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Cultural Competence Training
Allison, Kevin W; Echemendia, Ruben J; Crawford,
Isiaah; Robinson, W. LaVome. Training and work experience with clients from diverse groups were examined among 266 recent PhDs in counseling and clinical psychology. Surveys were mailed to 600 participants who completed their graduate work between 1985 and 1987. Analyses examined which training variables predicted self-rated competence in providing services to various cultural groups. Results indicated that most therapists reported competence in working with diverse clients, but there was notable variability among ratings of therapists' self-perceived competence with different client groups. Exposure during training to working with clients from specific cultural groups was important in predicting therapists' current perceived competence. Most respondents reported accessing education and training experiences in providing services to diverse client groups. A small but troubling number of respondents reported seeing clients despite reporting low levels of competence with that client group. Copeman RC. In spite of evidence of poor communication between Aboriginal patients and doctors, there are few reports of educational efforts to overcome this problem. This paper describes a brief teaching programme for fourth-year medical students that was aimed at improving their knowledge of, and attitudes towards, Aboriginal and migrant patients. It comprised a lecture, a clinical contact with an Aboriginal or migrant patient, and a tutorial. Evaluation of the programme by the "before-and-after" measurement of student attitudes and knowledge showed a modest improvement in some attitudes, although there was an increased tendency to see all Aborigines as the same. Students' knowledge improved in one of the areas that were tested but not in the other. Teaching in this area could be improved further by more clinical contacts, videotaped consultations, and a student log-book. Culhane-Pera KA. Like RC. Lebensohn-Chialvo P.
Loewe R. Background And Objectives: In 1985, results from a national survey indicated that 25% of family practice residencies taught about multicultural issues in their programs. Our current study identified the current status and content of the curricula and determined facilitating and impeding factors to multicultural curricula.
Methods: In 1998, the Society of Teachers of Family Medicine's Group on Multicultural Health Care and Education conducted a cross-sectional mail survey of all 476 family practice residency programs.
Results: With a 59% response rate, 58% of responding programs have an informal curriculum on multicultural issues, 28% have a formal curriculum, and 14% have no curriculum. Programs with a formal curriculum teach more content, employ more educational methods, use more evaluation techniques, and feel more successful than programs with an informal curriculum. Important factors that facilitate curricula include cultural diversity of communities and residents, multicultural interests of faculty and residents, and faculty's multicultural expertise. Factors that impede curricula include lack of time, money, resources, faculty expertise, and cultural diversity in the community. Programs with formal, informal, and no curriculum identify different facilitators and impediments.
Conclusion: There was a marked increase in the prevalence of multicultural curricula in family practice residencies from 1985 to 1998. Culhane-Pera KA. Reif C. Egli E. Baker NJ. Kassekert
R. Background And Objectives: To deliver effective medical care to patients from all cultural backgrounds, family physicians need to be culturally sensitive and culturally competent. Our department implemented and evaluated a 3-year curriculum to increase residents' knowledge, skills, and attitudes in multicultural medicine. Our three curricular goals were to increase self-awareness about cultural influences on physicians, increase awareness about cultural influences on patients, and improve multicultural communication in clinical settings. Curricular objectives were arranged into five levels of cultural competence. Content was presented in didactic sessions, clinical settings, and community medicine projects. Methods and Results: Residents did self-assessments at the beginning of the second year and at the end of the third year of the curriculum about their achievement and their level of cultural competence. Faculty's evaluations of residents' levels of cultural competence correlated significantly with the residents' final self-evaluations. Residents and faculty rated the overall curriculum as 4.26 on a 5-point scale (with 5 as the highest rating). Conclusion: Family practice residents' cultural knowledge, cross-cultural communication skills, and level of cultural competence increased significantly after participating in a multicultural curriculum. Edwards, S. L. Abstract: This study evaluates the effectiveness of the presented educational model on graduate social workers' cultural competence. This study also examines the most effective ways to teach culturally sensitive material, using a developmental model that considers racial identity and the relationship to social work education. This quasi-experimental sample consisted of 48 advanced standing MSW students at a Southern university in the summer of 1997. There were 41 women and seven men in the sample. There were 25 White students and 12 African American students. The age range was from 21 to 51. All participants completed D'Andrea, Daniels, & Heck's (1991) Multicultural Awareness, Knowledge, and Skills Survey at the beginning and at the end of the course. The study group participated in the presented educational model, and the comparison group participated in a traditional teaching format that generally stresses the knowledge component. The study group also completed Janet