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A Model and Instrument for Addressing Cultural Competence in Health Care
... Campinha-Bacote [10,18] identified cultural encounters as healthcare providers' engaging in cross-cultural interactions with individuals from culturally diverse backgrounds. Although the concern for stereotyping groups of individuals based on interactions with an individual from one cultural group is present, cultural encounters are an additional opportunity for healthcare providers to learn about others' cultural beliefs and values [10] . ...
... Campinha-Bacote [10] highlighted that healthcare providers must not assume they are an expert on a cultural group after one cultural encounter with a member of that group. Due to intra-ethnic variation within cultural groups, even after providers have experienced three or four encounters with individuals from one culture, they must be mindful that they are not experts in that one culture [18] . Cultural encounters exemplify the process of becoming culturally competent, as this is a continuous, dynamic process without an endpoint. ...
... Cultural desire is the healthcare providers' desire to engage in the process of cultural competence because they have a desire, as opposed to an obligation [10,18] . Cultural desire centers on the concept of caring [10] . ...
... Students completed the Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version © (IAPCC-SV) [20] and a demographic survey within 4 weeks of admission (F), and within 4 weeks of graduation (T). A survey was developed by the primary researcher to gather student demographics and characteristics of ILEs that research suggests are related to ICC. ...
... Total scores range from 25-80 with higher scores reflecting greater skills in ICC. Scores are translated into four levels (score range) of ICC on a developmental continuum; cultural incompetence , cultural awareness (41-59), cultural competence (60-74), and cultural proficiency (75-80) [20]. Despite the labeling of the continuum, the highest level (cultural proficiency) does not indicate completion of learning and development, but rather the accomplishment of student objectives related to ICC [23]. ...
... Both cohorts demonstrated statistically significant increases over time, indicating a positive impact of the curricula. Mean IAPCC-SV total scores for the first and third-year students in that study were relatively similar to this study with third-year students' mean IAPCC-SV total scores in the third level (cultural competence) of the IAPCC-SV [20]. ...
Background
Physical therapists (PTs) work in diverse communities with individuals whose identities and beliefs may differ significantly from their own. Academic institutions must include intentional curriculum aimed at graduating PTs who can skillfully navigate intercultural encounters. Being prepared to engage with difference and demonstrate skills related to intercultural competencies (ICC) will prepare entry-level PTs to provide individualized, high-quality care. Intercultural competencies are essential skills that can reduce healthcare disparities, and promote equitable and inclusive healthcare delivery. This study examined the impact of PT curricula, student demographics, and participation in intercultural learning experiences (ILEs) on students’ development of ICC.
Methods
A cross-sectional study of 8 Doctor of Physical Therapy (DPT) programs in the United States (US) compared ICC in first-year (F) and third-year students (T), and T who participated in an ILE (T + ILE) to those who did not (T-only). Subjects included 1,038 students. Outcome measures included The Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV), and a demographic survey.
Results
Independent t-tests showed that group T (mean = 64.34 ± 5.95, 95% CI: 63.78-64.90) had significantly higher IAPCC-SV total scores than group F (mean = 60.8 ± 5.54, 95% CI = 60.33-61.27, p < 0.05). Group T + ILE (mean = 65.81 ± 5.71, 95% CI = 64.91-66.71) demonstrated significantly higher IAPCC-SV total scores than group T-only (mean = 63.35 ± 5.8, 95% CI = 62.6-64.1, p = 0.039). A one-way ANOVA and post hoc comparisons showed that the 25 to 34-year age group (mean = 63.80 ± 6.04, 95% CI = 63.25-64.35, p < 0.001) and the ≥ 35-year age group (mean = 64.21 ± 5.88, 95% CI = 62.20-66.22, p < .024) had significantly higher IAPCC-SV total scores, than the 18 to 24-year age group (mean = 60.60 ± 5.41, 95% CI = 60.09-61.11). Students who identified in US census minority ethnic or racial categories (US-Mn) (mean = 63.55 ± 5.78, 95% CI = 62.75-64.35) had significantly higher IAPCC-SV total scores than students who identified in US majority ethnic or racial categories (US-Mj) (mean = 61.98 ± 5.97, 95% CI = 61.55-62.413, p = .0001).
Conclusions
Results of the study support the hypothesis that DPT programs can promote the development of intercultural skills in students. The ultimate objective of this academic preparation is to improve the student’s ability to deliver equitable, person-centered healthcare upon entry into practice. Specific ICC for entry-level DPT students are not clearly defined by US physical therapy professional organizations, academic institutions, or accrediting body. Students who participated in an ILE exhibited higher levels of ICC when compared to those who did not. Findings from this study can guide curriculum development, utilization of resources, and outcomes assessment. More research is needed to examine characteristics of an ILE that could inform best practice.
... Cultural competence is "the ongoing process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community)" [1]. Cultural competence promotes the questioning of one's own preconceptions and prejudices, as well as other cultural humility and anti-oppressive principles such as respecting differences, minimizing power disparities, forming alliances, and learning from patients [2]. Campinha-Bacote (1999), in her conceptual model of cultural competence, "The Process of Cultural Competence in the Delivery of Healthcare Services", suggested five constructs of cultural competency that could be used to develop and implement culturally responsive healthcare services: cultural awareness; cultural knowledge; cultural skill; cultural encounter; and cultural desire [2]. ...
... Cultural competence promotes the questioning of one's own preconceptions and prejudices, as well as other cultural humility and anti-oppressive principles such as respecting differences, minimizing power disparities, forming alliances, and learning from patients [2]. Campinha-Bacote (1999), in her conceptual model of cultural competence, "The Process of Cultural Competence in the Delivery of Healthcare Services", suggested five constructs of cultural competency that could be used to develop and implement culturally responsive healthcare services: cultural awareness; cultural knowledge; cultural skill; cultural encounter; and cultural desire [2]. In this model, there is an interdependence and an intersection between the constructs; the stronger the intersection, the greater the integration of cultural competence constructs in the healthcare provided to people from diverse races, ethnicities, genders, religions, and countries of origin [2]. ...
... Campinha-Bacote (1999), in her conceptual model of cultural competence, "The Process of Cultural Competence in the Delivery of Healthcare Services", suggested five constructs of cultural competency that could be used to develop and implement culturally responsive healthcare services: cultural awareness; cultural knowledge; cultural skill; cultural encounter; and cultural desire [2]. In this model, there is an interdependence and an intersection between the constructs; the stronger the intersection, the greater the integration of cultural competence constructs in the healthcare provided to people from diverse races, ethnicities, genders, religions, and countries of origin [2]. ...
