Evaluation of a Cultural Competence Course

Intercultural gaps in knowledge, skills and attitudes of public health professionals: a systematic review

BACKGROUND

Previous cultural competence reviews focused on medical professions. Identifying intercultural competence gaps for public health professionals is long overdue. Gaps will inform training to work effectively within increasingly diverse cultural contexts.

METHODS

A systematic review was conducted identifying intercultural competence gaps using hand/electronic searches: MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL and CDSR, 2004-March 2020. Data were extracted on intercultural knowledge, skills and attitude gaps. Themes were coded into an emerging framework, mapped against three competences. Studies were assessed using validated tools.

RESULTS

506 studies retrieved and 15 met inclusion criteria. Key findings include: intercultural knowledge requires local demographics framing within global context to better understand culturally informed community health needs; intercultural skills lack training opportunities applying cultural theory into practice using flexible, diverse methods encouraging culturally appropriate responses in diverse settings; intercultural attitude gaps require a non-judgemental focus on root causes and population patterns, preventing stereotypes further increasing health disparities.

CONCLUSION

Gaps found indicate understanding local public health within its global context is urgently required to deliver more effective services. Flexible, diverse training opportunities applying cultural theory into practice are essential to engage successfully with diverse communities. A non-judgemental focus on population patterns and root causes enables selecting culturally aligned health strategies to mitigate stereotyping communities and increasing health disparities.

Designing, implementing, and evaluating a mobile app-based cultural care training program to improve the cultural capacity and humility of nursing students

BACKGROUND

Given the growing cultural diversity among healthcare clients, it is crucial for nursing education to have a clear mission: to effectively train future nurses by incorporating cultural care curricula. The goal is to equip them with the necessary cultural capacity and humility. This study focused on designing, developing, and evaluating a mobile app-based cultural care training program, with the aim of enhancing the cultural capacity and humility of nursing students.

METHODS

This experimental study utilized the five steps of the ADDIE instructional model (analysis, design, development, implementation, and evaluation) to design a mobile app-based cultural care training program. The first three steps involved designing and developing the program, drawing upon Purnell's model for cultural competence and Foronda's rainbow model of cultural humility. In the fourth step, the cultural care training program was implemented in 16 modules among 80 internship nursing students. These students were randomly assigned to either the intervention or control groups, with 40 students in each group. Finally, in the fifth step, the effectiveness of the mobile app-based program was evaluated by administering the Cultural Capacity Scale, and the Foronda Cultural Humility Scale before and one month after the cultural care training. The collected data were analyzed using SPSS22, employing techniques such as paired t-test, chi-square test, and independent samples t-test.

RESULTS

A total of 76 students completed the study, with 39 students in the intervention group and 37 students in the control group. Prior to the mobile app-based cultural care training program, there were no significant differences in cultural capacity and humility scores between the two groups (p > 0.05). However, following the completion of the program, the intervention group exhibited higher scores in cultural capacity and humility compared to the control group (p < 0.05).

CONCLUSION

Based on the findings, it can be concluded that the mobile app-based cultural care training program had a positive impact on the cultural capacity and humility of undergraduate nursing students. These results indicate the importance of nurse educators designing comprehensive training programs that incorporate innovative approaches to enhance cultural capacity and humility among nursing students at all academic levels.

Professional Development in Health Sciences: Scoping Review on Equity, Diversity, Inclusion, Indigeneity, and Accessibility Interventions

INTRODUCTION

Equity, diversity, inclusion, indigeneity, and accessibility (EDIIA) are critical considerations in the formation of professional development (PD) programs for health care workers. Improving EDIIA competency in health care serves to enhance patient health, staff confidence and well-being, delivery of care, and the broader health care system. There is a gap in the literature as to the efficacy of EDIIA-based PD programs and their individual components. The present article will review available quantitative data pertaining to EDIIA-based PD programs for health care workers as well as their effectiveness.

METHODS

A scoping review of articles published in the EBSCOhost, MEDLINE, PubMed, EMBASE, and CINAHL databases was performed. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

A total of 14,316 references were identified with 361 reaching full-text review. A final 36 articles were included in the scoping review with 6552 total participants (72.9% women; 26.9% men; 0.2% nonbinary). EDIIA-based PD interventions were developed around the topics of culture ( n = 22), gender ( n = 11), sexual orientation ( n = 9), indigeneity ( n = 6), race ( n = 6), ableism ( n = 1), and ageism ( n = 1).