Helm's Social Identity Scales (1990) during the course. A second design included students' and instructor's journals, This qualitative representation hopefully provides a better understanding of the quantitative data. The students who received the affective educational model displayed significantly greater improvement in the competency area of awareness than students who did not receive the intervention. A positive correlation was also shown between some racial identity stages and cultural competency scores. The exercises gave the students the opportunity to think about how their personal identity in terms of race, gender, ethnicity and, sexual orientation might influence their practice. The journal entries also gave the students the opportunity to describe the interventions and the impact that it had on them. This study offers empirical research in determining the effective teaching strategies for improved multicultural competence, highlighting affective components. The data strongly suggests that only through enhanced educational experiences will students become culturally competent, and only through that improved cultural competence will services be delivered to clients in culturally acceptable ways. Farnill D. Todisco J. Hayes SC. Bartlett D. In a multicultural society such as Australia, with over 20% of its population born overseas, interpreters are often required to facilitate medical interviews. However, where a patient has some proficiency in English, medical interviews are sometimes conducted across the boundaries of culture and language. This is a report of an educational innovation to teach interviewing skills to pre-clinical medical students with the assistance of volunteers of non-English-speaking backgrounds. Pre-clinical students interviewed community volunteers on topics of general life history in a sequence of 16 tutorials. Each student conducted two interviews. Teaching methods included feedback from the volunteers, tutorial discussion facilitated by playback of videotapes, and modelling of skills by the teachers. Evaluations by volunteers and students indicated high satisfaction with the teaching methods and outcomes. Students gained confidence in interviewing people from different cultures. Evaluation of students' pairs of videotapes by an independent rater achieved satisfactory reliabilities and indicated significant gains in inquiry skills and the communication of positive attitudes. Skills in communicating empathy and in using simple language did not improve measurably. Flores G. Gee D. Kastner B. Purpose Despite the importance of culture in health care and the rapid growth of ethnic diversity in the United States and Canada, little is known about the teaching of cultural issues in medical schools. The study goals, therefore, were to determine the number of U.S. and Canadian medical schools that have courses on cultural issues, and to examine the format, content, and timing of those courses. Method: The authors contacted the deans of students and/ or directors of courses on cultural issues at all 126 U.S. and all 16 Canadian medical schools. Using a cross-sectional telephone survey, they asked whether each school had a course on cultural sensitivity or multicultural issues and, if so, whether it was separate or contained within a larger course, when in the curriculum the course was taught, and which ethnic groups the course addressed. Results: The response rates were 94% for both U.S. (118) and Canadian (15) schools. Very few schools (U.S. = 8%; and Canada = 0%) had separate courses specifically addressing cultural issues. Schools in both countries usually addressed cultural issues in one to three lectures as part of larger, mostly preclinical courses. Significantly more Canadian than U.S. schools provided no instruction on cultural issues (27% versus 8%; p = .04). Few schools taught about the specific cultural issues of the largest minority groups in their geographic areas: only 28% and 26% of U.S. schools taught about African American and Latino issues, respectively, and only two thirds of Canadian schools taught about either Asian or Native Canadian issues. Only 35% of U.S. schools addressed the cultural issues of the largest minority groups in their particular states. Conclusions: Most U.S. and Canadian medical schools provide inadequate instruction about cultural issues, especially the specific cultural aspects of large minority groups. Freed, JR Executive Summary: Sociocultural factors present significant barriers to dental health care for members of minority groups in the United States. With this grant from The Robert Wood Johnson Foundation, The University of California, Los Angeles (UCLA), School of Dentistry has developed a set of educational materials – six videotapes and accompanying instructor's manuals – designed to teach dental students, faculty, and practitioners how to effectively communicate with a culturally diverse population. These materials include one videotape with 25 stimulus vignettes – short statements based on actual experiences – featuring actors from a variety of racial/ethnic groups, and five videotapes using the Interpersonal Process Recall (IPR) method of instruction. The IPR tapes were developed by recording the initial encounter / interview of patients by dentists, who then each separately viewed and commented on the tape; these recalls were then edited back into the initial encounter. An instructor's manual was prepared for each videotape. These educational materials were presented at the American Association of Dental Schools' conference in March 1996. They are currently being used in a 20-hour "Culture and Health" required course at UCLA School of Dentistry, in a communications course at the dental school at the University of Colorado, and in a faculty development program at the dental school of the University of Michigan. Litrownik AJ. Elder JP. Campbell NR. Ayala GX.