As cultural diversity gains global prominence, healthcare professional educators (HPEs) are expected to exhibit a high level of cultural competence in education. Responding to this necessity requires the establishment of healthcare education that is oriented toward sustainability. This study aimed to investigate HPEs’ perceptions of cultural competence at the Qatar University-Health Cluster (QU-HC). A convergent mixed-methods design was applied. The quantitative phase involved 118 HPEs at QU-HC responding to the Multicultural Teaching Competency Scale (MTCS). The qualitative phase included 3 focus groups (FGs) with 22 HPEs guided by Campinha-Bacote’s (1999) model of cultural competence. Thematic analysis was applied to analyze FGs data. Seventy-one educators responded to the MTCS (response rate was 60.2%), and twenty-two educators attended the FGs. HPEs demonstrated a moderate level of cultural awareness (total MTCS mean = 57 ± 7.8). The FGs revealed that the HPEs exhibited awareness and responsive teaching, but individual and institutional factors needed improvement. This study expands upon the existing literature concerning the cultural diversity impacts on the teaching and learning aspects of health profession programs, specifically within the Middle East context. It is recommended that health professional programs intensify the cultural orientation provided to educators, reanalyze the curricular content to serve diverse patients, and explore innovative approaches that embrace cultural diversity and sustainability.
... Cultural competence has been defined as a process rather than an endpoint. In this process, nurses continuously endeavor to acquire information on the cultural content of individuals, families, and society in an effective manner [4,18,21]. The present study investigated the degree of cultural competence among nursing educators and faculties at medical sciences universities of the 2nd regional planning of Iran in 2021. ...
... The cultural awareness acquisition process is essential for the progress of cultural competence and is the most significant component in Campinha-Bacote's cultural competency model [22]. In this research, the highest score belonged to the cultural awareness subscale (4.11), which was expectable since cultural awareness was constantly recognized as the most paramount element of cultural competence regarding past research [21,23,24]. In her study in 2003, Sealey aimed to determine the cultural competence of faculty of baccalaureate nursing programs in Louisiana in the United States and estimated the mean score of the cultural awareness subscale at 4.14. ...
... I require that students be knowledgeable about diseases that have a high incidence among clients in our service area from diverse cultural, racial, and ethnic groups.17. I have a clear understanding of the differences in meaning of the following terms; acculturation, assimilation, and socialization.21. My students are expected to demonstrate knowledge of their client's world views, beliefs, and practices by incorporating this knowledge in their plans of care.22. ...
Background
One of the facets of nursing care, as a holistic profession, is cultural care. Considering the role of culture in individuals’ health behaviors, nurses are recommended to be mindful of cultural care. Since nursing educators should be culturally competent to teach cultural care to students, this study aimed to determine the cultural competence of nursing educators of medical sciences universities in the 2nd regional planning in Iran.
Methods
The current research was a descriptive and survey study framed within Campinha-Bacote’s cultural competency model. All nursing educators of universities of medical sciences in the 2nd regional planning of Iran (Tabriz, Urmia, Ardabil, Khoy, Maragheh, Sarab, and Khalkhal) were considered as research units, and the cultural diversity questionnaire for nursing faculties (CDQNE-R) was sent to them. Out of 129 questionnaires sent, 84 were turned back. The data were analyzed by the SPSS 22 software.
Results
The results of this study showed that the research participants agreed with the subscales of cultural awareness, cultural knowledge, cultural skill, and cultural desire according to Sealey and Yates’ interpretation scale. Also, the research units cast doubts on the cultural encounter subscale. The mean scores of the participants’ responses to the questions of every subscale equaled 4.11, 3.52, 3.71, 3.38, and 3.93 for the subscales of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire, respectively. Likewise, the mean scores of participants’ responses to the subscales of transcultural educational behaviors and general cultural competence equaled 3.90 and 3.73.
Conclusions
The nursing faculties participating in the present study agreed with the 4 sub-models of Campinha-Bacote cultural care and the presence of cultural competence criteria. Also, the research units had doubts about the cultural encounter subscale. This result means that the research participants were undecided about their level of participation in face-to-face interactions with people from different cultural, racial, and ethnic groups. According to the results of the study, it is important to hold transcultural nursing training workshops and courses to maintain and improve the level of cultural competence of nursing faculties at universities of medical sciences in the 2nd regional planning in Iran.
... Cultural competence is a theoretical concept and is defined as an ongoing process that encourages health professionals to strive to improve their personal and professional capacities in adjusting the clinical practices congruently with the clients' cultural context in sensitive and effective ways (Campinha-Bacote, 1999, 2002Henderson et al., 2018;Liu et al., 2021). Several theoretical models of cultural competence have been developed to explain the concept, but few have been tested empirically (Alizadeh & Chavan, 2016). ...
... And ultimately, more encounters might encourage the health professionals to work on their motivation and willingness to become culturally competent (Campinha-Bacote, 2011). Still, the five cultural constructs described by the PCCDHS are described as equal parts of the ongoing process of becoming culturally competent and are all assumed to be interrelated (Campinha-Bacote, 1999, 2002, 2011Fitzgerald & Campinha-Bacote, 2019). Although the process of cultural competence is described by the PCCDHS model from this point of view, the process remains sparsely studied in the literature. ...
... For the secondary analysis, the 29 items from the CCCTQ-PRE and their distribution over the four subscales were scrutinized in relation to the PCCDHS model (Campinha-Bacote, 1999, 2002, 2011 and assessed in relation to the results of the previous factor analysis (Wahlström et al, 2020). This review resulted in some of the items being sorted into other subscales to better fit the constructs of the theoretical model and the results of the factor analysis. ...
Introduction:
Encounters with children of foreign origin call for school nurses’ cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses’ cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness.
Methodology:
Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence.
Results:
The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R2 = 13.4, p = .06).
Discussion:
Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.
... 14,15 CC has become an unquestionable and ubiquitous aspect of health professional development and linked to efforts to eliminate culture-based health disparities through sympathetic health workers training. 16 A growing body of literature [17][18][19][20][21][22][23][24][25] recognizes that the health workforce or providers' CC assessment become a priority of health research, education, and practice in countries where health workers encounter culturally diverse patients to improve healthcare outcome quality. To realize the benefit of CC assessment, scholars develop, adapt, and validate CC measuring tools for nursing students 26 ; nurses active at work 10,27 ; rehabilitation practitioners 28 ; professionals living and working in multicultural settings 29 ; and healthcare providers. ...
... Her model is called the Process of CC in the Delivery of Health Care Services. 10,17,78 Her 1991 model incorporated a limited number of constructs such as cultural awareness (CA), cultural knowledge (CK), cultural skill (CSK), and cultural encounters (CE) without expressing their interdependence at the same time. She then decided to revise her model, adding a fifth construct called cultural sensitivity (CS) and changing the pictorial representation from linear to a set of circles. ...
... However, to use as a guiding framework for the selection and evaluation of items, the first group of experts and researchers have agreed to keep two CC tools such as IAPCC 17 and TSET. 98 This is because most the existing CC instrument development, validation, and adaptations are informed either by the two instruments or the frameworks they used to develop their respective tools. ...
Background: Cultural competence (CC) is a crucial attribute in attaining quality healthcare service outcomes, mitigating malfunctioning practices, and improving patient satisfaction. Studies suggested comprehensive CC assessment requires appraising existing CC tools to measure health workers’ CC in the Ethiopian context. Selecting existing CC tools, identifying sub-constructs, pinpointing demographic characteristics, and evaluating items are the study objectives.
