Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research

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Abstract

Background

Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities.

Objective

The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research.

Design

The authors performed electronic searches in the MEDLINE/PubMed, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included.

Measurements

Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted.

Results

Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect.

Conclusion

There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-010-1529-0) contains supplementary material, which is available to authorized users.

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Most cited references 29

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Association between funding and quality of published medical education research.

Darcy Reed, David A. Cook, Thomas Beckman … (2007)

Methodological shortcomings in medical education research are often attributed to insufficient funding, yet an association between funding and study quality has not been established. To develop and evaluate an instrument for measuring the quality of education research studies and to assess the relationship between funding and study quality. Internal consistency, interrater and intrarater reliability, and criterion validity were determined for a 10-item medical education research study quality instrument (MERSQI). This was applied to 210 medical education research studies published in 13 peer-reviewed journals between September 1, 2002, and December 31, 2003. The amount of funding obtained per study and the publication record of the first author were determined by survey. Study quality as measured by the MERSQI (potential maximum total score, 18; maximum domain score, 3), amount of funding per study, and previous publications by the first author. The mean MERSQI score was 9.95 (SD, 2.34; range, 5-16). Mean domain scores were highest for data analysis (2.58) and lowest for validity (0.69). Intraclass correlation coefficient ranges for interrater and intrarater reliability were 0.72 to 0.98 and 0.78 to 0.998, respectively. Total MERSQI scores were associated with expert quality ratings (Spearman rho, 0.73; 95% confidence interval [CI], 0.56-0.84; P < .001), 3-year citation rate (0.8 increase in score per 10 citations; 95% CI, 0.03-1.30; P = .003), and journal impact factor (1.0 increase in score per 6-unit increase in impact factor; 95% CI, 0.34-1.56; P = .003). In multivariate analysis, MERSQI scores were independently associated with study funding of $20 000 or more (0.95 increase in score; 95% CI, 0.22-1.86; P = .045) and previous medical education publications by the first author (1.07 increase in score per 20 publications; 95% CI, 0.15-2.23; P = .047). The quality of published medical education research is associated with study funding.

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Patient race/ethnicity and quality of patient-physician communication during medical visits.

Debra Roter, M. Johnson, Neil R. Powe … (2004)

We examined the association between patient race/ethnicity and patient-physician communication during medical visits. We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md-Washington, DC-Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient-centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters. Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did. Patient-physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians' patient-centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.

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Cultural competence: a systematic review of health care provider educational interventions.

Aysegul Gozu, Mary Beach, Ana Palacio … (2005)

We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals. This was a systematic literature review and analysis. We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria. We sought evidence of the effectiveness and costs of cultural competence training of health professionals. Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs). Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

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Author and article information

Contributors

: +1-714-4565171 , +1-714-4567984 , dalie@uci.edu

Journal

Journal ID (nlm-ta): J Gen Intern Med

Title: Journal of General Internal Medicine

Publisher: Springer-Verlag (New York )

ISSN (Print): 0884-8734

ISSN (Electronic): 1525-1497

Publication date (Electronic): 16 October 2010

Publication date PMC-release: 16 October 2010

Publication date (Print): March 2011

Volume: 26

Issue: 3

Pages: 317-325

Affiliations

[1 ]Department of Family Medicine, School of Medicine, University of California, 101 The City Drive S, Bldg 200, Ste 512, Orange, CA 92868 USA

[2 ]Albert Einstein College of Medicine of Yeshiva University, New York, NY USA

[3 ]David Geffen School of Medicine at the University of California at Los Angeles School of Medicine, Los Angeles, CA USA

[4 ]Stanford University School of Medicine, Stanford, CA USA

Article

Publisher ID: 1529

DOI: 10.1007/s11606-010-1529-0

PMC ID: 3043186

PubMed ID: 20953728

SO-VID: f19d0b58-70ec-43ea-a3ad-6d49b90e591e

History

Date received : 21 June 2010

Date revision received : 14 September 2010

Date accepted : 20 September 2010

Custom metadata

ScienceOpen disciplines: Internal medicine

Keywords: assessment,health disparities,patient outcomes,cultural competency curriculum

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ScienceOpen disciplines: Internal medicine

Keywords: assessment, health disparities, patient outcomes, cultural competency curriculum

Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research

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Abstract

Background

Objective

Design

Measurements

Results

Conclusion

Electronic supplementary material

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Most cited references 29

Association between funding and quality of published medical education research.

Patient race/ethnicity and quality of patient-physician communication during medical visits.

Cultural competence: a systematic review of health care provider educational interventions.

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