Slymen DJ. Parra-Medina D. Zavala FB. Lovato CY.
Methods: A total of 660 Hispanic migrant families participated
in a randomized pre-post control group study that was utilized to determine
the impact of the intervention on parent-child communication. Both treatment
and attention-control groups of youth were exposed to an eight-session
culturally sensitive program presented by bilingual/bicultural college
students. Parents jointly attended three of the eight sessions and participated
in helping their child complete homework assignments supporting the content
of each session. The content of the treatment intervention included (1)
information about tobacco and alcohol effects, (2) social skills training
(i.e., refusal skills), and (3) the specific development of parent-child
communication skills to support healthy youth decisions. Results: Significant intervention by household size interactions
for both parent and youth perceptions of communication were found indicating
that the treatment was effective in increasing communication in families
with fewer children. Based on the effect size and the previously established
relationship between communication and susceptibility to tobacco and alcohol
use, it was determined that the intervention effect could be translated
into a future 5 to 10% decrease in susceptibility for these smaller families.
Conclusions: A culturally sensitive family-based intervention for migrant Hispanic youth was found to be effective in increasing perceived parent-child communication in families with fewer children. It is expected that increases in this important protective factor will lead to later observed decreases in tobacco and alcohol use. Mala TA. Gottlieb KL. Purpose: To design a health care program that allows Alaska Natives to receive culturally appropriate health services in their homes, thus avoiding the trauma of institutionalization and significantly increasing the quality of the patient's life during the course of the treated illness. Method: Utilizing the culturally appropriate sensitivity that is found within Tribal Health Corporations, Southcentral Foundation is designing a federally based community health care model to bring health support services into the patient's home. Health Aides and Community Health Representatives play an important role in extending this model into an urban community setting. The cost of care is significantly reduced, as it is more cost-effective to keep patients in their own home environments rather than in institutions. Results: Major outcomes for patients are increased cultural sensitivity to their needs, personal comfort, dignity, and care in their own home surroundings. Outcomes for the federal care system are significant savings and more efficient personalized health care Marin G. Marin BV. Perez-Stable EJ. Sabogal F.
Otero-Sabogal R. Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period. Marin G. Perez-Stable EJ.