DISCUSSION

Despite an increased interest in developing EDIIA-based PD curricula for health care workers, there are glaring disparities in the quality of care received by marginalized and equity-seeking populations. The present scoping review delineated key features which were associated with increased quantitative efficacy of EDIIA-based PD training programs. Future work should focus on large-scale implementation and evaluation of these interventions across health care sectors and levels of training.

Effect of a mobile app-based cultural competence training program for nurses: A pre- and posttest design

BACKGROUND

Importance of providing culturally competent nursing care and cultural competence training for nurses has increased due to diversification of the cultural backgrounds of patients in South Korea. Currently there is little cultural competence training provided to nurses in South Korea.

OBJECTIVES

This study aimed to develop and evaluate a mobile app-based cultural competence training program for nurses working at a tertiary teaching hospital in South Korea.

DESIGN

A one group pre- and posttest intervention design.

SETTINGS

A tertiary teaching hospital in South Korea.

PARTICIPANTS

A total of 49 nurses participated in the study.

METHODS

A mobile app-based cultural competence training program for nurses was developed using the five stages of the ADDIE instructional model. Cultural competence scores were compared between pre- and posttest using the paired t-test. The differences in cultural competence scores between pre- and posttests were also compared by participant characteristics using analysis of variance, the Kruskal-Wallis test, and the Mann-Whitney-Wilcoxon test.

RESULTS

The mean total score of the nurses increased significantly after participating in the program, from 63.00 to 81.06 (p < 0.001). Comparisons of differences in cultural competence scores between pre- and posttests by participant characteristics revealed that the improvement in cultural competence was greater in those with no experience abroad for longer than 1 month compared to those who had experience abroad for longer than 1 month (p < 0.001) and in those who had never cared for a foreign patient compared to those who had cared for more than three foreign patients per week (p < 0.05).

CONCLUSIONS

The mobile app-based cultural competence training program developed in this study was demonstrated to be effective in improving the cultural competence of nurses in South Korea. Our novel training program can be applied as on-the-job training to improve the cultural competence of nurses.

Increasing undergraduate nursing students' cultural competence: an evaluation study

BACKGROUND

Cultural competence has become increasingly important for Chinese health professionals because of internationalization and the opening up of China to overseas visitors and business as well as a growing awareness of the needs of minority groups within China. This study aimed to evaluate a workshop designed to improve cultural competence among Chinese undergraduate nursing students.

METHODS

A one-group pretest and posttest design was applied. The intervention was a one-day workshop based on transformative learning theory using a variety of teaching strategies. Forty undergraduate nursing students from a university in Wuhan, China selected by convenient sampling received the intervention. Data were collected before the intervention (T1), immediately after the intervention (T2), and 1 month (T3) and 3 months (T4) following the intervention through the Chinese version of Cultural Competence Inventory for Nurses (CCIN). A researcher-designed evaluation form including open-ended questions was also used.

RESULTS

Participants' scores by CCIN increased significantly in the total score (p < .001) as well as the components of cultural awareness (p = .003), cultural knowledge (p < .001), cultural understanding (p = .007) and cultural skills (p < .001), but not in cultural respect. This improvement maintained at T3 and T4. Overall, participants were satisfied with the workshop, and the qualitative results supported the effects of this intervention.

CONCLUSIONS

The one-day workshop was effective in improving nursing students' cultural competence. Replication or further refinement of this workshop is recommended for future research among additional nursing students with diverse backgrounds.

Improving Evaluation of Dental Hygiene Students' Cultural Competence with a Mixed-Methods Approach

Most dental hygiene educational programs include cultural competence education, but may not evaluate student outcomes. The aim of this study was to design and implement a mixed-methods evaluation to measure dental hygiene students' progression toward cultural competence. Two cohorts consisting of consecutive classes in one U.S. dental hygiene program participated in the study. A total of 47 dental hygiene students (100% response rate) completed self-assessments to measure their attitudes and knowledge at three time points between 2014 and 2016. Mean scores were calculated for three domains: Physical Environment, Communication, and Values. Qualitative analysis of the students' cultural diversity papers was also conducted to further evaluate students' knowledge and skills. Bennett's five-level conceptual framework was used to code phrases or sentences to place students in the general categories of ethnocentric or ethno-relative. The quantitative and qualitative results yielded different outcomes for Cohort 1, but not for Cohort 2. The Cohort 1 students assessed themselves statistically significantly lower over time in one of the three measured domains. However, the Cohort 2 students assessed themselves as statistically significantly more culturally competent in all three domains. Qualitative results placed 72% of Cohort 1 students and 83% of Cohort 2 students in the more desirable ethno-relative category. Since quantitative methods consisting of student self-assessments may not adequately measure students' cultural competence, adding qualitative methods to measure skills specific to patient care in this study added a robust dimension to evaluating this complex dental hygiene student competence.

