Details if other :. Thanks for telling us about the problem. Return to Book Page. Emphasizing health promotion and education for the elderly, this administrative handbook describes standard approaches to developing programs for health and social services in a variety of agencies. Each step of the process is outlined, with particular attention to program planning, development, and. Get A Copy. Paperback , pages. More Details Original Title.
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We will contact you if necessary. The studies reviewed provide some innovative examples of cultural adaptation and engagement strategies utilized by cultural competency services and programs.
Clear and effective communication between health service providers and users is critical to quality and safe health-care provision. Interestingly, even when programs were made language accessible, it was not necessary that this was utilized by participants. For example, while Jones et al. Similarly, Taylor et al. These studies both highlighted a point that was stated throughout many studies.
When working with people with worldviews divergent from the biomedical model, language accessibility needs to go beyond the use of interpreters and translators As noted by Vass et al. For example, miscommunication has been extensively documented in interactions between health-care providers and aboriginal Australian people accessing health care, related to a lack of shared understanding around basic health concepts 53 — When working in cross-cultural spaces, an extensive exploration of the meaning of words in health and specific health topics is needed, as is the development of health interventions and information which incorporates and builds on both traditional and contemporary indigenous health frameworks Some of the included studies addressed such issues of intercultural communication in the context of worldview differences.
Some studies also detailed the testing of translated program resources for appropriateness with the target population, while others did not. When reported, different levels of detail around the process and quality of the translation were provided in the included studies. This issue of differences in fundamental concepts of health and comprehension of health information is one area that deserves further attention in cultural competency program design and implementation.
The included studies utilized varying levels of integration of community-, cultural-, and linguistically focused cultural competency strategies. Okamoto et al. This concept of a continuum of cultural adaptations in health programs has predominantly been discussed in relation to the adaptation of evidence-based treatments EBT 57 , Nonetheless, it has relevance beyond EBT to the design and implementation of other cultural competency interventions. The literature points out that surface and deep-structure adaptations can be very effective for many interventions with different groups.
However, for some groups, particularly indigenous peoples, there is a greater need for culturally grounded approaches which are embedded in and created from the specific cultural viewpoint and needs of communities from the outset To improve the evaluation quality of cultural competency services and programs, greater attention on the use of appropriate, and where available, validated measurement tools is needed.
The included studies provide useful evidence on intermediate outcomes such as satisfaction levels and service utilization rates. Nevertheless, the presence of key methodological flaws, such as a lack of pre-intervention comparisons, diminishes the strength of outcome data on intermediate health outcomes. In contrary, the studies demonstrating improved health outcomes generally used fairly rigorous study designs with appropriate measurement tools. This kind of attention to study quality is needed to measure intermediate and health outcomes, both of which are important indicators of intervention success.
Viewed together, these studies illustrate a wealth of potential approaches to inform future health promotion services and programs to improve culturally competency.
The similarities in intervention strategies seen across these studies can be useful when planning cultural competence interventions in health services and programs.
However, we would caution against the assumption that what works in one context is appropriate for others, even with the same cultural or ethnic group. The types of adaptations and strategies that are appropriate will differ according to the unique needs and circumstances of each community and target group. This reaffirms the importance of community partnerships to ensure that health interventions are responsive to the local context in which they are placed. The publications in this review were identified with a non-exhaustive search strategy designed to produce peer- and non-peer-reviewed health studies that evaluated cultural competence interventions in health services.
Therefore, it is possible that some relevant publications were not found. Additionally, because of the breadth of this field, only studies that explicitly addressed improving cultural competency were included. This strategy possibly excluded studies that might have implicitly aimed to increase cultural competency. For the development of the literature base on the effectiveness of various interventions to improve cultural competency, it is important that studies explicitly address this in their aims and measures.
Another limitation occurred within the frameworks used to study quality. To determine whether and to what extent culturally competent service provision enhances outcomes of services and treatment, it is essential that cultural competency is accurately assessed 8. However, a lack of systematic tools and approaches for measuring the presence, level, and contribution of cultural competency interventions to quality health care continues to weaken the growing evidence base 8 , Additionally, there was a preponderance of intermediate and short-term health outcome reported.
Further research is needed into longitudinal, population-based studies to determine the overall impact of cultural competence interventions on population health and health disparities among groups. The included studies demonstrate a growing evidence base for the impact of health promotion services and programs to improve cultural competency on intermediate and health outcomes. Nonetheless, because of methodological issues related to appropriate indicators and study design, it cannot be definitively concluded what types of interventions produce what types of outcomes with particular populations.
The primary lesson from reviewing the strategies and approaches to culturally tailoring or developing culturally grounded health interventions for minority population groups is that each needs to be consistent with the unique cultural needs and characteristics of target populations and need to be embedded in context and community. CJ is the primary author and was responsible for the data extraction of the search update and the writing of the final review manuscript.
RB completed the data extraction for the first search and authored a paper on the larger review in which informed this review. All authors have: contributed significantly towards the development of the review concept and structure; been involved in drafting the paper and critically reviewing content during the editing process; previewed the final version of the review; and approved it for publication.
The authors are assured of the accuracy and integrity of the review and agree to be accountable for all aspects of the publication manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors acknowledge the contributions of Mary Kumjav for conducting the literature search, Komla Tsey for participating in the screening process, and Anton Clifford for participating in the screening process and contributing authorship to the larger systematic review which this review is part of.
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