Purpose: Our goal was to evaluate the effectiveness of the Programa
Latino Para Dejar de Fumar (PLDF) in disseminating smoking-cessation information
in San Francisco's Latino community. Methods: Annual cross-sectional telephone surveys were conducted
from 1986 to 1993 of Latino adults, 18-65 years of age, living in census
tracts with at least 10% Latinos. Surveys in 1986 and 1987 formed the
base line for comparison of PLDF effects. Results: Awareness of a Hispanic smoking-cessation program (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.09-1.14), awareness of PLDF specifically (OR = 1.14; 95% CI = 1.10-1.17), awareness of available printed information to help smokers quit (OR = 1.09; 95% CI = 1.06-1.12), and having a copy of the Guia Para Dejar de Fumar (OR = 1.09; 95% CI = 1.05-1.14) were significantly associated with year of survey. In addition, those same variables were significantly associated with a lower acculturation score (respective ORs = 3.95, and 95% CI = 3.57-4.37; OR = 5.40, and 95% CI = 4.86-6.01; OR = 0.63, and 95% CI = 0.58-0.69; and OR = 4.54, and 95% CI = 3.89-5.30). Women were more likely than men to report awareness of a Hispanic smoking-cessation program (OR = 0.88; 95% CI = 0.81-0.96), awareness of PLDF (OR = 0.84; 95% CI = 0.77-0.92), and awareness of available printed information (OR = 0.78; 95% CI = 0.72-0.85). Cigarette-smoking prevalence decreased from 1986 through 1990, stabilized in 1991, and appeared to increase among all groups in 1993. Prevalence of smoking cessation remained stable overall, but it showed a steady increase among less acculturated respondents. CONCLUSION: We conclude that a culturally appropriate community intervention to promote nonsmoking can be successful at disseminating information about smoking cessation. Latino community norms about smoking are evolving, leading to decreased social acceptability. Mattson S. Lew L. Objective: To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing. Design: Survey through questionnaires administered as interviews. Setting: In clients' homes or via telephone. Participants: 119
women from SEAHP's case files of recently delivered clients. Measurements
and Main Results: Interviews were conducted by four community workers
fluent in Cambodian or Lao. The majority of women were satisfied with
SEAHP, particularly the interpretation and education in native languages.
Women were also satisfied with SEAHP, encouraging others to seek care.
Conclusions: SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services. (14 ref) McAvoy BR. Raza R. Objectives: To determine the effects of three different methods of providing health education on the uptake of cervical smear testing among Asian women, and to evaluate the acceptability of different health education materials. Design: Prospective cohort study over one year of effects of written materials by post, personal visit to give written materials, and personal visit to show a video on the uptake of smear testing. Techniques included a personally administered questionnaire. Setting: Leicester, a city with a large Asian population. Subjects: 737 randomly selected Asian women aged 18 to 52 who were not recorded on the central cytology laboratory's computer as ever having had a cervical smear test. 159 declined to participate or were not contactable. Interventions: Women were randomised into four groups: visited and shown a video (263), visited and shown a leaflet and fact sheet (219), posted a leaflet and fact sheet (131), not contacted at all (124). Main Outcome Measures: Cervical smear test recorded on computer within four months after intervention. Results: 57 (37%, 26% of group) of the women visited and given leaflets and 80 (47%, 30% of group) shown the video attended for cervical smears. Only six (5%) of those who were not contacted and 14 (11%) of those sent leaflets had a smear test during the study. Conclusion: Health education interventions increased the uptake of cervical cytology among Asian women in Leicester who had never been tested. Personal visits were most effective irrespective of the health education materials used, but there was some evidence that home viewed videos may be particularly effective in one of the most hard to reach groups: Urdu speaking, Pakistani Moslems. Written translated materials sent by post were ineffective. McPhee SJ. Bird JA. Davis T. Ha NT. Jenkins CN.
Le B. Introduction: We investigated barriers to breast and cervical
cancer screening among Vietnamese women in San Francisco and Sacramento,
California. Methods: Face-to-face interviews were conducted in 1992 of 306
Vietnamese women in San Francisco and of 339 women in Sacramento. Results: In both communities, only about one half of Vietnamese
women had ever had routine check-ups, clinical breast examinations, mammograms,
and Pap smear tests, and only about one third were up-to-date for these
screening examinations. Among women age 40 or older, 35% had never even
contemplated having a mammogram. This study identified several significant
barriers to recognition, receipt, and currency of screening tests. Negative
predictors of test recognition included low level of education and not
having a regular physician. Negative predictors of test receipt included
low level of education, not having a regular physician, short duration
of residence in the United States, and never having been married. A major
negative predictor of test currency was low level of education. With a
few exceptions, attitudes and beliefs generally were not important predictors.