Methods: 20 cultural competence tools of 20 to 83 items, 1-5 sub-constructs, and 4–10 Likert-Type rating options were identified, to be rated by eight experts in three groups. Consensus based Standards for the selection of health Measurement INstruments (COSMIN) and test construction literature are used to develop raters rating codes to compute Inter-Raters Reliability (IRR). The first group of three experts was rated to decide the inclusion of CC tools, factors, and demographic information. The second group of three experts selected six CC tools and 65 items. Two experts in the third group further evaluated the selected items.
Results: Reliability for the inclusion of CC tools, factors, and demographic variables were found to be 75%–87%, 50%–93%, and 50%–86% respectively. 13 items that violate test construction principles like absoluteness, endorsement, proneness to multiple interpretation, ambiguity and double barring were excluded. Cultural skill, cultural knowledge, and cultural awareness are the three most common sub-constructs. Cultural sensitivity, cultural desire, and cultural encounters are the least incorporated factors. Gender, age, language, department, patients encounter, education, and cultural diversity training are demographic variables to assess health workers’ CC.
Conclusions: Items of CC instruments cover cognitive, affective, and skill domains as prominent dimensions of CC tools. The reviewed tools consist of items that violate test construction principles. To conduct CC assessment in the Ethiopian context, apart from refining and validating selected items, generating additional items is recommended.
... Cultural competence (CC) in health care is defined as "a process in which the health care provider continually strives to achieve the ability to work effectively within the cultural context of a patient." This includes five key interdependent elements: cultural awareness, cultural knowledge, cultural ability, cultural encounters, and cultural desire [1] Campinha-Bacote developed her model in 1969, deriving her work from several authors in the multicultural field of healthcare [2][3][4]. The CC framework for this study is based on the synthesis of the culturally competent care models of Helman [5] and Campinha-Bacote [6]. ...
... Cultural competence and safety are considered as a continuous process consisting of five constructs [1,6]. These five constructs have an independent relationship; however, the model is dynamic, therefore, any improvement in one of them will result in improvements in all five constructs. ...
... The model of cultural competence and safety focuses on the process by which healthcare professionals develop cultural awareness, knowledge and skills that lead to changing attitudes, valuing diversity, and understanding their own cultural biases. Therefore, this process requires providers to be truly culturally competent, with prior cultural encounters, and to possess cultural awareness, knowledge, and skills that enable effective cross-cultural communication [1,2,6]. This process enhances the ability of healthcare providers to provide culturally safe care in a multicultural healthcare setting [9]. ...
Background
Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs.
Method
A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula.
Results
Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects’ syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses.
Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline.
Conclusion
Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects’ syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching–learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients’ cultural characteristics and needs.
... Cultural skills are the ability to gather cultural facts relevant to the patient's present health problem, and a cultural encounter is a cross-cultural engagement. Cultural competence is culturally desirable to be willing to provide care to patients of other cultures (Campinha-Bacote, 1999). It is essential to provide equity in health care because the aim of healthcare equity is to ensure that everyone can access affordable, culturally competent health care regardless of race, ethnicity, age, ability, sex, gender identity or expression, sexual orientation, nationality, socioeconomic status, and geographic location. ...
... Lack of cultural competence contributes to disparities in the delivery of health care services, poor health outcomes, and lower cost-effectiveness (Betancourt, Corbett & Bandaryk, 2014). It creates a barrier between the patient and healthcare provider and hinders safe patient care (Campinha-Bacote, 1999). Cultural conflicts and non-compliance can occur if professional nursing care is not compatible with the beliefs and values of the care receiver. ...
... Cultural awareness is the deliberate, cognitive process by which health care providers appreciate and become sensitive to the cultures, values, beliefs, ways of life, practices, and problemsolving strategies of their clients (Campinha-Bacote, 1999). It is the concept of having a basic understanding, acceptance, respect, and valuing of differences that exist between cultures (Sealey, 2003). ...
... The phenomenological case study methodology was selected to allow the experiences of a group to be supported by a common educational experience (Creswell, 2013). Concepts for the study were developed from research related to cultural competence strategies of patient care, experience with meeting cultural needs, and assessment of cultural competence education (Campinha-Bacote, 1998, 1999, 2001, 2002Campinha-Bacote et al, 1996;Cartwright & Shingles, 2011;Dunagan et al, 2014;Ford, 2003;Hawala-Druy & Hill, 2012;Horevitz et al, 2013;Lie et al, 2012;Long, 2012;Loue et al, 2015;Mayo et al, 2014;Meydanlioglu et al, 2015;Reyes et al, 2013;Sobel & Metzler Sawin, 2016;Steinke et al, 2015;Truong et al, 2017;Vasiliou et al, 2013;Volberding, 2014;Waite et al, 2013). A guided protocol with open-ended questions was developed to allow participants to share reflections and experiences within their employment setting when working with diverse patients. ...
... This study investigated the ability of athletic trainers to identify and enumerate culturally competent healthcare in clinical practice. The origin of cultural competence research in allied health professions started nearly 30 years ago (Campinha-Bacote, 1997, 1998, 1999, 2001, 2002Campinha-Bacote et al, 1996;Cartwright & Shingles, 2011). Today, the topic remains significantly relevant based on current societal and sport demographics (Grantham, 2015;National Athletic Trainers' Association, 2020b, 2020c, National Collegiate Athletic Association, 2020a, 2020bNynas, 2015;Truong et al, 2017;Volberding, 2013Volberding, , 2014Volberding, , 2015. ...
Athletic trainers are allied health professionals providing healthcare to individuals from diverse personal and ethnic backgrounds in various of practices settings. The purpose of this phenomenological case study was to explore cultural competence of practicing athletic trainers, credentialed to practice between one and three years, having graduated from one accredited athletic training program in Texas. The guided protocol included five research questions to assess knowledge and skills of the participants in provision of culturally competent strategies used in clinical practice. Eleven athletic trainers were interviewed to assess the ability to define cultural competence and enumerate experiences of implementation of effective patient care. The findings revealed the participants of this study provided culturally competent care to diverse patient groups. Additional findings included the ability to recognize the importance of effective communication, sociocultural considerations, and expanded needs for educational content for professional preparation. Findings in study suggested the following implications: athletic trainers must be aware of patient diversity, the relationships between athletic trainer and patient are important for assisting patient outcomes, effective use of appropriate communication techniques are paramount to patient outcomes, and athletic training curricula need to provide a foundation of cultural competence with expanded content on patient diversity and treatment methods for enhanced preparation of future athletic training professionals to provide effective culturally competent care.
... Cultural competence has been de ned as a process rather than an endpoint. In this process, nurses continuously endeavor to acquire information on the cultural content of individuals, families, and society in an effective manner [4,19,20]. The present study investigated the degree of cultural competence among nursing educators and faculties at medical sciences universities of the 2nd regional planning of Iran in 2021. ...
