Skip to main content
SpringerLink
Log in
Book cover

Cultural Competence in Health pp 115–125Cite as

Cultural Competence Strengths, Weaknesses and Future Directions

  • Chapter
  • First Online:

Part of the book series: SpringerBriefs in Public Health ((BRIEFSPUBLIC))

Abstract

An analytical overview of the current status of cultural competence interventions across Canada, Australia, New Zealand and the USA (CANZUS) was provided in the previous chapters. This chapter outlines the main findings of the review in terms of reported outcomes. The review findings are discussed in relation to the two drivers of cultural competence outlined at the beginning of the book: sociocultural factors impacting healthcare and healthcare and health disparities. It looks at the extent to which current cultural competence interventions achieve outcomes consistent with the core drivers of cultural competence. Suggestions are made for future directions to improve cultural competence intervention and evaluation approaches to better assess their impact on these drivers.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. J.R. Betancourt, Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad. Med. 78(6), 560–569 (2003)

    Article  PubMed  Google Scholar 

  2. C. Brach, I. Fraserirector, Can cultural competency reduce racial and ethnic health disparities? a review and conceptual model. Med. Care Res. Rev. 57(Suppl 1), 181–217 (2000)

    Article  PubMed  PubMed Central  Google Scholar 

  3. S. Arora, A.K. Kurji, M.T.S. Tennant, Dismantling sociocultural barriers to eye care with tele-ophthalmology: lessons from an Alberta Cree community. Clin. Invest. Med. 36(2), E57–E63 (2013)

    Article  PubMed  Google Scholar 

  4. B.A. Guadagnolo et al., A pre-post survey analysis of satisfaction with health care and medical mistrust after patient navigation for American Indian cancer patients. J. Health Care Poor Underserved 22(4), 1331–1343 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  5. L. Jandorf et al., Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system. Health Educ. Res. 28(5), 803–815 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  6. C.A. Jones et al., Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP). BMC Public Health 13, 160 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  7. E.C. Ward, R.L. Brown, A culturally adapted depression intervention for African American adults experiencing depression: oh happy day. Am. J. Orthopsychiatry 85(1), 11–22 (2015)

    Article  PubMed  Google Scholar 

  8. A. Wiley, At a cultural crossroads: lessons on culture and policy from the New Zealand DISABILITY STRATEGY. Disabil. Rehabil. 31(14), 1205–1214 (2009)

    Article  PubMed  Google Scholar 

  9. R. Weech-Maldonado et al., Cultural competency assessment tool for hospitals: evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards. Health Care Manag. Rev. 37(1), 54 (2012)

    Article  Google Scholar 

  10. D.H. Thom et al., Development and evaluation of a cultural competency training curriculum. BMC Med. Educ. 6(1), 1–9 (2006)

    Article  Google Scholar 

  11. A.C. Wu et al., The interpreter as cultural educator of residents. Arch. Pediatr. Adolesc. Med. 160(11), 1145 (2006)

    Article  PubMed  Google Scholar 

  12. R. Weech-Maldonado et al., Moving towards culturally competent health systems: organizational and market factors. Soc. Sci. Med. 75(5), 815–822 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  13. W.H. Meyer, Indigenous rights, global governance, and state sovereignty. Hum. Rights Rev. 13(3), 327–347 (2012)

    Article  Google Scholar 

  14. K.O. Anderson, C.R. Green, R. Payne, Racial and ethnic disparities in pain: causes and consequences of unequal care. J. Pain 10(12), 1187–1204 (2009)

    Article  PubMed  Google Scholar 

  15. K. Fiscella, M.R. Sanders, Racial and ethnic disparities in the quality of health care. Annu. Rev. Public Health 37, 375–394 (2016)

    Article  PubMed  Google Scholar 

  16. M.-Y. Lin, N.R. Kressin, Race/ethnicity and Americans’ experiences with treatment decision making. Patient Educ. Couns. 98(12), 1636–1642 (2015)

    Article  Google Scholar 

  17. B.D. Smedley et al., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (National Academies Press, Washington, DC, 2003)

    Google Scholar 

  18. K.G. Keppel, Ten largest racial and ethnic health disparities in the United States based on healthy people 2010 objectives. Am. J. Epidemiol. 166(1), 97–103 (2007)

    Article  PubMed  Google Scholar 

  19. G. Veenstra, A.C. Patterson, Black–white health inequalities in Canada. J. Immigr. Minor. Health 18(1), 51–57 (2016)

    Article  PubMed  Google Scholar 

  20. L.J. Einsiedel, L.A. Fernandes, R.J. Woodman, Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000–2005. Med. J. Aust. 188(10), 568 (2008)

    PubMed  Google Scholar 

  21. R. Costilla, M. Tobias, T. Blakely, The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities. Aust. N. Z. J. Public Health 37(3), 218 (2013)

    Article  PubMed  Google Scholar 

  22. G. Wong et al., Asian Smokefree communities: evaluation of a community-focused smoking cessation and smokefree environments intervention in New Zealand. J. Smok. Cessat. 5(1), 22–28 (2010)