Conclusions: Health education and screening programs for early breast and cervical cancer detection among Vietnamese women must be culturally appropriate and conducted in the Vietnamese language. Special outreach efforts are needed to assist recent immigrants in obtaining recommended breast and cervical cancer screening examinations. Michielutte R. Sharp PC. Dignan MB. Blinson K. Cancer is the third-leading cause of death among American Indians. The persistent disadvantage in cancer survival rates among American Indian populations emphasizes the importance of developing effective cancer control programs for prevention and early detection. However, substantial cultural differences between American Indians and whites can affect the success of these programs. This paper examines the concept of cultural sensitivity in the context of developing cancer control programs for American Indian populations. It explores fundamental differences in beliefs, behaviors, and values between American Indian and white majority cultures, and presents examples of culturally sensitive health education programs. The paper highlights insights and experiences gained in developing the North Carolina Native American Cervical Cancer Prevention Project, and gives recommendations for the development of future programs. Miano LY. Rojas MS. Trujillo M. Purpose: The United States Hispanic population has tripled since the mid-1950s and is projected to be the largest growing segment of the population through the year 2000. The traditional support group model has not been effective in reaching this population. Healthcare professionals must become innovative to better understand and provide programs for Spanish-speaking cancer patients. Description of Project: At the M.D. Anderson Cancer Center, a
group program titled "Platicas y Merienda" was developed that derived
from several group modalities: education, social, and peer support. The
program is coordinated and facilitated by Spanish-speaking social workers
and uses other professionals within the institution as speakers to promote
a multidisciplinary approach to providing support services. Findings: Participants experienced an increased sense of social and emotional well-being, expanded their knowledge of health-related information, and became aware of other services and benefits available to them. Clinical Implications: During this time of change in the healthcare environment, innovation in clinical practice and program development is necessary to address the needs of the growing Hispanic population. (8 ref) Naish, J., J. Brown, et al.
Design: Qualitative study by means of focus group discussions between October 1993 and March 1994. Setting: East London Subjects: Non-health specific established community groups and specially convened groups of Bengali, Kurdish, Turkish, Urdu and Punjabi, and Chinese speaking women. Conclusion: Contrary to popular belief among general practitioners in east London, women from ethnic minorities are enthusiastic about cervical cytology screening once they understand the purpose of the test and the call and recall procedures. It is possible to consult with community groups in their own language through focus group discussions, working with bilingual health advocates who have had a short practical training in facilitating small group discussions. This form of user consultation could be carried out focussing on other aspects of health promotion. Nevid JS. Javier RA. Purpose: The Purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition. Design: Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals. Setting. The study was based in predominantly Hispanic neighborhoods in Queens, New York. Participants. Ninety-three Hispanic smokers participated: 48 men and 45 women. Intervention: The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls. Measures: Smoking outcomes were based on cotinine-validated abstinence and self-reported smoking rates. Predictors of abstinence were examined, including sociodemographic variables, smoking history, nicotine dependence, acculturation, partner interactions, reasons far quitting, self-efficacy, and linguistic competence. Results: Significant group differences in cotinine-validated abstinence rates in favor of the multicomponent group were obtained, but only at posttreatment. With missing data included and coded for nonabstinence, validated abstinence rates at posttreatment were 21% for the multicomponent group and 6% for the self-help group. At the 6-month follow-up, the rates were 13% for the