... The cultural awareness acquisition process is essential for the progress of cultural competence and is the most signi cant component in Campinha-Bacote's cultural competency model [22]. In this research, the highest score belonged to the cultural awareness subscale (4.11), which was expectable since cultural awareness was constantly recognized as the most paramount element of cultural competence regarding past research [19,23,24]. In her study in 2003, Sealey aimed to determine the cultural competence of faculty of baccalaureate nursing programs in Louisiana in the United States and estimated the mean score of the cultural awareness subscale at 4.14. ...
Background: One of the facets of nursing care, as a holistic profession, is cultural care. Considering the role of culture in individuals’ health behaviors, nurses are recommended to be mindful of cultural care. Since nursing educators should be culturally competent to teach cultural care to students, this study aimed to determine the cultural competence of nursing educators of medical sciences universities in the 2nd regional planning in Iran.
Methods: The current research was a descriptive and survey study framed within Campinha-Bacote’s cultural competency model. All nursing educators of universities of medical sciences in the 2nd regional planning of Iran (Tabriz, Urmia, Ardabil, Khoy, Maragheh, Sarab, and Khalkhal) were considered as research units, and the cultural diversity questionnaire for nursing faculties (CDQNE-R) was sent to them. Out of 129 questionnaires sent, 84 were turned back. The data were analyzed by the SPSS 26 software.
Results: The results of this study showed that the research participants agreed with the subscales of cultural awareness, cultural knowledge, cultural skill, and cultural desire according to Sealey and Yates’ interpretation scale. Also, the research units cast doubts on the cultural encounter subscale. The mean scores of the participants' responses to the questions of every subscale equaled 4.11, 3.52, 3.71, 3.38, and 3.93 for the subscales of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire, respectively. Likewise, the mean scores of participants' responses to the subscales of transcultural educational behaviors and general cultural competence equaled 3.90 and 3.73.
Conclusions: The nursing faculties participating in the present study agreed with the 4 sub-models of Campinha-Bacote cultural care and the presence of cultural competence criteria. Also, the research units had doubts about the cultural encounter subscale. This result means that the research participants were undecided about their level of participation in face-to-face interactions with people from different cultural, racial, and ethnic groups. According to the results of the study, it is important to hold transcultural nursing training workshops and courses to maintain and improve the level of cultural competence of nursing faculties at universities of medical sciences in the 2nd regional planning in Iran.
... In addition to the TACCT, the development of the TALHT was guided by the widely used theoretical model, 'The Process of Cultural Competence in the Delivery of Healthcare Services.' This model describes cultural competency as a perpetual process that healthcare providers continue to learn throughout their practice (Campinha-Bacote, 1999). In this model, five domains of cultural competency guide education and evaluation: (1) cultural awareness, (2) cultural knowledge, (3) cultural skill, (4) cultural encounters, and (5) cultural desires (Campinha-Bacote, 1999). ...
... This model describes cultural competency as a perpetual process that healthcare providers continue to learn throughout their practice (Campinha-Bacote, 1999). In this model, five domains of cultural competency guide education and evaluation: (1) cultural awareness, (2) cultural knowledge, (3) cultural skill, (4) cultural encounters, and (5) cultural desires (Campinha-Bacote, 1999). Although this model is focused on practicing healthcare providers, the domains helped guide item and domain construction for the TALHT. ...
Background
There is a lack of comprehensive lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) content in pre-licensure nursing curricula. LGBTQI+ people commonly experience mistreatment from nurses and healthcare providers due to a lack of knowledge or personal biases. To date, few instruments exist to guide LGBTQI+-specific curricular improvement.
Objectives/design/setting/participant/methods
Johns Hopkins School of Nursing LGBTQI+ Health Initiative and Emory University School of Nursing developed the Tool for Assessing LGBTQI+ Health Training (TALHT) to assist in evaluating gaps and redundancies in LGBTQI+ health content within pre-licensure nursing curricula. Face and content validity were evaluated among experts in LGBTQI+ health, curricular development, nursing education, and measure development (N = 22). The TALHT was modified based on expert feedback and a pilot with pre-licensure faculty (N = 13) to evaluate utility and acceptability of the refined measure.
Results
Face and content validity evaluation of the 60-item iteration of the TALHT showed that the majority of items were consistently relevant among external expert reviewers. However, the clarity and readability of items were lacking. We triangulated the quantitative and qualitative data from experts to adapt and reduce the number of items in the TALHT to 20 items. Pilot testing of the revised 20-item measure found that utility and acceptability of the tool were rated highly among pre-licensure faculty.
Conclusion
The validation of the TALHT comes at a time when this type of instrument is clearly needed. The Future of Nursing 2020–2030 report calls for nursing education to incorporate competencies in caring for diverse populations to promote health equity. The Essentials: Core Competencies for Professional Nursing Education calls for a transition to operationalization of competency-based nursing education. The TALHT provides faculty and programs with a valid and reliable means to operationalize implementation of those competencies as they pertain to LGBTQI+ health.
... First, cultural awareness relates to becoming appreciative of and sensitive to other cultures' values, beliefs, lifeways, practices and problem-solving strategies (Campinha-Bacote, 1999). It also entails examining one's cultural prejudices and biases towards other cultures and engaging in an in-depth exploration of one's cultural background (Suh, 2004). ...
This article presents a cultural competence-based (CCB) framework to analyse contemporary science culture. Starting from the observation that two separate views of culture-as-context and culture-as-practice cannot address the ongoing transitions in the contemporary sciences towards esoteric–exoteric trans-sphere governance and multicultural science, we introduce key ideas from ‘older’ varieties of competence-based culture theories. We argue that a spectrum of cultural and sociocultural systems shapes contemporary science culture by being (un)supportive of individual scientists acquiring cultural competence and guiding scientists’ research practices. In contrast, individual scientists’ cultural competence shapes the fabrication of cultural and sociocultural systems through their scientific practices, thereby shaping contemporary science cultures. We also synthesize different concepts of science culture, reflect the transitions in contemporary sciences and construct three dimensions of the cultural system, sociocultural system and cultural competence from various elements. By providing a conceptual framework that contributes to a better understanding and management of contemporary science culture, we hope to enhance effective work ethics and fit-for-purpose science knowledge to address emerging ‘wicked’ societal challenges.
... Cultural competence encompasses knowledge, attitudes and skills that enable cross-cultural communication and efficient interaction [4]. In healthcare, cultural competence is exhibited when practitioners understand and respect differences in health beliefs and behaviours, acknowledge and accredit variations within cultural groups, and adapt their practice to provide effective interventions for people from different ethnic backgrounds [5]. In newer contexts, cultural competence includes skills that enable a healthcare professional to navigate socio-cultural factors [6], including recognising and reconciling communication styles of patients from diverse cultural backgrounds and their significance in managing their illnesses or disease conditions [7,8]. ...
Background:
Being culturally competent would enhance the quality of care in multicultural healthcare settings like Nigeria, with over 200 million people, 500 languages, and 250 ethnic groups. This study investigated the levels of training and practice of cultural competence among clinical healthcare professionals in two purposively selected Nigerian tertiary hospitals.