Effectiveness of Interventions Teaching Cross-Cultural Competencies to Health-Related Professionals With Work Experience: A Systematic Review

INTRODUCTION

Because of the increasing diversity in society, health professionals are working with patients from many different cultural backgrounds. Interventions to improve culture-specific competencies in health care have been shown to be successful. However, there is an increasing demand for continuing professional development in general cross-cultural competencies that do not focus on specific cultures. Previous reviews do not differentiate between general cross-cultural and culturally specific competencies. This review assesses the effectiveness of interventions that aim to increase cross-cultural competencies in health professionals.

METHODS

Databases were searched systematically to identify quantitative and qualitative studies that focus on cross-cultural competencies in health care professions. Two independent raters used an assessment tool (Quality Assessment Tool for Studies with Diverse Designs, QATSDD) to rate the quality of the results.

RESULTS

Thirty-one of 34 identified studies described cross-cultural competency interventions to be effective in terms of participants' satisfaction with the interventions and self-rated knowledge improvement. Nineteen studies relied exclusively on subjective assessment methods. Most of them reported significant findings, whereas results from five studies with independent ratings or objective assessments were mostly not significant. Many studies lacked in providing sufficient data on intervention descriptions.

DISCUSSION

Cross-cultural competency interventions seem to be effective-according to self-ratings by participants. However, the definitions of cultural competency, the objectiveness of measurements, and the types of study outcomes were varied. To evaluate the success of cross-cultural competency interventions, more evidence from objective, behavioral assessments is needed. Studies should investigate the differential impact of various intervention types and need to provide detailed reporting on methods and outcomes.

Psychometric Analysis of a Scale Assessing Self-Efficacy for Cultural Competence in Patient Counseling

Background:

The Accreditation Council for Pharmacy Education adopted revised accreditation standards and guidelines for the PharmD degree program in January 2006. The revised standards mandate the inclusion of cultural competence in pharmacy curricula. Assessment tools to evaluate the impact of training are needed.

Objective:

To examine the psychometric properties of a 12 item scale designed to estimate the impact of cultural competence training on pharmacy students' self-efficacy in providing culturally appropriate patient care.

Methods:

A 12 item scale to assess the impact of an elective course on pharmacy students' (N = 175; 173 analyzable) perceived self-efficacy in providing culturally competent patient care was used before and after students completed the training. Principal components analysis was conducted to examine the underlying structure of the scale, and the Cronbach α statistic was computed as an estimate of internal consistency. Pre- versus posttraining responses for each item and for the total scale scores were compared as an indicator of concurrent validity.

Results:

The principal components analysis yielded a one-component solution, “self-efficacy for cultural competence,” which included all 12 contributing items and accounted for 46% of the total variance. Item communalities ranged from 0.25 to 0.58. Component loadings ranged from 0.50 to 0.76. Overall, the scale exhibited a Cronbach α estimate of internal consistency of 0.89. Posttraining scores were significantly higher than pretraining scores for both the total scale scores (posttest and pretest mean ± SD score = 47.96 ± 5.15 and 34.21 ± 6.19, respectively; p < 0.001) and for each item (p values < 0.001). These comparisons provide evidence of concurrent validity.

Conclusions:

Our results suggest that our 12 item scale exhibits acceptable psychometric properties and is a useful tool for estimating the impact of cultural competence training on pharmacy students' perceived self-efficacy for providing culturally competent care and services.

Community-Based Approaches to Strengthen Cultural Competency in Nursing Education and Practice

This article explores existing informal as well as formal approaches that address health disparities in the communities where they occur, enhancing the opportunity to strengthen the cultural competency of providers, students, and faculty. A particular focus centers on the community-based participatory research approaches that involve community members, providing opportunities to develop mutually respectful, trusting relationships through co-teaching and co-learning experiences. With community-based participatory research approaches to community involvement in place, the stage is set for partnerships between communities and schools of nursing to collaboratively design, implement, and integrate informal and formal cultural competence components in nursing curricula.