multicomponent group and 9% for the self-help group. By the 12-month follow-up the rates declined to 8% and 7% for the multicomponent and self-help groups, respectively. A dose-response relationship between attendance at group sessions and abstinence status was shown at posttreatment and 6-month follow-up intervals. Conclusions: The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control. (37 ref) Nevid JS. Javier RA. Moulton JL 3rd. Factors predicting participant attrition in a community-based, culturally specific smoking-cessation program enrolling 93 Hispanic smokers were examined. Analysis of univariate predictors showed noncompleters (n = 18) to have lower incomes, to have expressed greater initial confidence in their ability to stop smoking, and to have perceived themselves to be in poorer general health and poorer health in relation to peers, than completers. Noncompleters were also more likely to have reported cardiovascular problems. Multivariate logistic regression analysis showed that confidence in stopping smoking, health compared with that of peers, and reported cardiovascular problems contributed significantly to prediction while controlling for other significant univariate predictors. The results are discussed in terms of factors that might mitigate premature termination in community-based smoking-cessation interventions targeting Hispanic smokers. Rubin, Deborah Block. Children with serious emotional difficulties often receive services from disparate service sectors. Case management services for these children and their families can provide coordination of care, support parents and help children remain at home. This study examined parent satisfaction with case management services and parents' perceptions of the cultural competence of their children's case managers. One hundred forty-six randomly selected parents of children with extensive mental health needs were interviewed. Twenty-six additional families receiving services from an agency providing intensive case management services were also interviewed. All families received medical assistance for some or all of their child's treatment. New measures of case management satisfaction and cultural competence were administered and required parents to rate specific aspects of satisfaction and cultural competence on a 1 to 5 scale, Interviews also included five measures of child and family functioning. Summary scores from these measures were used to construct a severity index. Case management services were categorized for all respondents as either 'traditional' or 'intensive'. Results from the study showed that mothers of children who were employed were significantly more satisfied with case management services than those who were not employed. Other demographic variables were not significant. Parents receiving intensive case management were more satisfied than those receiving traditional case management when controlling for demographic variables and functional status of the child and the family. Cultural competency scores were significantly related to overall satisfaction scores and intervened in the relationship between type of case management and parent satisfaction. There appeared to be conceptual overlap in the instruments used to measure satisfaction and cultural competency. Cultural competency appears to be difficult to operationalize as a discreet concept although racial match of the parent and case manager was significantly related to cultural competency but not satisfaction scores. No relationship was found between functional status and type of case management suggesting that children receive case management services for reasons other than severity of their or their families' problems. Further research is needed to determine who receives intensive case management and to refine measures of cultural competency. Shapiro J. Simonsen D. Experiences and observations based on an ongoing parent education-support group for Mexican-origin Latino parents of children with Down syndrome were described. Culturally mediated concepts were discussed in terms of their relevance to specific aspects of group functioning, including group structure, membership, and leadership. Problems of particular concern to this population that might adversely affect maintenance and growth of the group were also examined. Finally, the potential value of such support groups for this parent population were considered as were guidelines for enhancing the group experience. [References: 35] Shintani T. Beckham S. O'Connor HK. Hughes C.