Methods:
The research was a cross-sectional study. A multi-stage sampling technique was used to recruit participants who completed the adapted version of Cultural Competence Assessment Instrument (CCAI-UIC). Data were analysed using descriptive statistics, Pearson's correlation, ANOVA, and multivariate linear regression.
Results:
The participants were mainly women (66.4%), aged 34.98 ± 10.18 years, with ≤ 5 years of practice (64.6%). Personal competence had a positive weak correlation with age (p < 0.001), practice years (p = 0.01), training (p = 0.001), practice (p < 0.001), and organisational competence (p < 0.001). There were significant professional differences in the level of training (p = 0.005), and differences in training (p = 0.005), and personal competence (p = 0.015) across levels of educational qualifications. Increasing practise years (p = 0.05), medical/dental profession relative to nursing (p = 0.029), higher personal (p = 0.013), and organisational (p < 0.001) cultural competences were significant predictors of the level of training. Male gender (p = 0.005), higher years in practice (p = 0.05), local language ability (p = 0.037), rehabilitation professionals relative to nursing (p = 0.05), high culturally competent practice (p < 0.001), higher training opportunities (p = 0.013), and higher organisational competence (p = 0.001) were significant predictors of higher personal competence.
Conclusion:
About a third of the participants had no formal training in cultural competence. Incorporating cultural competence in Nigerian healthcare professionals' education curricula may enhance the quality of care in the multicultural setting.
... Errors in medical procedures could lead to the incorrect treatment of patients or endanger their lives. This is a prerequisite for building a relationship of trust with patients [41]. In Japan, nurses' main duties include personal care such as cleaning, transfer assistance, excretion assistance, and meal assistance. ...
Background: Migrant nurses require support when they work overseas, but what they need support for requires clarification.This study aimed to developed a scale measuring the nursing difficulties experienced by migrant nurses and examined its reliability and validity.
Methods: Using convenience sampling, China-educated nurses who worked as nurses in Japan were recruited. Exploratory factor analysis, criterion validity, and known-groups technique were used to assess the self-created 24-item scale of the nursing difficulties experienced by migrant nurses.
Results: A total of 662 migrant nurses who working in Japan participated, and 303 responses were collected. A three-factor scale with 20 items was identified, consisting of “language competence in medical conversation,” “considerate of patients’ feelings with nursing practice,” and “smooth relationships with colleagues.” The Cronbach’s α for the scale was .96, and αs ranged from .84 to .90 for each factor. The correlation between each factor ranged from .52 to .68, indicating significant positive correlations. Regarding validity, we based our analysis on the known-groups technique and found significant negative correlations with the number of years of nursing experience, which was hypothesized, and difficulty was reduced by accumulating nursing experience in Japan. Criterion validity correlations were noted between the developed scale and the Professional Identity Scale for Nurses (r = -0.29, 95% confidence interval -0.40 ~ -0.18) and the Burnout Assessment Tool (r = 0.36, 95% confidence interval 0.25 ~ 0.46).
Conclusions: The scale was confirmed to be valid and reliable, and it can be used to measure the nursing difficulties experienced by migrant nurses.
... Fourth, we excluded instruments that focus on specific contexts, because they cannot be easily compared with other instruments. Examples include instruments specifically related to the nursing/healthcare context with items about medical aspects or about the doctor-patient relationship, such as Campinha-Bacote (1999). Finally, we excluded instruments for which available information was too limited to perform an in-depth evaluation. ...
We provide a comprehensive review of how cross-cultural competence (CCC) has been measured over the past half-century in order to more closely align theoretical constructs and empirical measures. Based on a content analysis of 68 academic and commercial CCC instruments and a supplemental survey of 160 experts, we review the approaches used in these instruments to conceptualize and quantify CCC, discuss their limitations, and recommend best practices and directions for future researchers and practitioners when selecting and using CCC instruments or developing new alternatives.
... Não obstante o conceito de "competência cultural", na literatura da disciplina de Enfermagem, ter sido criado por Leininger, o estudo de Blanchet Garneau & Pepin (2015a) revelou que a definição de competência cultural mais frequentemente citada na literatura científica é da autoria de Campinha-Bacote (1999). A autora definiu este conceito como o processo em que o profissional de saúde se esforça continuamente para alcançar a capacidade de prestar um cuidado de saúde eficaz, tendo em conta o contexto cultural do cliente, entendido como a pessoa, a família ou a comunidade. ...
Os modelos de competência cultural guiam a ação de enfermeiro/a/s para uma prática de cuidado culturalmente competente, a qual se revela essencial no mundo multicultural em que vivemos. Considerando que um cuidado de enfermagem culturalmente relevante é um cuidado sensível, centrado na pessoa e que reflete a compreensão pela sua identidade cultural, as autoras procuraram conhecer o que tem sido publicado neste âmbito. A análise crítica que se apresenta parte dos conceitos de cultura e de competência cultural, assim como da sua relação com os desenhos conceptuais desenvolvidos pelos modelos de competência cultural. A literatura aponta a coexistência das perspetivas essencialista e construtivista do conceito de cultura, as quais, sendo antagónicas, determinam diferenças substanciais na construção dos modelos de competência cultural. As diferenças encontradas refletem-se também na definição de competência cultural em que se ancoram, dando origem à categorização em modelos teóricos e modelos metodológicos. As limitações observadas nos modelos de competência cultural relacionam-se principalmente com a visão essencialista da cultura em que se fundamentam e que pode reforçar uma posição etnocêntrica do cuidado. Em decorrência de serem muito abstratos, poucos modelos têm sido empiricamente testados. Outra limitação refere-se ao facto dos modelos avaliarem apenas a competência cultural dos profissionais de saúde, desconsiderando os clientes e a saúde. A conceção essencialista da cultura emerge também nas estratégias de ensino-aprendizagem mais utilizadas. A imersão cultural é apontada como estratégia central para o sucesso do treino da competência cultural, observada como um processo contínuo, dinâmico e em permanente evolução. O desenvolvimento da competência cultural é determinante para a prestação de um cuidado de enfermagem culturalmente relevante, o qual contribui para a redução das iniquidades na saúde nos contextos de diversidade cultural.
... (9,10,11,12) Leininger plantea que la competencia cultural es un requisito indispensable para brindar cuidados de enfermería con congruencia cultural, por lo que las enfermeras deben estar preparadas para ser competentes en el cuidado de personas de diferentes creencias y maneras de vivir. (13) Campinha-Bacote (14) señala que la competencia cultural es un proceso en el cual los profesionales sanitarios se preparan para brindar cuidados eficientes dentro del contexto cultural de la persona, familia y comunidad. ...
Introducción:
En el contexto de una sociedad global y diversa, los cuidados de enfermería con congruencia cultural son una necesidad apremiante. Los acelerados procesos migratorios, los cambios en la economía global y el reconocimiento universal de los derechos humanos son evidencias inequívocas de esta necesidad.