Disability Diversity Training in the Workplace: Systematic Review and Future Directions

Purpose Misinformation and negative attitudes toward disability contribute to lower employment rates among people with disabilities. Diversity training is an intervention intended to improve intergroup relations and reduce prejudice. We conducted a systematic review to determine the use and effectiveness of disability diversity training aimed at improving employment outcomes for employees with disabilities. Methods Five databases were searched for peer-reviewed studies of disability diversity training interventions provided within the workplace. Studies identified for inclusion were assessed for quality of methodology. Results Of the total of 1322 articles identified by the search, three studies met the criteria for inclusion. Two of the three articles focused specifically on training to improve outcomes related to workplace injuries among existing employees. The other study provided an initial test of a more general disability diversity training program. Conclusions There is currently a lack of empirically validated diversity training programs that focus specifically on disability. A number of disability diversity trainings and resources exist, but none have been well researched. Related literature on diversity training and disability awareness suggests the possibility for enhancing diversity training practices through training design, content, participant, and outcomes considerations. By integrating best practices in workplace diversity training with existing disability training resources, practitioners and researchers may be able to design effective disability diversity training programs.

Understanding Cultural Competence in a Multicultural Nursing Workforce

Purpose: In Saudi Arabia, the health system is mainly staffed by expatriate nurses from different cultural and linguistic backgrounds. Given the potential risks this situation poses for patient care, it is important to understand how cultural diversity can be effectively managed in this multicultural environment. The purpose of this study was to explore notions of cultural competence with non-Saudi Arabian nurses working in a major hospital in Saudi Arabia. Design: Face-to-face, audio-recorded, semistructured interviews were conducted with 24 non-Saudi Arabian nurses. Deductive data collection and analysis were undertaken drawing on Campinha-Bacote’s cultural competence model. The data that could not be explained by this model were coded and analyzed inductively. Findings: Nurses within this culturally diverse environment struggled with the notion of cultural competence in terms of each other’s cultural expectations and those of the dominant Saudi culture. Discussion: The study also addressed the limitations of Campinha-Bacote’s model, which did not account for all of the nurses’ experiences. Subsequent inductive analysis yielded important themes that more fully explained the nurses’ experiences in this environment. Implications for Practice: The findings can inform policy, professional education, and practice in the multicultural Saudi setting.

Cultural competency among nurses with undergraduate and graduate degrees: implications for nursing education

AIM

To compare the level of cultural awareness, knowledge, skills, and comfort of nurses with undergraduate and graduate degrees when encountering patients from diverse populations.

BACKGROUND

Cultural competency is a core curriculum standard in undergraduate and graduate nursing programs. Assessing cultural awareness, knowledge, skills, and comfort among nurses can help identify areas to strengthen in nursing curricula.

METHOD

A prospective, cross-sectional, descriptive study design was used. Two thousand surveys were sent to nurses in a southeastern state; 365 nurses participated.

RESULTS

Undergraduate-degree nurses scored lower than graduate-degree nurses on cultural knowledge. Scores on cultural awareness, skills, and comfort with patient encounters did not vary between groups. Both groups of nurses reported little cultural diversity training in the workplace or in professional continuing education.

CONCLUSION

The findings of this study indicate areas of need for undergraduate and graduate nursing education.

Measures of cultural competence in nurses: an integrative review

Background. There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. Design. An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. Method. There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. Results. The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. Conclusions. The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

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.

[Competency to provide cross-cultural nursing care for people with disability: a self-assessment instrument]

This study addresses the Cross-Cultural Nursing Theory, which develops foundations for care delivery, as the essence of nursing work, based on anthropology, which supports and explains culture and care aspects. This reflexive study was based on the Theory Analysis method to study the concepts aimed at constructing a Self-Assessment Instrument of Competencies for Cross-Cultural Care to Disabled People. After analyzing the main concepts, Culturally Competent Care and Cultural Communication, were analyzed, as well as the sub-concepts: assessment, values, bio-cultural diversity, skill, knowledge, identity, code and cultural empathy. The analysis cycle of cultural values supporting self-assessment was summarized. The Self-Assessment Instrument of Competencies for Cross-Cultural Nursing Care to Disabled People was constructed, specifically deafness, blindness or low sight, physical impairment and mental impairment, regarding greeting, accepting, helping, knowing and advocating. It is concluded that the theory joins characteristics for care delivery to disabled people.

