomly assigned to receive existing brochures about services or a psychoeducational booklet about stigma based on experiences of Black mental health consumers. At 3-month follow-up, clients reported that both types of information were helpful; there were no significant differences between the types of information on treatment attendance. However, individuals who reported higher perceived treatment need or greater uncertainty about treatment showed greater stigma reduction from the psychoeducation. Findings indicate the need to move beyond "customer satisfaction" to evaluate educational interventions, as well as for greater understanding of differential impact of stigma reduction interventions.