Cochrane for Clinicians
Putting Evidence into Practice
Cultural Competence Education for Health Care Professionals
Am Fam Physician. 2015 Apr 15;91(8):523-524.
Does cultural competence education for health care professionals affect outcomes for patients (satisfaction, perception of health care), professionals (clinician awareness, patient-clinician relationship), or organizations (increase in patient engagement, increased likelihood of meeting treatment goals)?
Low-quality evidence suggests that training health care professionals in patient-centered communication improves the engagement of patients from culturally and linguistically diverse backgrounds in their health care. Interventions that were primarily educational appeared to be ineffective. (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)
Cultural competence education for health care professionals may reduce persistent disparities in health care quality and outcomes among persons from minority cultural and linguistic backgrounds. If barriers to intercultural communication, linguistic and otherwise, can be overcome, communication and collaboration between patients and physicians may facilitate better health outcomes.1 Although many institutions train clinicians in cultural competency, there is no consensus definition or well-established curriculum for teaching it.2,3 This Cochrane review examined whether cultural competence education improved patient, professional, or organizational outcomes in patients and clinicians from culturally and linguistically diverse backgrounds and ethnic minorities.
Five randomized controlled trials that involved 337 health care professionals and 8,400 patients compared the effects of cultural competence education for health professionals vs. no training. Three studies were from the United States, one study was from Canada, and one study was conducted in the Netherlands. The studies reviewed different types of interventions, including those that focused on communication, cultural sensitivity training, and delivering training to health care professionals with performance feedback. Study participants included clinicians and patients from culturally diverse backgrounds. Interventions ranged in duration from four to 36 hours. All interventions were compared with usual care. Primary outcomes included treatment outcomes such as target cholesterol levels, health behaviors such as attendance at scheduled appointments, involvement in care, and patient evaluation of care. Patient knowledge and understanding were secondary outcomes. Positive, low-quality evidence showed improvement in patients' engagement in their care after clinicians were trained in patient-centered communication. Interventions that were primarily educational appeared to be ineffective. No studies assessed adverse outcomes.
Despite mixed evidence, organizations such as the Joint Commission support cultural competence interventions to reduce disparities among culturally and linguistically diverse populations and to improve patient safety and patient satisfaction.4,5 Medical schools and residency programs are increasingly incorporating cultural competence education into their curricula,6 and this review suggests that patient-centered communication should be a key component. The Joint Commission defines patient-centered communication as effective communication of health information that takes into consideration a patient's language needs, individual understanding, and cultural and other issues.5 Practicing clinicians should continue to be aware of cultural differences and potential cultural barriers to care.
The practice recommendations in this activity are available at http://summaries.cochrane.org/CD009405.
Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database Syst Rev. 2014;(5):CD009405.
REFERENCESshow all references
1. Wilson-Stronks A, Lee KK, Cordero CL, Kopp AL, Galvez E. One size does not fit all: meeting the health care needs of diverse populations. Oakbrook Terrace, Ill.: The Joint Commission; 2008. http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf. Accessed December 2014....
2. Grant J, Parry Y, Guerin P. An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition. Aust N Z J Public Health. 2013;37(3):250–256.
3. Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):e294.
4. Goode TD, Dunne MC, Bronheim SM. The evidence base for cultural and linguistic competency in health care. New York, NY: The CommonwealthFund; October 2006. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2006/Oct/The%20Evidence%20Base%20for%20Cultural%20and%20Linguistic%20Competency%20in%20Health%20Care/Goode_evidencebasecultlinguisticcomp_962%20pdf.pdf. Accessed December 2014.
5. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. Oakbrook Terrace, Ill.: The Joint Commission; 2010.
6. Westerhaus M, Finnegan A, Haidar M, Kleinman A, Mukherjee J, Farmer P. The necessity of social medicine in medical education. Acad Med. Epub ahead of print November 18, 2014.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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