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.

Cultural competence of practicing nurses entering an RN-BSN program

AIM

The aim of this exploratory research was to examine the cultural competence of practicing nurses entering an RN to BSN program.

BACKGROUND

As nonwhite populations increase in the United States, the cultural competence of nurses increases in importance. With 38 percent of baccalaureate nursing students in RN-BSN programs, it is important to examine the cultural competence of this population.

METHOD

Fifty-three RN-BSN students completed the Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-Revised (IAPCC-R) upon program entry; 50.9 percent were culturally competent as determined by the tool.

RESULTS

A strong correlation existed between IAPCC-R scores and student age, with students 20 to 30 years old scoring significantly higher than those in the age range of 41 to 50.

CONCLUSION

The findings suggest and invite more extensive research on the success of the systematic nursing education initiatives of current associate degree programs and adherence to NLNAC standards for cultural competence, particularly in the cultural skill construct.

Constructivism in cultural competence education

A graduate course on cultural diversity, based in constructivist theory and structured on the Process of Cultural Competence in the Delivery of Healthcare Services model, was developed and taught through classroom and online methods. The following research questions were explored: 1) Can an educational experience, built on constructivist learning theory tenets, change students' perceptions, attitudes, knowledge, and skills in the area of cultural competence? 2) Does the delivery method, online or traditional classroom, influence the degree of change? The study used a quasi-experimental, pretest-posttest control group design using the Inventory for Assessing the Process of Cultural Competence Among healthcare Professionals Revised. Findings showed significant changes (p<0.001) in cultural competence scores and subscores for all learners with both teaching modalities based on interval scale and in categories of cultural knowledge, skills, desire, and overall competence based on a nominal scale. The untaught construct of cultural desire showed the most significant improvement.

Psychometric evaluation of the Swedish adaptation of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals--Revised (IAPCC-R)

The purpose of this study was to describe the translation, adaption, and psychometric evaluation process in relation to validity and reliability of the Swedish version of the instrument, Inventory for Assessing The Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) following the translation, adaptation, and psychometric evaluation process. Validity tests were conducted on the response processes (N = 15), the content (N = 7), and the internal structure of the instrument (N = 334). Reliability (alpha = .65 for the total scale varying between -.01 and .65 for the different subscales) was evaluated in terms of internal consistency. Results indicated weak validity and reliability though it is difficult to conclude whether this is related to adaptation issues or the original construction.The testing of the response process identified problems in relation to respondents' conceptualization of cultural competence. The test of the content identified a weak correspondence between the items and the underlying model. In addition, a confirmatory factor analysis did not confirm the proposed structure of the instrument. This study concludes that this instrument is not valid and reliable for use with a Swedish population of practicing nurses or nursing students.

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

AIMS

To find and review studies in which investigators evaluated cultural-competence training in community-based rehabilitation settings; critique study methods, describe clinical outcomes, and make recommendations for future research.

BACKGROUND

A review of the effectiveness of cultural-competence training for health professionals in community-based rehabilitation settings was conducted.

DATA SOURCES

Research citations from 1991-2006 in CINAHL, Medline, Pubmed, PsycInfo, SABINET, Cochrane, Google, NEXUS, and unpublished abstracts were searched.

METHODS

Searching, sifting, abstracting, and assessing quality of relevant studies by three reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. A meta-analysis was not conducted because the studies did not address the same research question.

RESULTS

Five studies and one systematic review were evaluated. Positive outcomes were reported for most training programs. Reviewed studies generally had small samples and poor design.

CONCLUSIONS/IMPLICATIONS

The paucity of studies and lack of empirical precision in evaluating effectiveness necessitate future studies that are methodologically rigorous to allow confident recommendations for practice.

Current approaches to integrating elements of cultural competence in nursing education

Cultural competence in nursing education is receiving renewed emphasis. Curricular input to incorporate such knowledge, attitudes, and skills encompasses a wide variety of teaching and learning methods. Five are described here: specialty focus, required courses, models, immersion experiences, and distance learning or simulation. Despite progress in incorporating cultural content into nursing curricula, several issues characterize all levels of nursing programs, including lack of consensus on what should be taught, lack of standards, limited and inconsistent formal evaluation of effectiveness, a decline of curricular specialty courses on culture, a focus on the microlevel of the nurse-patient encounter, and the need for, support of, and preparation of faculty.