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

Racial equity in and through medical interaction scholarship: A scoping review

OBJECTIVE

We conducted a systematic scoping review to characterize the landscape of communication scholarship within racial health equity in and through the patient-provider interaction.

METHODS

We employed three waves of data collection to identify relevant articles (N = 454) about racial equity within provider-patient interactions. We iteratively developed a codebook concerning article characteristics, coding for journal names, data source, descriptive characteristics for the study samples, and presence of theory and equity in sections of the manuscripts.

RESULTS

This search identified studies (N = 206) that were published in 76 peer-reviewed scientific journals. The majority of studies reported primary data analyses and used survey and interview methodology. Many studies examined participants as patients generally rather than in reference to particular health conditions. Among those with a specific health condition, the largest proportion focused on cancer control. Very few studies included samples with Native American and Pacific Island heritage. Most studies included cisgender men and/or women, but none included transgender men or women. The vast majority of research focused on the patient experience; few centered on providers' and caregivers' experiences. The body of scholarship was largely atheoretical; the most frequently noted constructs were patient-provider communication (including patient-centered communication and patient-centered care), implicit/explicit racial bias, shared decision-making. There was wide variation in the extent to which equity was woven through the manuscripts. Equity is typically mentioned in the literature review, and racial identity in the sample may serve as a marker of racialized experiences.

CONCLUSION

This study demonstrates the need for the development of theory that elevates the centrality of health equity to attend to the bi- or multi-directional flow of communication that shapes the quality of these interactions.

PRACTICE IMPLICATIONS

These insights can serve as a strong foundation for the development of interventions to address equity in clinical interactions.

Social accountability in radiography education: Scoping review

INTRODUCTION

Social accountability (SA) in medical education mandates that medical schools address community health priorities. While well-established in medical education, its integration into radiography education and practice remains underexplored. This review aims to explore the current landscape of (SA) in radiography by identifying key themes, educational strategies, and gaps that could inform future development in educational and clinical settings.

METHODS

The scoping review followed the Arksey and O'Malley framework, enhanced by Levac et al. A comprehensive search across PubMed, MEDLINE, CINAHL, Scopus, and Web of Science. Data were synthesised through thematic analysis, with insights validated by consultations with radiography educators and practitioners.

RESULTS

A total of 126 were screened. Of them, 19 articles were included, meeting the inclusion criteria. The included articles were from the UK, contributing 9 (47.37 %) articles, followed by Australia 3 (15.79 %), South Africa 2 (10.53 %), and smaller contributions 5 (26.31 %) from the United States, Italy, Nigeria, and Tanzania, underscoring a global research scope and broadening perspectives. The 19 articles under review were published across several journals, with the majority appearing in Radiography (11 articles, 57.9 %). Five themes emerged: (1) compassionate communication and patient-centred care, (2) cultural sensitivity and equity, (3) environmental sustainability, (4) education and training aligned with community needs, and (5) research addressing healthcare needs and disparities.

CONCLUSION

The findings underscore the need for a standardised approach to SA in radiography education, equipping radiographers to address diverse health needs and promote equitable, patient-centred care. Future research should explore effective implementation strategies for systemic change.

IMPLICATION FOR PRACTICE

Educational institutions should adopt validated models to assess SA and establish supportive policies. Accrediting bodies must update standards to align with evolving societal needs.

Key Themes in the Care of Inflammatory Bowel Diseases Among Immigrant Populations: A Systematic Review

BACKGROUND

The care of inflammatory bowel disease (IBD) requires special attention among immigrants due to different disease incidence, phenotype, and risk profiles. We aimed to highlight key themes among existing literature to inform equitable care in all immigrants living with IBD.

METHODS

A systematic literature search was conducted in MEDLINE, EMBASE, the Cochrane library, Scopus, and ProQuest from inception to February 2023 to identify studies capturing the care of IBD among immigrants who moved from one country to another, irrespective of the timing of IBD diagnosis. Studies on immigrant children and children of immigrants were also included. We reported qualitative and quantitative data as reported in each individual study, and where applicable, we noted comparisons between immigrants and non-immigrants, defined as natives of the adopted country.

