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Developing a Research Agenda for Cultural Competence in Health Care:
Culturally Competent Health Promotion
Draft research agenda--version 1.0

Resources for Cross Cultural Health Care
and the U.S. Department of Health and Human Services
Office of Minority Health and the Agency for Healthcare Research and Quality  

We invite public input on our draft research agendas. Please read the following document and send your comments to rcchc@aol.com. We are especially looking for recommendations for additional research questions and methodological/policy considerations. We are also seeking additional bibliographic references for the literature review abstracts. Comments received by December 10 will be incorporated into the final report–comments will also be posted online.

Definition

Health promotion refers to the process by which individuals, communities and populations are given the tools necessary to improve health outcomes. Culturally competent health promotion implies the incorporation of culturally sensitive concepts and practices into health promotion activities. Developing CCHP policies and interventions entails the integration of a multilevel community organization and development approach. Activities associated with this approach include community input into the design, implementation and evaluation of programs and associated activities, a comprehensive understanding of the health issues and needs of the target population, and the provision of health information and education. When conducted with a high degree of cultural and linguistic specificity, it is hypothesized that these interventions are more effective in improving outcomes.  

Synthesis Of Finding From Current Literature

The literature suggests that culturally competent health promotion consists of a combination of efforts aimed at improving health outcomes, through promoting health healthy behaviors, early detection and treatment of disease, and care of chronic disease. Literature suggests that programs used several culturally and linguistically sensitive interventions to improve outcomes including; community input in the planning process, multicultural providers, racial/ethnic concordance, traditional healers, lay health workers, community health workers, translated materials, interpreters, multilingual informational videotapes and cultural competence training. Due to the number of interventions that can be used to define CCHP programs, the amount of descriptive literature highlighting the design, methods and processes of such programs is tremendous. Although limited, studies that empirically measured the impact of CCHP programs on outcomes examined satisfaction, service utilization (e.g. impact on screening rates), increases in health knowledge, changes in health behavior and practices, and prevention. Findings suggest that some of the individual interventions association with CCHP programs were found to have potential added value while others had inconsistent results. Community health workers were found to have a successful impact on recruitment into screening and health education programs and assisted in the facilitation of program completion (see also the research agenda on community health workers). Several studies attempted to measure both knowledge and behavioral change as a result of program participation. While some studies indicated increases in both measures, others found that increases in knowledge could not be linked to behavioral changes. Another study revealed that the impact of one CCHP program on different racial and ethnic study populations revealed different results.

In those studies that reported positive results on intermediary outcomes, no scientific links could be made to improvements in health outcomes. However, it was theorized that subsequent changes in health status changes were attributed to the positive impact of these interventions.

Search findings also revealed gaps or weaknesses in methodological design when examining the impact of CCHP programs and associated interventions on outcomes. Very few studies were identified that specifically document improvements in health outcomes as a result of integrating culturally sensitive interventions into delivery approach. Although comparison studies were conducted between CCHP and other case management approaches, no highly controlled designs examining the impact culturally sensitive program intervention versus a standard health promotion program were identified whereby weakening the findings of those studies that did report positive improvements in health outcomes.

Literature Search Terms

Culturally competent health promotion, health promotion, health education, translated materials, interpreters, education, culturally sensitive/responsive/appropriate/tailored health promotion, culturally competent health interventions, provider training, community input, outreach, community involvement

Key Research Questions

• What is the impact of culturally competent health promotion programs versus standard health promotion program? Is the effect isolated to the receipt of the intervention itself or is it the cultural competence aspects of the intervention that make the difference?
• Is there a significant improvement in outcomes when the intervention is highly tailored to subgroups and subcultures as opposed to generalized culturally competent health promotion programs?
• Conduct isolated comparisons of the culturally sensitive methods utilized by CCHP programs to determine which elements improve access, quality and utilization of services?

Methodological Considerations Impacting Future Research

The Research Advisory Committee (RAC) expressed concern about future research efforts directed at assessing the impact of culturally competent health promotion interventions. Many felt that breaking up a multi-component culturally competence health promotion program into discreet elements for the purposes of evaluation (eg. the impact of interpretation, family inclusion, or lay health workers) would result in a dilutional effect of the overall intervention, and determining the impact of these elements may not be possible.

The RAC also suggested that research assessing the impact of CCHP efforts may need to be conducted on specifically targeted cultural groups and subcultures, and success may need to be defined as it relates to specific target populations.

Concern was also expressed regarding the availability of theoretical models, lack of instruments and methodologies to measure and validate CCHP elements. Suggestions were made to include both quantitative and qualitative approaches in the assessment of culturally sensitive interventions.

Future efforts need to be made to conduct appropriately controlled experiments measuring the impact between standard programs and culturally competent programs rather than attempting to measure the impact of the intervention compared to no intervention.

literature review abstracts >

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