Sato A. The Waianae Diet Program (WDP) is a community-based program designed at the Waianae Coast Comprehensive Health Center in response to the high rates of obesity and chronic disease among Native Hawaiians. Its foundation is a 3-week program of traditional Hawaiian diet and cultural teachings. It employs 8 innovations in clinical nutrition and health promotion theory:
It has demonstrated significant weight loss with no calorie restriction, improvement in blood pressure, serum glucose, and serum lipids. It appears to have wide acceptance in the Hawaiian community. More studies are warranted to determine the long-term effect of this program. Soto Mas FG. Kane WM. Going S. Ford ES. Marshall
JR. Staten LK. Smith JE. Despite the popularity and widespread use of theory in health education, practitioners still find it difficult to design and implement theory-based interventions. This is especially true when working with ethnic/racial minority groups, including Hispanic groups. Practitioners working with Hispanic communities face additional barriers that may often discourage them from using theories when planning interventions. These barriers include the diversity that exists within the Hispanic population, lack of reliable data, and issues related to cross-cultural applicability of current behavior theories. However, the use of theory constitutes a valuable tool for developing more effective programs, and theorist researchers should be more sensitive to practitioners' needs. By explaining the processes for selecting and applying theory in the same detail as outcome results, researchers will contribute to increasing practitioners' interest in theory. This article describes Camine con Nosotros, a theory-based physical activity program for Hispanic women, and explains the process of selecting the theoretical framework of the program and connecting theory and practice. (64 ref) Stevenson HC, Gay KM, Josar L Video education is the most popular and effective medium for informing the adolescent population. This study investigated the impact of a culturally relevant HIV/AIDS video education. One hundred and ninety-four African-American teenagers were assigned to either a culturally sensitive or culturally dissimilar video education intervention. Results indicate that both interventions were effective in increasing AIDS knowledge scores. An interaction effect was found between levels of perceived AIDS risk knowledge and participation in the culturally sensitive intervention (CSV). Only the CSV intervention was effective with adolescents who claimed to "know a lot" about AIDS (e.g., "Know-It-All" subgroup). Students in both conditions who were worried about getting AIDS demonstrated higher AIDS risk knowledge at post-assessment. This study provides further evidence of within-ethnicity diversity among African-American youth and for developing culture- and subgroup-specific HIV/AIDS education. Stillman FA, Bone LR, Rand C, Levine DM, Becker
DM Background: This article provides a descriptive overview of the implementation process of the Heart, Body, and Soul program. The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African-Americans in East Baltimore. Method: This study constitutes a prospective randomized trial among inner-city African Americans designed to improve quit rates among church attenders. A random-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking, examine attendant attitudes, and determine the presence of known cardiovascular risk factors among community residents of the catchment area. A similar survey was conducted among churchgoers to establish a baseline. Twenty-two churches were recruited and randomly assigned to either intensive or minimal (self-help) intervention strategies. Baseline health screenings were held in all participating churches. Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches. Results: Pastors of all churches were directly involved in all aspects of the planning and implementation process. A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches. An additional 272 church members were trained to conduct their church's health screenings. Conclusion: The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies. This description of the project is presented to assist others involved in church-based trials in urban African American communities. Sung JF. Blumenthal DS. Coates RJ. Williams JE.
Alema-Mensah E. Liff JM. Introduction: We conducted a randomized controlled trial to determine if an in-home educational intervention conducted by lay health workers (LHWs) could increase adherence among low-income, inner-city, African-American women to breast and cervical cancer screening schedules. Methods: We recruited 321 African-American women from diverse
inner-city sources. After baseline interviews, they were randomly assigned
to either the intervention (n = 163) or the control (n = 158) group. Those
in the intervention group were visited in their homes up to three times
by LHWs who provided a culturally sensitive educational program that emphasized
the need for screening. Results: Ninety-three (93) women in the intervention group and
102 in the control group completed the postintervention interview. For
Pap smears, the increase in screening was similar in both groups. For
clinical breast exams (CBEs), however, there was a modest increase in
the intervention group. The improvement was greatest for mammography,
for which there was a 10% to 12% increase. Among women who were not on
recommended schedules at baseline, the improvement was substantial and