Objetivo:
Identificar las evidencias sobre los beneficios del cuidado de enfermería con congruencia cultural, en el bienestar y satisfacción del paciente.
Métodos:
Revisión sistemática integrativa de estudios originales publicados del 2000-2019, en español e inglés. Se utilizaron siete bases de datos: SciELO, Lilacs, EBSCO Host, Dialnet, DOAJ, Redalyc y Pubmed, con la estrategia de búsqueda: “cuidado cultural” AND “enfermería”, “cultural congruent care” AND “nursing” OR “cultural care” AND “nursing”, cuidado cultural. Se seleccionaron 14 artículos a los que se realizó análisis de contenido.
Conclusiones:
Los artículos seleccionados permitieron identificar los beneficios de los cuidados de enfermería con congruencia cultural observados en diferentes grupos como adultos, adultos mayores y sus cuidadores, madres lactantes, escolares y adolescentes. Los beneficios del cuidado cultural se evidenciaron al abordar fenómenos como la funcionalidad familiar, la sobrecarga del cuidador, la promoción de la lactancia materna, el manejo del estrés, la ansiedad, la depresión y la calidad de vida de las sobrevivientes de cáncer de mama. Los cuidados de enfermería con congruencia cultural evidenciaron el desarrollo de una mejor relación enfermera-paciente y una mayor satisfacción de los pacientes y sus familias.
... It was developed by the researcher based on previous studies [11,[13][14][15][16] and mainly according to the five constructs of the Campinha Bacote Model viz. cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire [12]. ...
Background: Cultural competence (CC) is essential for nurses because cultural diversity challenges health care providers, especially nurses, to provide culturally competent care to diverse populations. Cultural competence training in nursing education is a timely need in Sri Lanka and worldwide.Objective: The purpose of this study is to compare the level of cultural competence between senior and junior student nurses studying in the School of Nursing at Kurunegala and Vavuniya to identify how current nursing education influences CC improvement.Methods: A comparative descriptive cross-sectional study was conducted in Schools of Nursing, Vavuniya and Kurunegala, Sri Lanka. A systematic random sampling technique was used to select participants from first and third-year nursing students. Data were collected by a validated self-administered questionnaire and analysed using Statistical Packages for Social Sciences (SPSS) version 22. Ethical approval was obtained from the Ethics Review Committee of the Faculty of Medicine, Colombo, Sri Lanka.Results: The mean score of junior student nurses’ CC was 3.72 (SD±0.38). The mean scores of cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire of junior student nurses were 3.80 (±0.37), 3.55 (±0.54), 3.48 (±0.71), 3.54 (±0.56) and 4.26 (±0.46), respectively. The mean score of CC of senior student nurses was 3.92 (SD±0.28), and the mean scores of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire were 3.94(±0.35), 4.00 (±0.38), 3.77 (±0.50), 3.63 (±0.44), and 4.29 (±0.49), respectively. Independent sample t-test indicated no significant difference between the senior and junior student nurses when compared to CC (p = 0.697).Conclusion: The CC was at a moderate level for both junior and senior students and there is an essential need to increase it to the highest level possible due to the cultural diversity of the patients that they have to provide healthcare in Sri Lanka.
... While multi-dimensional measures of cultural competency exist, they are often designed for professional populations and/or focus on specific aspects of cultural competency [3]. Cultural competency measures commonly include factors pertaining to professionals' awareness, knowledge, and skills (e.g., Multicultural Counseling Inventory, Inventory for Assessing Process of Cultural Competence among Health Professionals; Multicultural Awareness, Knowledge, and Skills Survey) [25][26][27]. Other measures for professionals include some of these components (e.g., Cultural Self-efficacy Scale, factors representing knowledge and skills; Multicultural Counseling knowledge and Awareness Scale, factors resenting knowledge and awareness) or focus on other factors broadly associated with cultural competency (e.g., Cultural Competence Self-Assessment Questionnaire, factors representing knowledge of community, personal involvement, service delivery, proactive, community outreach, etc.) [28,29]. ...
Measuring cultural competence has been difficult for conceptual and practical reasons. Yet, professional guidelines and stated values call for training to improve cultural competence. To develop a strong evidence-base for training and improving cultural competence, professionals need reliable and valid measures to capture meaningful changes in cultural competence training. We developed a measure for cultural competence that could be used in a general population to measure changes in awareness, knowledge, and skills in interacting with culturally diverse others. We built an 81-item scale with items conceptually categorized into awareness, knowledge, and skills and was presented to an expert panel for feedback. For evaluation, a national panel of 204 adults responded to the new scale and other measures associated with cultural competence. Factor analysis revealed four factors with strong reliabilities: Awareness of Self, Awareness of Others, Proactive Skills Development, and Knowledge (as = .87-.92). The final overall scale, Awareness, Knowledge, Skills-General (ASK-G) had 37 items and strong reliability (a = .94). The ASK-G was then compared to validated scales to provide evidence of concurrent, convergent, and divergent validity. Strong evidence emerged for these. The ASK-G is a promising tool to measure cultural competence in a general population.
... 27 Health extension workers have sufficient understanding of the cultural aspects of rural communities; however, there were times when they displayed behaviour of which is aggravated by cultural shock, 7,28 as well as limited cultural awareness and sensitivity. 29,30 The side-by-side presentation of the quantitative and qualitative results is presented in Table 2. ...
Background:
Namibia is undergoing an epidemiological transition after decline in local transmission of malaria, and the country is now in a position to move towards eliminating local transmission by 2030. However, malaria prevalence cannot be adequately explained from medical and modern prevention points of view alone. The persistence of malaria might appear as a result of not recognising sociocultural factors that seem useful in the prevention of malaria, Hence, studies on sociocultural factors are limited.
Aim:
The aim of this study was to describe the sociocultural factors that influence the prevention of malaria in Ohangwena region.
Setting:
The study was conducted in Ohangwena region of northern Namibia.
Methods:
This study was a cross-sectional study and a mixed methods, convergent parallel design was employed.
Results:
The major theme revealed that traditional prevention methods of malaria are widely available in rural communities. The best accepted traditional prevention methods include tumbleweed, bitter bush and animal dung. Quantitative findings indicated that 67.0% of participants felt that nets are expensive. Key barriers included the long distance to access health facilities (29.1%), long waiting times (25.8%) and the lack of money to pay for services and transport (22.5%).
Conclusion:
The limited access to and cost of Western prevention methods minimise protection because of priority and resource allocations, but it could be mitigated with the use of locally available traditional prevention practices used for many years in curbing malaria. There is a need to create awareness about socioculturally congruent malaria care.Contribution: This study has revealed the need to combine standard prevention with traditional prevention practices in the fight against malaria, and it intensified research focusing on interventions that address sociocultural factors for the prevention of malaria in endemic regions. In addition, part of the novelty of the study is establishing the need to test the efficacy of traditional practices used.
... Both male and female students perceived female faculty as role models, while only male students perceived male faculty as role models. Implicit gender bias has been reported in students' medical and non-medical academic faculty evaluations [19][20][21][22][23]. One study reported that women are evaluated differently from men in two key areas [24]. ...