    Article  Google Scholar 

  23. S. Chavez-Korell et al., Improving access and reducing barriers to depression treatment for Latino elders: Un Nuevo Amanecer (a new dawn). Prof. Psychol.: Res. Pract. 43(3), 217–226 (2012)

    Article  Google Scholar 

  24. P.R. Sanderson et al., Breast cancer education for Navajo women: a pilot study evaluating a culturally relevant video. J. Cancer Educ. 25(2), 217–223 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  25. L.S.I. Ka’opua et al., Testing the feasibility of a culturally tailored breast cancer screening intervention with native Hawaiian women in rural churches. Health Soc. Work 36(1), 55–65 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  26. J. Davies et al., Development of a culturally appropriate bilingual electronic app about hepatitis B for indigenous Australians: towards shared understandings. JMIR Res. Protoc. 4(2), e70 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  27. D. Knoche, A. Clarke, N. Shanahan, K. Rowley, Treating Us Right: A Summary Report Describing and Evaluating Wadja’s new Model of Care for Aboriginal Children and Families at the Royal Children’s Hospital (Onemda VicHealth Koori Health Unit, The University of Melbourne, Melbourne, 2012)

    Google Scholar 

  28. K.A. Taylor et al., Intercultural communications in remote aboriginal Australian communities: what works in dementia education and management? Health Sociol. Rev. 21(2), 208–219 (2012)

    Article  Google Scholar 

  29. D.C. LoGiudice et al., Lungurra Ngoora—a pilot model of care for aged and disabled in a remote Aboriginal community can it work? Rural Remote Health 12, 2078 (2012)

    CAS  PubMed  Google Scholar 

  30. A. Yeung et al., Culturally sensitive collaborative treatment for depressed chinese americans in primary care. Am. J. Public Health 100(12), 2397–2402 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  31. C.S. Oser et al., Cooperative strategies to develop effective stroke and heart attack awareness messages in rural American Indian communities, 2009–2010. Prev. Chronic Dis. 10, E80 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  32. T.K. Houston et al., Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann. Intern. Med. 154(2), 77 (2011)

    Article  PubMed  Google Scholar 

  33. B.J. McElmurry et al., Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot. Pract. 10(2), 293–302 (2009)

    Article  PubMed  Google Scholar 

  34. J. Roncoroni et al., Patient perceived cultural sensitivity of clinic environment and its association with patient satisfaction with care and treatment adherence. Am. J. Lifestyle Med. 8(6), 421–429 (2014)

    Article  Google Scholar 

  35. A. Castro, E. Ruiz, The effects of nurse practitioner cultural competence on Latina patient satisfaction. J. Am. Acad. Nurse Pract. 21(5), 278–286 (2009)

    Article  PubMed  Google Scholar 

  36. K.A. Paez et al., Physician cultural competence and patient ratings of the patient-physician relationship. J. Gen. Intern. Med. 24(4), 495–498 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  37. G.B. Gaston, African-Americans’ perceptions of health care provider cultural competence that promote HIV medical self-care and antiretroviral medication adherence. AIDS Care 25(9), 1159–1165 (2013)

    Article  PubMed  Google Scholar 

  38. G. Michalopoulou et al., Linking cultural competence to functional life outcomes in mental health care settings. J. Natl. Med. Assoc. 106(1), 42–49 (2014)

    Article  PubMed  Google Scholar 

  39. V.L. Viets et al., Reducing health disparities through a culturally centered mentorship program for minority faculty: the Southwest Addictions Research Group (SARG) experience. Acad. Med. 84(8), 1118 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  40. S.-T. Liaw et al., Improving cultural respect to improve Aboriginal health in general practice: a multi-methods and multi-perspective pragmatic study. Aust. Fam. Physician 44(6), 387–392 (2015)

    PubMed  Google Scholar 

  41. Z. Kumaş-Tan et al., Measures of cultural competence: examining hidden assumptions. Acad. Med. 82(6), 548–557 (2007)

    Article  PubMed  Google Scholar 

  42. J. Capell, G. Veenstra, E. Dean, Cultural competence in healthcare: critical analysis of the construct, its assessment and implications. J. Theory Constr. Test. 11(1), 30 (2007)

    Google Scholar 

  43. R. Weech-Maldonado et al., The consumer assessment of healthcare providers and systems (CAHPS) cultural competence (CC) item set. Med. Care 50(9 Suppl 2), S22 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  44. W. Wall et al., Patients’ perceived cultural sensitivity of health care office staff and its association with patients’ health care satisfaction and treatment adherence. J. Health Care Poor Underserved 24(4), 1586–1598 (2013)

    Article  PubMed  Google Scholar 

  45. D.H. Thom et al., Patient trust in the physician: relationship to patient requests. Fam. Pract. 19(5), 476–483 (2002)

    Article  PubMed  Google Scholar 

  46. D.H. Thom, M.A. Hall, L.G. Pawlson, Measuring patients’ trust in physicians when assessing quality of care. Health Aff. 23(4), 124–132 (2004)

