Cultural Competence in Health (eBook)

Dr Janya McCalman is Associate Professor of Indigenous health research at Central Queensland University where she co-leads the research in Resilience for Aboriginal Health and Wellbeing Program with Associate Professor Roxanne Bainbridge. Her multi-method research with Aboriginal and Torres Strait Islanders partners over the last 15 years has spanned mental health, youth resilience, maternal and child health, health services and implementation research. She has published more than 45 peer reviewed papers and one book. Her PhD was conferred with a Deans Excellence Award and she currently holds a 4 year fellowship from Australia’s National Health and Medical Research Council. Janya comes from New Zealand and now lives in northern Australia. Dr Crystal Jongen is a qualified Social Worker with a background in Psychology who has worked in direct practice with diverse client groups, including Indigenous Australians, and asylum seekers and refugees. She has been undertaking research in the field of Indigenous health, wellbeing and empowerment for the past three years, collaborating on various research projects to increase knowledge and evidence base to address in key areas of Indigenous health and wellbeing. Crystal´s practice, whether in direct client and community work or research work, is informed by critical perspectives with a focus on social justice and community empowerment. Of Dutch and Australian parents, Crystal lives in Australia but maintains close ties to The Netherlands. Dr Roxanne Bainbridge is Associate Professor of Indigenous health research at Central Queensland University. Roxanne’s interest is in improving the integrity and quality of research evidence as a contribution to the health and prosperity of Indigenous Australians. She has published 35 academic papers including 7 systematic reviews. She served as Editor of the Australian and New Zealand Journal of Public Health and is a member of Lowitja Institute’s national committee on Community Capability and the Social Determinants of Health. She holds a 4 year Fellowship from Australia’s National Health and Medical Research Council and previously held 2 awards from the Australian Research Council. Roxanne is a Gungarri woman from Queensland, Australia. Dr Anton Clifford is a Senior Lecturer in the School of Public Health, University of Queensland (UQ) where he teaches in Indigenous health. He has high level experience in undertaking research in Aboriginal healthcare and community settings. He is former Manager of Research & Evaluation at the Institute for Urban Indigenous Health, a regional Aboriginal Community Controlled Health Organisation. He has published more than 20 papers including: systematic reviews of cultural competence and Indigenous health; dissemination; intervention; and measurement research. Anton recently completed a 3 year early career research fellowship with the Australian Research Council. Of British and Basotho parents and raised in an Aboriginal family, he now lives in Queensland, Australia. 

Foreword 6
Preface 8
Contents 11
Chapter 1: Introduction 15
1.1 Cultural Competence Defined 15
1.2 Cultural Competence-Related Terms 17
1.3 The Historical Development of Cultural Competence 17
1.4 What Does Cultural Competence Encompass 18
1.5 A Multilevel Framework for Cultural Competence in Healthcare 19
1.6 The Purpose of This Book 20
1.7 The Objectives of This Book 20
1.8 Structure of the Book 21
1.8.1 Chapter 2: The Drivers of Cultural Competence 21
1.8.2 Chapter 3: Methods 21
1.8.3 Cultural Competence: A Multilevel, Systematic Scoping Review 21
1.8.4 Chapter 4: Health Workforce Development Interventions to Improve Cultural Competence 22
1.8.5 Chapter 5: Cultural Competence Education and Training Interventions for Health and Medical Students 22
1.8.6 Chapter 6: Programs and Services to Improve Cultural Competence in Healthcare 22
1.8.7 Chapter 7: Health Organisation and System Cultural Competence Interventions 23
1.8.8 Chapter 8: Cultural Competence Strengths, Weaknesses and Future Directions 23
1.8.9 Chapter 9: Multilevel Cultural Competence Intervention Implementation and Evaluation Framework 23
References 23
Chapter 2: The Drivers of Cultural Competence 26
2.1 Introduction: The Conceptual Underpinnings of Cultural Competence 26
2.1.1 Pathway 1: Cultural or Sociocultural Differences 26