RESULTS

This review included 50 eligible studies. 12/19 (63.1%) studies reported lower incidence of IBD among immigrants, although rates increased from first- to second-generation immigrants in five studies. Most immigrants had significant changes in their diet after immigration, and their gut microbiota was different compared to non-immigrants. Immigrants had different environmental exposures and in certain populations, more severe IBD phenotypes and extra-intestinal manifestations (EIMs). Medical and surgical treatments were lower among immigrants in certain regions, although they had appropriate healthcare utilization and similar hospitalization rates compared to non-immigrants.

CONCLUSIONS

IBD care among immigrants is unique due to their different risk profiles and disease phenotypes, and the potential barriers with healthcare access. Understanding IBD among immigrants is key to ensure equitable care in this unique population.

Predictors of cultural competence among healthcare professional in maternity department: A systematic review

BACKGROUND

In recent years, the number of foreign women seeking perinatal care from health services has increased. These women come from diverse cultural and social backgrounds, highlighting the importance of properly training healthcare professionals to respond effectively to their needs. Cultural Competence refers to the set of skills, knowledge, and awareness that providers must possess to deliver care to patients from different cultures.

AIM

This study aims to investigate the determinants of Cultural Competence in healthcare professionals who assist women during childbirth.

METHOD

A systematic literature review was conducted using MEDLINE/PubMed, Web of Science, CINAHL, Scopus, and ProQuest. Quantitative studies were included if they investigated at least one psychosocial characteristic in midwives or staff assisting pregnant women.

FINDINGS

Out of 4,193 articles, 8 were selected that measured the level of Cultural Competence using validated scales. These studies related the data to the sociodemographic characteristics of the chosen population. Variables significantly associated with Cultural Competence that recurred in at least two studies were selected: age, gender, years of experience, role, and previous Cultural Competence training. These determinants were categorized as (a) individual variables and (b) Jobs-related variables.

DISCUSSION

Age diversity boosts Cultural Competence (CC) in healthcare teams, enhancing care for diverse women. Our study confirms prior cultural training and experience with different cultures predict CC. Health services should promote CC, but understanding in high-income countries remains limited.

CONCLUSIONS

By strategically promoting age diversity, facilitating cultural training, and encouraging experiences with diverse populations, healthcare institutions can significantly improve the Cultural Competence of their staff.

Factors influencing communication issues during hospital discharge for older adults in 11 high-income countries: a secondary analysis of the 2021 International Health Policy Survey

OBJECTIVES

To determine the prevalence of hospital discharge communication problems with older adults, compare them across countries and determine factors associated with those problems.

DESIGN

Secondary analysis of cross-sectional survey data.

SETTING

2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults conducted across 11 high-income countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

PARTICIPANTS

4501 respondents aged 60 and older in the USA and 65 and older in all other included countries who were hospitalised at least once in the past 2 years before the survey and answered discharge communication-related questions.

PRIMARY OUTCOME MEASURE

Our primary outcome measure is poor discharge communication (PDC), a composite variable of three IHP questions related to written information, doctor follow-up and medicines discussed.

RESULTS

Overall PDC rate was 19.2% (864/4501), although rates varied by nation. PDC was highest in Norway (31.5%) and lowest in the USA (7.5%). Gender, education, income and the presence of at least one chronic disease were not statistically associated with PDC.

CONCLUSIONS

Given the high rate of PDC observed, hospital discharge teams and leadership should carefully examine communication during the hospital discharge process to ensure minimisation of care gaps, particularly regarding medication, since this was the most reported problem.

Increasing Graduate Student Awareness of Cultural Competence Through Bias Exploration Related to Diverse Cultural Families

Emphasis by the American Nurses Association and the American Association of Colleges of Nursing regarding the importance of cultural competence in nursing education led to the development of a strategy to address personal bias in graduate nursing students. With the updated Essentials and a change to competency-based education, a need to address culturally congruent practices while increasing awareness of professional organization recommendations exists. Since Domain 2 of the Essentials highlights that culturally competent care is essential to person-centered care, a strategy that enhances knowledge by expanding the definition of culture beyond ethnicity and race was developed.