greater in the intervention group. Conclusions: LHWs' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms, but had no effect on Pap smears. A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention. Wang CY. Abbott LJ. Purpose of this project was to develop rapport with a Chinese Community Association and then establish preventive diabetic and hypertension programs with the Chinese in Chinatown, Hawaii. Subjects were recruited from this Chinese Community Association. Two hundred Chinese responded to the invitation. Among these, 75 individuals had either Type 2 diabetes, hypertension or both. Thirty-six males and 39 females ranging in age from 51 years old to 96 years old (Mean = 71.76, SD = 9.58) participated. Surveys and educational programs were carried out in Chinese. Results were described in terms of quantitative measures (family support and health outcomes) and qualitative experiences (case studies). Eighty percent of participants had decreased their diastolic blood pressure from above 95 mmHg to below 90 mmHg and systolic blood pressure from above 155 mmHg to below 140 mmHg. Ninety-five (n = 71) percent of participants had maintained their glucose level within the 90 mg/dL to 150 mg/dL range with a mean reduction of 57.86 mg/dL in one year. The hardest thing for families was the glucose self-monitoring. Case studies suggested that open-minded active listening and persistence formed the basis for developing a culturally sensitive community-based self management program for chronic diseases. Collaboration among the community, public health nurses, and diabetes nurse educators facilitated the process of community education and health promotion. Wong C, Yang K, Moua N, Mouanoutoua L, Carroll
A, Purpose: To review the findings from the Hmong Quality of Care Project related to interpersonal and technical processes of care and patient satisfaction including use of qualitative information to augment quantitative survey. Methods: Qualitative approaches, using in-depth interviews with Hmong leaders and focus groups with Hmong hypertensive patients, were used to develop a quantitative quality of care survey instrument. Using this culturally tailored, 94-item survey tool, we interviewed 200 Hmong hypertensive patients to assess their health services needs. Patients were recruited from clinics, health department and through outreach activities. Findings: Among those surveyed, almost all were insured under MediCal or Medicaid, spoke little or no English and frequently rated their health as poor. Although almost all were on hypertensive medications, more than half were told that their blood pressure levels were high during recent office visit, were often not explained how to take their medications nor discussed use of Hmong traditional treatments. Patients reported that their providers often did not explain reasons for and results of blood tests. Most respondents reported having difficulty finding information about hypertension. Overall, Hmong reported being satisfied with their care and more often gave a high score when rating their satisfaction with providers. In conclusion, Hmong patients receive less than optimal care for their hypertension management. However, they reported satisfaction with their providers and hypertension care. Results from the qualitative interviews suggest low expectations of health care providers, little knowledge about patient rights, providers’ roles and health plan responsibilities that underlie these observed incongruencies. Learning Objectives: Participants in this presentation will learn about Hmong health services needs and on ways to obtain reliable information to evaluate health care delivery for Hmong and other ethnic minorities. Wright AL. Naylor A. Wester R. Bauer M. Sutcliffe
E. Although many attempts have been made to promote breastfeeding in a variety of contexts, few programs have explicitly incorporated cultural beliefs in these efforts. This article describes a breastfeeding promotion program conducted on the Navajo reservation. This program was designed to be culturally appropriate. Background information regarding beliefs and factors affecting infant feeding practices in this setting is provided, followed by a description of the intervention. The intervention, which incorporated both social marketing and community participation techniques, consisted of three components: an intervention in the health care system, a community intervention, and an individual intervention. Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful. This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change. Yancey AK. Tanjasiri SP. Klein M. Tunder J. Background: Electronic media have demonstrated efficacy in increasing knowledge and promoting health-protective behavior among individuals at high risk for chronic disease. In "Stimulating Cancer Screening among Women of Color through Video" (A. K. Yancey and L. Walden, 1994, J Cancer Educ 9:46-52) the development of a cost-effective documentary format for culturally sensitive health education videos was described. These videos could not be independently evaluated within the cancer control program for which they were developed. Methods: A quasi-experimental study design tested the hypothesis that exposure to these videos increases cervical cancer screening behavior among samples of women from two clinic populations of predominantly low-income African-Americans and Latinos in New York City and Los Angeles. A 1-week-on-1-week-off design was utilized, in which the videos were continuously displayed in designated waiting rooms during on (intervention) weeks, with each facility serving as its own control during off weeks. Results: The proportion of women seen as patients during the
intervention weeks who subsequently obtained Pap smears was significantly
higher than that of those seen during the control weeks at each site (P
< 0.05).
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• Assuring Cultural Competence in Health Care: National Standards CLAS Standards project homepage • CLAS Standards Federal Register notice • Cultural competence contract language for managed care |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please let us know if you have other examples to include here. |
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