Objective
The objective of this study was to evaluate students’ perceptions of differences in learning from faculty of different gender.
Method
This cross-sectional study involved pre-doctoral dental students (years 2 to 4) who had a simulation and/or clinical experience working with dental faculty for at least one year. Students completed a self-administered questionnaire with three sections: demographic, difference between faculty related to their knowledge, skill, critical thinking, acceptance of cultural differences, and students’ preferences in working with faculty in specialty clinics.
Results
A total of 136 students completed the survey (75.4% response rate). Participants were 52.6% women, 62.2% self-identified as Caucasian/White. Students reported that female faculty are more understanding (p = 0.001) and accepting of cultural differences (p<0.001) compared to male faculty (p<0.05). Students reported perceiving female faculty more as being a role model than male faculty (p = 0.034). When comparing male and female students, male student’s perception of male faculty as a role model was significantly higher than female students (p<0.05). There was no significant difference in student’s perceptions between male and female faculty in their knowledge, skills, compassion, critical thinking, providing feedback, communication skills, and grading (p>0.05). Caucasian/White students perceived female faculty as more encouraging for discussions and male faculty as more rigid/inflexible (p<0.05).
Conclusions
Students perceived female faculty as more understanding and culturally competent compared to male faculty. There were no significant differences in student’s perceptions of male and female faculty in their knowledge, skills, compassion, critical thinking, feedback, communication skills, and grading. Students perceived female faculty as role models more than male faculty.
... For many years, cultural competence as a construct was widely trained and used 1 to define a medical professional's ability to work within varied cultural contexts and to effectively and sensitively engage with people of diverse cultures. 2 The assumption underlying cultural competence, however, is reductionist, assuming that there are a finite number of skills that can be learned to become literate in a culture. 3,4 Cultural humility is still an emerging concept, but it has been proposed as a flexible and ongoing process for engaging with people of different cultures. ...
Summary statement:
Standardized patients (SPs) play a pivotal role in medical education. They are proxies for real patients, preparing students to meet the challenges of excellent patient care. Human simulation, with SPs, is used for teaching and assessing communication and clinical skills in medical education around the world. Standardized patients work individually with other faculty, students, or in conjunction with medical faculty to facilitate learning with feedback. In most simulation centers, SPs receive extensive training in communication and clinical skills, yet they inhabit territory often unrecognized as professional in medical education. The manner in which SPs are seen and treated by faculty and students may be a reflection of how real patients are seen and treated-not always heard, not always respected-and this tension detracts from both simulated and real patient encounters. Exploring how SPs, as proxies for real patients, are treated in medical education is a key to what we might learn and how we might close gaps in cultural respect and, ultimately, in patient care.
Dünyanın göçmen sayısındaki artış Türkiye’yi de etkilemiş, savaş ve göçün de etkisiyle kültürel çeşitliliği artırmıştır. Artan
bu kültürel çeşitlilik sağlık bakımı erişimi ve sunumunda eşitsizliklere neden olmakta ve hemşirelerin kültürel olarak
uygun ve yeterli bakım vermesini zorunlu kılmaktadır. Hemşirelerin hastalara uygun kültürel yaklaşım geliştirme, kültürel
yeterli olma ve bakım sağlamada rehber olan bazı kültürel modeller bulunmaktadır. Bu derleme çalışmasında hemşirelere
rehberlik eden bir kültürel model odaklanmayı ve modelin hemşirelik araştırmalarında nasıl kullanıldığına dair bilgi
sunarak hemşirelerin klinikte ve araştırmalardaki model kullanımını artırmak hedeflenmektedir. Çalışmada kültürel
yeterli olma sürecini tanımlayan Campinha-Bacote Kültürel Yeterlilik Süreci Modeli ele alınmıştır. Model, kültürel tevazu
üzerine kurulan, kültürel farkındalık, kültürel bilgi, kültürel beceri, kültürel karşılaşmalar ve kültürel istek olarak beş
ayrı yapıdan oluşmaktadır. Hemşirelik araştırmalarında kesitsel-tanımlayıcı, nitel, deneysel ve karma tür olarak kültürel
yeterliliği belirleme, kültürel yeterliliğe dair çeşitli eğitim materyallerinin etkinliğini değerlendirme ve açık uçlu soru
hazırlamada ayrıca belirli bir konuya özgü kültürel yeterliliğin analizinde veya nasıl geliştirilebileceğine dair yapılacak
kapsam incelemelerinin yürütülmesinde Campinha-Bacote Modeli rahatlıkla kullanılabilmektedir. Hemşirelerin kültürel
yeterliliklerinin geliştirilmesi ve araştırmalarda kültürel modellerin kullanılmasında Camphina-Bacote modeli oldukça
uygundur. Hemşirelerin yeterli, kaliteli ve etkin klinik bakım vermesi ve akademik araştırmaların bilimsel kalitesini
artırması açısından bu ve diğer kültürel modellerin kullanımına dair çeşitli eğitimler düzenlenebilir.
Introduction
Doctor of Physical Therapy (DPT) education programs have been charged with developing a culturally competent health care workforce to better meet the needs of diverse communities and reduce health inequities. The purpose of this longitudinal, quasi-experimental educational intervention study was to examine the effects of an integrated DPT program curriculum on student cultural competence at a public, midsize, midwestern university.
Review of Literature
There is an abundance of research on conceptual models and frameworks for the development of cultural competence within health care education with many studies relying on self-perception to measure outcomes. Using the Model of Interculturalization as a theoretical framework, this study explored the development of cultural competence among DPT students using the Intercultural Development Inventory (IDI).
Subjects
A purposeful convenience sample of DPT students ( n = 177) was used.
Methods
The IDI was administered to 3 student cohorts. One cohort had data at 4 different time points, including upon entry into the program (baseline) and at the end of the first, second, and third year. Two cohorts had data for 2 time points. IDI Developmental Orientation (DO) and Orientation Gap (OG) scores were used to measure cultural competence and accuracy of self-perception of cultural competence. Data analysis was performed using descriptive statistics, independent and dependent sample t -tests, and analysis of variances.
Results
There were no differences between the cohorts. There were statistically significant improvements in both cultural competence (DO scores) and accuracy of self-perception of cultural competence (OG scores) for 2 cohorts. However, significant change only occurred during year 1. No other differences across time for any of the cohorts were significant.
Discussion and Conclusion
Findings can be leveraged and incorporated into recommendations for curricular revision and program reform targeting cultural competence development among DPT students.
Objectives
To clarify the conceptual structure of “cultural competence (CC)” among Japanese public health nurses (PHNs), to enhance culturally appropriate support.
Methods
A modified grounded theory approach (M‐GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M‐GTA.
Result
Five categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients’ cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice.
Conclusions
The concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.
Introduction
In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies.
The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short‐term placements in health professions education.
Methods
A systematic review was conducted using a meta‐narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio‐economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions.
Results
This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process.
Conclusion
The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.
