Health workforce cultural competency interventions: a systematic scoping review

Abstract

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

Addressing ethnic disparity in antenatal care: a qualitative evaluation of midwives’ experiences with the MAMAACT intervention

“…Previously, the term cultural competence has been misused with a static understanding of culture [36]. In a recent review of health workforce cultural competency interventions, such an interpretation of culture was considered as categorical cultural competence and it was criticised for potentially increasing cultural misunderstandings [37]. Nonetheless, cross-cultural approaches to cultural competence interventions were identified as having a focus on training general knowledge, attitudes and skills that are relevant to navigate in cross-cultural interactions [37].…”

“…In a recent review of health workforce cultural competency interventions, such an interpretation of culture was considered as categorical cultural competence and it was criticised for potentially increasing cultural misunderstandings [37]. Nonetheless, cross-cultural approaches to cultural competence interventions were identified as having a focus on training general knowledge, attitudes and skills that are relevant to navigate in cross-cultural interactions [37]. Furthermore, the cross-cultural approach was found to have positive effects on the attitudes, knowledge and skills of healthcare providers, indicating that using the cultural competence framework in the training of midwives may have been a suitable approach.…”

“…Furthermore, the cross-cultural approach was found to have positive effects on the attitudes, knowledge and skills of healthcare providers, indicating that using the cultural competence framework in the training of midwives may have been a suitable approach. However, for stronger evidence on the value of cultural competence interventions, there is a need for further development of methods that can be used to measure the effect of these interventions on healthcare provision as well as health outcomes [37,38].…”

Electronic health record year and country of birth testing and patient navigation to increase diagnosis of chronic viral hepatitis

“…Although identification and testing of patients can be automated, a need exists to report the result to the patient's healthcare provider, or the patient in a culturally competent manner. 22 In this regard, patient navigators (PNs) have been shown to be useful in assisting patients obtain and keep appointments with a treating physician. This is referred to as linkage to care (LTC).…”

“…Using these two simple structured data elements in an EHR combined with smart algorithms, patients can be identified to determine whether HCV and/or HBV testing is indicated. Although identification and testing of patients can be automated, a need exists to report the result to the patient's healthcare provider, or the patient in a culturally competent manner . In this regard, patient navigators (PNs) have been shown to be useful in assisting patients obtain and keep appointments with a treating physician.…”