2.1.2 Pathway 2: Healthcare Disparities 27
2.2 Pathway 1: Culture and Sociocultural Differences 28
2.2.1 What Is Culture? 29
2.2.2 Sociocultural Differences and Healthcare Appropriateness 30
2.2.3 Conflating Culture with Ethnicity and Race 31
2.2.4 Worldviews, Language and Healthcare Appropriateness 32
2.2.5 Increasing Population Diversity 34
2.3 Pathway 2: Disparities in Healthcare Treatment and Quality 35
2.3.1 The Role of Bias in Healthcare Disparities 37
2.3.2 The Social Determinants of Health 39
2.3.3 Racism as a Social Determinant of Health 41
2.3.4 Colonisation as a Social Determinant of Health 42
2.4 The Centrality of Power, Voice and Control 43
2.5 Summary: Complexity in the Cultural Competence Conceptual Landscape 44
2.6 Conclusion 46
References 46
Chapter 3: Methods 54
3.1 Introduction 54
3.2 Inclusion/Exclusion Criteria 54
3.3 Search Strategy 55
3.3.1 Identification, Screening and Inclusion of Publications 57
3.3.2 Data Extraction and Analysis 58
3.3.3 Limitations of the Review 59
References 59
Chapter 4: Health Workforce Development Interventions to Improve Cultural Competence 61
4.1 Background 61
4.2 Characteristics of Workforce Development Interventions 63
4.3 Cultural Competence Workforce Development Intervention Strategies 63
4.3.1 Cultural Competence Training 65
4.3.2 Professional Development Interventions 67
4.3.3 Delivery Mode 70
4.4 Intervention Outcomes 70
4.5 Measurement and Study Quality 72
4.6 Conclusion 73
References 74
Chapter 5: Cultural Competence Education and Training for Health and Medical Students 77
5.1 Introduction 77
5.2 Characteristics of Education and Training Interventions 78
5.3 Education/Training Intervention Strategies and Their Components 78
5.3.1 Integration of Cultural Competency into Curriculum 78
5.3.2 Cultural Immersion 80
5.3.3 Cultural Education and Training 82
5.4 Intervention Outcomes 83
5.5 Methodological Quality of Evaluations 83
5.6 Conclusion 84
References 85
Chapter 6: Services and Programs to Improve Cultural Competency 87
6.1 The Role of Programs and Services in Culturally Competent Healthcare Systems 87
6.1.1 Diversity of Terminology in the Cultural Competence Literature 88
6.1.2 Cultural Adaptation of Health Programs and Services 89
6.1.3 A Continuum of Adaptation Strategies 90
6.1.4 Research Evidence on the Effectiveness of Programs and Services 91
6.2 Characteristics of Programs and Services to Improve Cultural Competence 92
6.3 Intervention Strategies to Improve the Cultural Competency of Programs and Services 92
6.3.1 Community-Oriented Strategies 94
6.3.2 Culture-Oriented Strategies 97
6.3.3 Language-Oriented Strategies 99
6.4 Cultural Competence Intervention Outcomes 102
6.5 Study Quality 104
6.6 Conclusion 105
References 105
Chapter 7: Health Organisation and System Cultural Competence Interventions 110
7.1 Introduction 110
7.2 Results 112
7.3 Principles for Implementation 112
7.3.1 User Engagement 112
7.3.2 Organisational Readiness and Commitment 114
7.3.3 Multiple Sites of Delivery 115
7.4 Health System Cultural Competence Intervention Strategies 115
7.4.1 Audit and Quality Improvement Approaches Conducted Across or Within Health Services 115
7.4.2 Evaluations of Service-Level Policies and/or Strategies for Cultural Competence 117
7.5 Health System Interventions Outcomes 118
7.5.1 Organisational Healthcare Systems Outcomes 119
7.5.2 Client/Practitioner Encounter Outcomes 120
7.5.3 National Outcomes 120
7.6 The Quality of Available Evidence 121
7.7 Conclusion 121
References 122
Chapter 8: Cultural Competence Strengths, Weaknesses and Future Directions 125
8.1 Addressing the Drivers of Cultural Competence 125
8.1.1 Evidence Supporting the Positive Impact of Cultural Competence Interventions on the Effects of Sociocultural Differences in Healthcare 125
8.1.2 Evidence Supporting the Positive Impacts of Cultural Competence Interventions on Healthcare and Health Disparities 126
8.1.3 What Are the Major Gaps in the Evidence in Cultural Competence Literature? 128
8.2 Improved Measures to Assess the Impacts of Cultural Competence Interventions 128
8.3 Attention to Issues of Power 131
8.4 Conclusion 132
References 132
Chapter 9: Multilevel Cultural Competence Intervention Implementation and Evaluation Framework 136
9.1 A Multilevel Framework for Cultural Competence in Healthcare 136
9.2 Evaluating Multilevel Interventions 140
9.3 Conclusion 141
References 142
Glossary 143
References 146