    Article  Google Scholar 

  47. Y. Molina et al., Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect. 18(6), 2941–2950 (2015)

    Article  PubMed  Google Scholar 

  48. R.O. White et al., Perceptions of provider communication among vulnerable patients with diabetes: influences of medical mistrust and health literacy. J. Health Commun. 21(sup2), 127–134 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  49. B.A. Guadagnolo et al., Medical mistrust and less satisfaction with health care among native Americans presenting for cancer treatment. J. Health Care Poor Underserved 20(1), 210–226 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  50. R. Ahmed, B.R. Bates, Patients’ fear of physicians and perceptions of physicians’ cultural competence in healthcare. J. Commun. Healthc. 10(1), 55–60 (2017)

    Article  Google Scholar 

  51. C.M. Tucker et al., Roles of perceived provider cultural sensitivity and health care justice in African American/black patients’ satisfaction with provider. J. Clin. Psychol. Med. Settings 21(3), 282–290 (2014)

    Article  PubMed  Google Scholar 

  52. J. Gregg, S. Saha, Losing culture on the way to competence: the use and misuse of culture in medical education. Acad. Med. 81(6), 542–547 (2006)

    Article  PubMed  Google Scholar 

  53. L.S. Abrams, J.A. Moio, Critical race theory and the cultural competence dilemma in social work education. J. Soc. Work. Educ. 45(2), 245–261 (2009)

    Article  Google Scholar 

  54. M.C. Beach et al., Cultural competency: a systematic review of health care provider educational interventions. Med. Care 43(4), 356–373 (2005)

    Article  PubMed  PubMed Central  Google Scholar 

  55. M. Truong, Y. Paradies, N. Priest, Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Serv. Res. 14(1), 99–99 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  56. D.J. Burgess, Addressing racial healthcare disparities: how can we shift the focus from patients to providers? J. Gen. Intern. Med. 26(8), 828–830 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  57. J.F. Dovidio et al., Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc. Sci. Med. 67(3), 478–486 (2008)

    Article  PubMed  Google Scholar 

  58. C.M. Frantz et al., A threat in the computer: the race implicit association test as a stereotype threat experience. Personal. Soc. Psychol. Bull. 30(12), 1611–1624 (2004)

    Article  Google Scholar 

  59. E. Kowal, H. Franklin, Y. Paradies, Reflexive antiracism: a novel approach to diversity training. Ethnicities 13(3), 316–337 (2013)

    Article  Google Scholar 

  60. W.J. Hall et al., Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am. J. Public Health 105(12), e60–e76 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  61. L.A. Cooper et al., The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am. J. Public Health 102(5), 979–987 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  62. C.S. Levine, N. Ambady, The role of non-verbal behaviour in racial disparities in health care: implications and solutions. Med. Educ. 47(9), 867–876 (2013)

    Article  PubMed  Google Scholar 

  63. M.E. Peek et al., Race and shared decision-making: perspectives of African-Americans with diabetes. Soc. Sci. Med. 71(1), 1–9 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  64. I.V. Blair et al., Clinicians’ implicit ethnic/racial bias and perceptions of care among black and Latino patients. Ann. Fam. Med. 11(1), 43–52 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  65. N. Hagiwara et al., Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions. Soc. Sci. Med. 87, 123–131 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  66. A. Larson et al., It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Aust. N. Z. J. Public Health 31(4), 322–329 (2007)

    Article  PubMed  Google Scholar 

  67. M.A. Kelaher, A.S. Ferdinand, Y. Paradies, Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Med. J. Aust. 201(1), 44 (2014)

    PubMed  Google Scholar 

  68. Y. Paradies, A systematic review of empirical research on self-reported racism and health. Int. J. Epidemiol. 35(4), 888–901 (2006)

    Article  PubMed  Google Scholar 

  69. Y. Paradies et al., Racism as a determinant of health: a systematic review and meta-analysis. PLoS One 10(9), e0138511 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  70. S. Karlsen, J.Y. Nazroo, Agency and structure: the impact of ethnic identity and racism on the health of ethnic minority people. Sociol. Health Illn. 24(1), 1–20 (2002)

    Article  Google Scholar 

  71. V.L. Shavers et al., The state of research on racial/ethnic discrimination in the receipt of health care. Am. J. Public Health 102(5), 953–966 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  72. Y. Paradies, M. Truong, N. Priest, A systematic review of the extent and measurement of healthcare provider racism. J. Gen. Intern. Med. 29(2), 364–387 (2014)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, Queensland, Australia

    Crystal Jongen, Janya McCalman & Roxanne Bainbridge

  2. The Cairns Institute, James Cook University, Smithfield, Queensland, Australia

    Janya McCalman & Roxanne Bainbridge

  3. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia

    Anton Clifford

Authors
  1. Crystal Jongen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janya McCalman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roxanne Bainbridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anton Clifford
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 The Author(s)

About this chapter

Cite this chapter

Jongen, C., McCalman, J., Bainbridge, R., Clifford, A. (2018). Cultural Competence Strengths, Weaknesses and Future Directions. In: Cultural Competence in Health. SpringerBriefs in Public Health. Springer, Singapore. https://doi.org/10.1007/978-981-10-5293-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-5293-4_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-5292-7

  • Online ISBN: 978-981-10-5293-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation