Health workforce cultural competency interventions: a systematic scoping review

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Abstract

Background

Addressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. Research evidence in this area is primarily focused on cultural competency training and its effects on practitioners’ knowledge, attitudes, skills and behaviour. While improvements in measures of healthcare practitioner cultural competency and other healthcare outcomes have been reported, there are concerns around evidence strength and quality. This scoping review reports on the intervention strategies, outcomes, and measures of included studies with the purpose of informing the implementation and evaluation of future interventions to improve health workforce cultural competence.

Methods

This systematic scoping review was completed as part of a larger systematic literature search conducted on cultural competence intervention evaluations in health care in Canada, the United States, Australia and New Zealand published from 2006 to 2015. Overall, 64 studies on cultural competency interventions were found, with 16 aimed directly at the health workforce.

Results

There was significant heterogeneity in workforce intervention strategies, measures and outcomes reported across studies making comparisons of intervention effects difficult. The two main workforce intervention strategies identified were cultural competency training and other professional development interventions including other training and mentoring. Positive outcomes were commonly reported for improved practitioner knowledge (9/16), skills (7/16), and attitudes/beliefs (5/16). Although health care (6/16) and health (2/16) outcomes were reported in some studies there was very limited evidence of positive intervention impacts. Only four studies utilised existing validated measurement tools to assess intervention outcomes.

Conclusion

Training and development of the health workforce remain a principle strategy towards the goal of improved cultural competence in health services and systems. Diverse approaches are available to increase health workforce cultural competence. However, the effects of interventions beyond practitioner knowledge and attitudes remains unclear. Assessment of practitioner behavioural outcomes as well as measures of intervention impact on healthcare and health outcomes are needed to build a stronger evidence base.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3001-5) contains supplementary material, which is available to authorized users.

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Most cited references 55

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Patient centeredness, cultural competence and healthcare quality.

Sarah Cooper, Somnath Saha, Mary Beach (2008)

Cultural competence and patient centeredness are approaches to improving healthcare quality that have been promoted extensively in recent years. In this paper, we explore the historical evolution of both cultural competence and patient centeredness. In doing so, we demonstrate that early conceptual models of cultural competence and patient centeredness focused on how healthcare providers and patients might interact at the interpersonal level and that later conceptual models were expanded to consider how patients might be treated by the healthcare system as a whole. We then compare conceptual models for both cultural competence and patient centeredness at both the interpersonal and healthcare system levels to demonstrate similarities and differences. We conclude that, although the concepts have had different histories and foci, many of the core features of cultural competence and patient centeredness are the same. Each approach holds promise for improving the quality of healthcare for individual patients, communities and populations.

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Racial and Ethnic Disparities in the Quality of Health Care.

Kevin Fiscella, Mechelle R Sanders (2016)

The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models

Frida Jonsson, Miguel San Sebastián, Anne Hammarström … (2017)

Background Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of “being” in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories. Method The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9th grade in the municipality of Luleå, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months. Results Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03). Conclusion The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

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Author and article information

Contributors

Crystal Jongen:

ORCID: http://orcid.org/0000-0003-4516-6760

crystal.sky.jongen@gmail.com

Janya McCalman: j.mccalman@cqu.edu.au

Roxanne Bainbridge: r.bainbridge@cqu.edu.au

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 2 April 2018

Publication date PMC-release: 2 April 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 232

Affiliations

[1 ]ISNI 0000 0001 2193 0854, GRID grid.1023.0, School of Health, Medicine and Applied Sciences, Central Queensland University, ; Cnr Shields and Abbott Streets, Cairns, QLD 4870 Australia

[2 ]ISNI 0000 0001 2193 0854, GRID grid.1023.0, Centre for Indigenous Health Equity Research, Central Queensland University, ; Cnr Shields and Abbott Streets, Cairns, QLD 4870 Australia

Author information

Crystal Jongen http://orcid.org/0000-0003-4516-6760

Article

Publisher ID: 3001

DOI: 10.1186/s12913-018-3001-5

PMC ID: 5879833

PubMed ID: 29609614

SO-VID: 82f86759-704c-405a-9282-b105de61aec3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 December 2016

Date accepted : 14 March 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001790, Central Queensland University;

Award ID: Not applicable

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ScienceOpen disciplines: Health & Social care

Keywords: cultural competence,indigenous,ethnic minorities,cultural competence training,health workforce development

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ScienceOpen disciplines: Health & Social care

Keywords: cultural competence, indigenous, ethnic minorities, cultural competence training, health workforce development

Health workforce cultural competency interventions: a systematic scoping review

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Most cited references 55

Patient centeredness, cultural competence and healthcare quality.

Racial and Ethnic Disparities in the Quality of Health Care.

Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models

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