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Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include: Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials.

In order to increase the cultural competence of the health care delivery system, health professionals must be taught how to provide services in a culturally com-petent manner. Although many different types of training courses have been developed across the country, these efforts have not been standardized or incorpo-rated into training for health profession-als in any consistent manner. Important to note, however, is that cultural competence is a process rather than an ultimate goal, and is often developed in stages by building upon previous knowledge and experience.

This approach may lead to stereotyping and may ignore variation within a group, however. For example, the assumption that all Latino patients share similar health beliefs and behaviors ignores im-portant differences between and within groups. Latinos could include first-generation immigrants from Guatemala and sixth-generation Mexican Americans in Texas.

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  3. The population at risk for chronic conditions will become more diverse.
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  5. Racial and ethnic minorities are disproportionately burdened by chronic illness;
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Even among Mexican Americans, differences such as generation, level of acculturation, citizenship or refugee status, circumstances of immigration, and the proportion of his or her life spent in the U. It is almost impossible to know everything about every culture. Therefore, training approaches that focus only on facts are limited, and are best combined with approaches that provide skills that are more universal.

For example, skills such as communication and medical history-taking techniques can be applied to a wide diversity of clientele.

Cultural competence and health care disparities: key perspectives and trends.

Many professional organizations representing a variety of health professionals, such as physicians, psychologists, social workers, family medicine doctors, and pediatricians have played an active role in promoting culturally competent practices through policies, research, and training efforts. For example, the American Medical Association provides information and resources on policies, publications, curriculum and training materials, and relevant activities of physician associations, medical specialty groups, and state medical societies. Several organizations have instituted cultural competence guidelines for their memberships.

For example, based on ten years of work, the Society of Teachers of Family Medicine has developed guidelines for curriculum material to teach cultural sensitivity and competence to family medicine residents and other health professionals. These guidelines focus on enhancing attitudes in the following areas: Accreditation standards are important tools that can have widespread effects on the cultural competence of medical students, health care professionals, and health care organizations.

As a result, medical schools must now provide students with the skills to understand how people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Students must also be able to recognize and appropriately address racial and gender biases in themselves, in others, and in the delivery of health care.

Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. First, there are increasingly more state and federal guidelines that encourage or mandate greater responsiveness of health systems to the growing population diversity. Third, many health systems are finding that developing and implementing cultural competence strategies are a good business practice to increase the interest and participation of both providers and patients in their health plans among racial and ethnic minority populations.

In addition to increasing the cultural competence of health care providers, organizational accommodations and policies that reduce administrative and linguistic barriers to health care are also important. Organizational policies that address language and literacy barriers have been among the most successful efforts. Traditionally, community health centers that serve the Asian American or Latino communities have the most fully developed linguistic capabilities.

Cultural Competence | Mental Health America

When this is not possible, ACRS provides trained staff to act as co-providers with a licensed mental health professional. This national project includes training for interpreters, trainers, and health providers, as well as a mental health interpreter certification process. Within the Latino community, the use of promotoras, also known as peer edu-cators, is becoming increasingly popular. Promotoras are generally ordinary people from hard-to-reach populations who act as bridges between their community and the complicated world of health care.

They learn about health care principles from doctors or non-profit groups, and share their knowledge with their com-munities. The peer education model is not only cost-effective, but also has been shown to be more effective in terms of reaching populations who find the information more credible coming from someone with a familiar background. For example, at the To Help Everyone T.

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Clinic in Los Angeles, nurses and health care professionals speak individually with patients when they arrive at the health clinic to determine whether the patient prefers to learn by using written materials, pictures, verbal counseling, or some other technique. This method of assessment allows the patient to identify their own learning style preference without having to take a literacy test; it also reduces feelings of fear or humiliation that may occur when singled out.

The Department of Health and Human Services has provided important guidance on how to ensure culturally and linguistically appropriate health care services. States that have developed such standards have focused on managed care organizations, contracting agreements with providers, and specific health and mental health services in defined settings. In August , the Health Care Financing Administration now Centers for Medicare and Medicaid Services issued guidance to all state Medicaid directors regarding interpreter and translation services, emphasizing that federal matching funds are available for states to provide oral interpretation and written translation services for Medicaid beneficiaries.

