BACKGROUND
OBJECTIVES
METHODS
Data Sources and Searches
(cultural competence OR cultural competency OR cultural diversity OR cultural diversities OR health disparities OR health disparity) AND (training OR curriculum OR teaching) AND (patient outcomes OR outcome assessment OR health care quality assurance) AND (professional patient relations OR patient compliance OR patient adherence OR patient satisfaction OR patient cooperation).
Study Selection and Data Extraction
Data Synthesis and Analysis
RESULTS
Search Results and Data Abstraction
Qualitative Synthesis of Selected Studies
Author (year) | Learner and site characteristics (N) | Study design | Theory in curriculum | Teaching methods | Duration of durriculum | Study duration |
---|---|---|---|---|---|---|
Wade (1991) | Female psychology counselors8; single outpatient site | Quasi-randomized controlled trial of a convenience sample | Pederson's triad model of cross-cultural counseling | Racial and class influences in psychological care, and how black patients' attitudes affect sessions, with role-play component | 4 h of cultural sensitivity training | Not reported |
Mazor (2002) | Pediatric emergency department faculty9; single hospital | Pre/post field study: Convenience sample of self-selected physicians | Medical Spanish language and Latino culture training | Medical Spanish course emphasizing medical history taking and Hispanic cultural beliefs | 2 h per week for 10 weeks | 4.5 months (1 month for pre- and post-intervention data collection) |
Way (2002) | Staff and mental health professionals (~3,700); 20 state inpatient sites | Pre/post field study of required training | New York Office of Mental Health Core Curriculum Manual | Six modules: team building, change, recipient recovery, cultural competence, clinical issues, and safe therapeutic environment | 3 days | Training sequenced over 2 years by site |
Majumdar (2004) | Nurses/home health care workers (114 baseline, 76 final); 2 agencies, 1 hospital | Quasi-randomized study of self-selected participants | ‘Cultural sensitivity training’ | Curriculum content and methods not reported | 36 h over 3 months | 18 months |
Thom (2006) | Primary care physicians (53); four practice sites within single health system | Cluster randomized controlled trial (2 sites intervention, 2 sites control) | L-E-A-R-N (Listen, Engage, Acknowledge, Respect, Negotiate) model | Three interactive and experiential modules on: cultural knowledge, cross-cultural communication; use of interpreters and cultural brokering | Intervention group: 4.5-h block or 3- session curriculum with feedback | 6 months |
Control group: feedback only | ||||||
McElmurry (2009) | Providers and students of allied health professions (386); multisite, outpatient, single health system | Pre/post field study: Convenience sample of self-selected professionals and students | Not reported | Spanish immersion and cultural workshops to increase awareness of barriers to care experienced by limited English proficiency (LEP) patients | 8-week Spanish language series or 3-week Spanish immersion program | 3 years |
Sequist (2010) | Primary care clinicians-physicians, nurse practitioners and physician assistants (124); 8 sites, single health system | Cluster randomized controlled trial | Off-site negotiated program addressing trust/bias; disparities; skills to improve cross-cultural care | Mix of didactic lectures, group discussions, and community engagement activities with monthly clinician-level performance feedback on race-stratified patient outcomes (for HBA1C, cholesterol and blood pressure) | 2 days (for nurse practitioners and physician assistants); 1 day (for physicians) | 12 months |
Author (year) | Patients and clinical characteristics (N) | Patient outcomes measures | Timing of patient assessments | Impact on patient outcomes | Effecta
| Qualityb
| Qualityc
|
---|---|---|---|---|---|---|---|
Wade (1991) | Black female patients receiving mental health counseling (80 at baseline; 48 final) | Patient perceptions of counseling and of counselors, including bias (validated tools: Revised Barrett-Lennard Relationship Inventory and Counselor Effectiveness Scale) | Administered after each of 3 visits (mailed in) after counselor training, duration not reported | Patients reported modestly superior counseling skills and cultural sensitivity of intervention counselors; patient clinic attrition rates lower for intervention counselors | + | Low | Low |
Mazor (2002) | Latino emergency room patients' family (143); diagnoses not reported | Patient family satisfaction questionnaires (5-point Likert scale, validated) | Baseline (n = 85) and 4 weeks after physician training (n = 58); 90% response rate | Physician training associated with increased family satisfaction (ORs 2.1 to 3.0) and decreased utilization of professional interpreters (OR 0.34) | ++ | Mod d
| Mod |
Way (2002) | Selected mental health inpatients from 3 hospitals (77) | Consumer questionnaire and Ward Atmosphere Scale | Baseline and 12–15 weeks post-provider training | Patients reported greater perceived environmental changes favoring their interests and 'ethnic affinity' toward staff | Unable to assess | Low | Low |
Majumdar (2004) | European and British patients receiving home and hospital care (from baseline 133 to 37 final); diagnoses not reported | Self-reported satisfaction, resourcefulness, access to services, mental and physical health and activities of daily living (multiple validated tools, e.g., Health and Social Services Utilization Questionnaire) | Selected patient data collected at baseline, 3, 6, 9 and 12 months (response rates for each interval and scale not reported) | No impact of provider training on patient satisfaction, activities of daily living or resource utilization; modest improvement in patient use of social resources and functional capacity | 0/+ | Mod | Mod |
Thom (2006) | White, Latino, black and Asian patients with diabetes and/or hypertension (429) | Patient trust and satisfaction questionnaires, clinical measures (weight, systolic blood pressure, HbA1c) | Baseline and 6 months | No measurable impact of physician training on disease-specific outcomes or patient-reported physician cultural competence over 6 months | 0 | Mod | Mod |
McElmurry (2009) | Latino patients with type 2 diabetes (1994) | Patient HbA1c, self-care behaviors; provider perception of communication | Timing of patient data collection not reported | Providers reported improved patient communication. Positive impact on self-care behavior and HbA1c attributed to community health workers and not provider training | Unable to assess | Low | Low |
Sequist (2010) | 2,699 black and 4,858 white patients with type 2 diabetes | Disparities reduction for black patients, for outcomes of HbA1c, LDL cholesterol and blood pressure control | Baseline and 12 months | No impact of team training on disparities as measured by clinical indicators of diabetes care for black compared with white patients | 0 | Mod | Mod |