Cultural Competence and Nursing Work Environment: Impact on Culturally Congruent Care in Portuguese Multicultural Healthcare Units

BACKGROUND

Cultural competence is central to ensuring effective culturally congruent care to patients and fostering positive work environments, particularly in multicultural settings.

OBJECTIVE

This study aimed to analyse the relationship between cultural competence, the nursing work environment, and the delivery of culturally congruent care in multicultural units of a healthcare organisation in Portugal.

METHOD

This was a quantitative, descriptive, and cross-sectional study, targeting nurses from multicultural units. Data were collected using both online and paper-based questionnaires, which included the Cultural Competence Questionnaire for Help Professionals, the Nursing Work Index-Revised Scale (NWI-R-PT), and a single question assessing nurses' perceptions of the adequacy of the culturally congruent care they provide.

RESULTS

A moderate, positive correlation was identified between cultural competence and the Fundamentals for Nursing, while the nursing work environment was influenced by organisational support, professional category, and unit type.

DISCUSSION

The findings suggest that enhancing cultural knowledge and technical skills and reinforcing management support may positively impact culturally congruent care delivery in multicultural settings.

CONCLUSION

This study contributes to nursing knowledge by highlighting the complex interactions between cultural competence and the work environment in Portuguese multicultural healthcare units. Future research should explore the impact of transcultural nursing leadership on multicultural work environments and in the delivery of culturally congruent care.

Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands

INTRODUCTION

Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands.

METHODS

We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.'s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated.

RESULTS

We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome.

CONCLUSION

The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of professional interpreter costs.

"Trying to write a story together": general practitioners' perspectives on culturally sensitive care

BACKGROUND

Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs.

METHODS

In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses.

RESULTS

Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care.

CONCLUSIONS

This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.

'Creating a culturally competent pharmacy profession': A qualitative exploration of pharmacy staff perspectives of cultural competence and its training in community pharmacy settings

INTRODUCTION

Cultural competence is an important attribute underpinning interactions between healthcare professionals, such as pharmacists, and patients from ethnic minority communities. Health- and medicines-related inequalities affecting people from underrepresented ethnic groups, such as poorer access to healthcare services and poorer overall treatment outcomes in comparison to their White counterparts, have been widely discussed in the literature. Community pharmacies are the first port of call for healthcare services accessed by diverse patient populations; yet, limited research exists which explores the perceptions of culturally competent care within the profession, or the delivery of cultural competence training to community pharmacy staff. This research seeks to gather perspectives of community pharmacy teams relating to cultural competence and identify possible approaches for the adoption of cultural competence training.

METHODS

Semistructured interviews were conducted in-person, over the telephone or via video call, between October and December 2022. Perspectives on cultural competence and training were discussed. Interviews were audio-recorded and transcribed verbatim. The reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Ethics Committee (reference: 25680/2022).

RESULTS

Fourteen participants working in community pharmacies were interviewed, including eight qualified pharmacists, one foundation trainee pharmacist, three pharmacy technicians/dispensers and two counter assistants. Three themes were developed from the data which centred on (1) defining and appreciating cultural competency within pharmacy services; (2) identifying pharmacies as 'cultural hubs' for members of the diverse, local community and (3) delivering cultural competence training for the pharmacy profession.

CONCLUSION

The results of this study offer new insights and suggestions on the delivery of cultural competence training to community pharmacy staff, students and trainees entering the profession. Collaborative co-design approaches between patients and pharmacy staff could enable improved design, implementation and delivery of culturally competent pharmacy services.

PATIENT OR PUBLIC CONTRIBUTION

The Patient and Public Involvement and Engagement group at Newcastle University had input in the study design and conceptualisation. Two patient champions inputted to ensure that the study was conducted, and the findings were reported, with cultural sensitivity.