These standards are intended to correct current inequities in the health services system and to make these services more responsive to the individual needs of all patients. They are designed to be inclusive of all cultures, with a particular focus on the needs of racial, ethnic, and linguistic population groups that experience unequal access to the health care system. The CLAS standards provide consistent definitions of culturally and linguistically appropriate services in health care and offer a framework for the organization and implementation of services.

Cultural competence is not an isolated aspect of medical care, but an important component of overall excellence in health care delivery. Issues of health care quality and satisfaction are of particular concern for people with chronic conditions who frequently come into contact with the health care system. Efforts to improve cultural competence among health care professionals and organizations would contribute to improving the quality of health care for all consumers. Betancourt, J. Cultural competence in health care: Emerging frameworks and practical approaches.

New York: The Commonwealth Fund. Collins, K. Edwards, J. Diverse communities, common concerns: Assessing health care quality for minority Americans. Druss, B. The most expensive medical conditions in America. Health Affairs, 21, Given the lack of specific and agreed-upon terms that capture cultural competence and the priority populations, and the diffused state of the literature, we will approach the search process strategically, using both inductive and deductive approaches.

We will also iteratively return to bibliographic databases to search the literature as new terms are uncovered or new relevant interventional approaches are discovered. As bibliographic database searches are completed for each priority group, we will review the search results for studies relevant to our PICOTS framework and study-specific criteria. The literature set identified at this phase will be examined from a content analysis perspective for emerging themes. Focused searches will then be developed to specifically search for further examples of that intervention theme in the literature.

Search results will be downloaded to EndNote. All studies identified as relevant by either investigator will undergo full-text screening. Two investigators will independently screen full text to determine if inclusion criteria are met. Differences in screening decisions will be resolved by consultation between investigators, and, if necessary, consultation with a third investigator.

We will document the inclusion and exclusion status of citations undergoing full-text screening. Throughout the screening process, team members will meet regularly to discuss training material and issues as they arise to ensure consistency of inclusion criteria application. Bibliographic database searches will be supplemented with backward citation searches of highly relevant systematic reviews. We will also share search results with the TEP for ask for themes which may have been missed in the initial searches.

We will conduct additional grey literature searching to identify other search efforts into the priority populations or cultural competence for further MeSH or natural language keyword search terms. Relevant grey literature resources include trial registries and governmental or research organizations. We will search ClinicalTrials.

Studies meeting inclusion criteria will be distributed among investigators for data extraction.

Health Literacy and Cultural Competency

One investigator will extract relevant study, population demographics, and outcomes data. Data fields to be extracted will be determined based upon proposed summary analysis. These fields will include author, year of publication; setting, author definition of cultural competence, subject inclusion and exclusion criteria, intervention and control characteristics intervention definition and components, timing, frequency, duration, fidelity , followup duration, participant baseline demographics, enrollment, descriptions and results of primary outcomes and adverse effects, and study funding source.

Relevant data will be extracted into extraction forms created in Excel. Evidence tables will be reviewed and verified for accuracy by a second investigator.

Bibliographic Information

We will use data from relevant comparisons in previous systematic reviews to replace the de novo extraction process when the comparison is sufficiently relevant. Data elements abstracted from included systematic reviews, whether the elements are at the individual study or systematic review levels, will depend on how the systematic review will be used. Use may range using individual elements to updating a review, to using the review without modification. Only systematic reviews that assess included study risk of bias will be assessed for review quality.

Systematic reviews with fair or good methodology will be used. Systematic reviews that are deemed to have potential author conflict of interest, such as due to reviewing a body of literature to which the authors had substantially contributed, will be subjected to random quality checks of 10 percent of included study data abstraction. Risk of bias of eligible studies will be assessed using instruments specific to study design. The seven domains included in this tool include sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data i.

Additional items will be developed to assess potential risk-of-bias not addressed by the Cochrane tool. Outcomes measurement issues inherent in the psychometric properties of the questionnaires used to measure outcomes and assessment methods used to detect change in those questionnaire results will be specifically evaluated for detection bias.

Additional items may be necessary to evaluate potential risk-of-bias associated with treatment definition and implementation treatment fidelity. Specific study methodology or conduct will be used to judge potential risk of bias with respect to each domain following guidance in the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.