Introduction
Structural inequity and stigma impose barriers toward substance use prevention and recovery support for persons with an Islamic migration background in non-Islamic majority countries. Similar issues of differential power often keep them silenced in research. Therefore, we explore the continuum of care for substance use problems regarding persons with an Islamic migration background.
Methods
We draw from a co-creative case study with Arafat, whose lived and professional experiences as a Muslim with a history of problem substance working in the field, were blended with academic literature through the process of ‘plugging in’.
Results
We discuss (1) culturally competent and selective substance use prevention, (2) facilitating access to adequate support services, (3) culturally competent substance use treatment and (4) supporting long-term recovery for persons with an Islamic background from a combined academic, professional and lived experiences perspective.
Discussion
We discuss the need for tailored interventions that are able to overcome structural inequities and address ethnocultural sensitivities, needs and strengths. Intermediary community organizations, cultural competence of treatment and recovery-oriented systems of care may bridge the gaps between what is needed and what is available. However, it is important to be conscious that hands-on solutions at the personal level do not absolve the responsibility of searching for systemic solutions. Furthermore, awareness of the fine line between cultural competence and culturalization, taking into account the danger of essentializing, othering and overlooking other intersectional traits of diversity, is needed.
As educational systems emphasize and experiment with forms of online and remote learning, it is increasingly important to investigate the cultural competence of instructional designers. This chapter addresses the experiences of instructional designers in a 3D virtual learning environment designed for development of cultural competence. Design-based research (DBR) and user experience (UX) methodologies were employed to explore experience of six instructional designers in 3D virtual environment. A taxonomy of experience (ToE) established by Coxon guided qualitative data collection and analysis. Through examples and data, the chapter emphasizes the necessity for instructional designers to keep in mind the challenge of cultural diversity in the backgrounds of students and their own, and bring guidelines and principles into culturally sensitive and responsive instructional design processes. The authors recommend four future research directions, including cross-cultural instructional designer competencies along with research into cultural personas, avatars, and guest-host relations.
Background and Purpose: Previous research shows significant benefits resulting from improving culturally competent nursing care. Thus, the purpose of this study was to translate, adapt, and validate the Cultural Competence Assessment (CCA) in a sample of Portuguese nurses. Methods: A psychometric study of the CCA, after translation into European Portuguese, was performed with a snowball sample of 284 nurses. Participants were asked to fill in a sociodemographic questionnaire and the CCA. Results: The four-factor model of the CCA (Portuguese version) exhibited satisfactory indices of fitness without item nine. Cronbach’s alpha was 0.85. Correlations between subscales and the total score scale were strong and statistically significant. Conclusions: These data add to the cultural competence knowledge of nurses to promote better practices and culturally competent care.
Background:
Clinician bias contributes to health disparities; therefore, educational standards and professional expectations incorporate cultural humility. Vague standards and numerous pedagogical methods make implementing an effective and uniform curriculum challenging. Classroom and clinical faculty's attitudes and behaviors are pivotal; however, evidence on roles beyond instruction is lacking.
Purpose:
This study explored physical therapy (PT) students' perceptions of faculty's role in improving their cultural humility.
Methods:
This study was rooted in a phenomenological approach that incorporated elements of both descriptive and interpretive phenomenology. Thirteen first-year PT students participated in one-on-one interviews which underwent reflexive thematic analysis.
Results:
Reflexive thematic analysis generated two hundred-ninety codes, six categories, and one overarching theme. Dissonance emerged between students' perceptions of faculty's role and the explicit and implicit curriculum.
Conclusion:
Explicit messaging from classroom instruction and implicit messaging from clinical encounters and unspoken attitudes, values, and behaviors were disparate. Faculty role modeling, diversity, cultural awareness, and perceived comfort interacting with a diverse patient population improved students' self-confidence and cultural humility. Professional development including field experience with a cognitive apprenticeship approach, and standardized, discipline-specific cultural humility competencies may provide uniform and clear guidelines.
Bir coğrafi yer değişimi olarak tanımlanan göç, dünya çapında artarak devam ederken özellikle zorunlu göç edenler için önemli sorunları da beraberinde getirmekte ve toplumun genelinde sosyal yaşamı, kültürel normları, ekonomik ve fizikî koşullarla birlikte göçmen sağlığına da olumsuz etki etmektedir. Kadınlar, mülteci grubunun dezavantajlı gruplarındandır. Türkiye’de; Irak, Rusya Federasyonu, Türkmenistan, İran, Suriye, Azerbaycan, Özbekistan, Afganistan, Ukrayna, Kazakistan, Suriye vb. ülkelerden mülteci statüsünde gelenler arasında Suriye’den gelenlerin çoğunluğu oluşturduğu görülmekte ve kalıcı nüfus oluşturan topluluğun neredeyse yarısının kadın olması dikkat çekmektedir. Bu da, politikalar belirlenirken üzerinde durulması gereken önemli bir konudur. Kadınların yaşam tarzı, sağlık inançları ve sağlık uygulamalarının dikkate alındığı bir yaklaşım; hem kadınlar hem sağlık profesyonelleri için pratikte stres ve çatışmayı azaltılabilir ve sağlık bakımında verimi artırabilir. Doğurganlık dönemi; 15-49 yaş aralığı, kadınların en yüksek oranda hizmete ihtiyaç duydukları dönem olarak bilinmektedir. Bu dönemdeki kadınların aile planlaması, üreme ve kadın sağlığı ile ilgili sağlık hizmetlerine ulaşması ve alabilmesi önemlidir. Süreçte hizmet sunacak sağlık profesyonelleri arasında ebeler yer almalıdır. Görev tanımları gereği ebeler, verecekleri kültürlerarası ebelik bakımı ile meslek temsilcisi sivil toplum kuruluşları ve diğer disiplinlerle ortak çalışma sonucu süreç yönetimine katkı sağlayabilir. Bu çalışma, göçmen kadın sağlığına genel bakışla birlikte göç sürecinden en çok etkilenen kadınlara destek sağlamada ve uyumunu kolaylaştırmada ebelerin, kültürlerarası yaklaşımla katkı sağlayabilecek diğer bir disiplin olduğunu göstermek amacı ile ele alınmıştır.
Background:
Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients.
Aims:
The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts.
Methods:
Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out.
Results:
The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general.
Conclusions:
Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.
Background:
Cultural competence resides at the core of undergraduate and postgraduate medical and health professional education. The evolution of studies on cultural competence has resulted in the existence of multiple theoretical frameworks and models, each emphasising certain elements of culturally appropriate care, but generally lacking in providing a coherent and systematic approach to teaching this subject.
Methods:
Following a meta-ethnographic approach, a systematic search of five databases was undertaken to identify relevant articles published between 1990 and 2022. After citation searching and abstract and full article screening, a consensus was reached on 59 articles for final inclusion. Key constructs and concepts of cultural competence were synthesised and presented as themes, using the lens of critical theory.
Results:
Three key themes were identified: competences; roles and identities; structural competency. Actionable concepts and themes were incorporated into a new transformative ACT cultural model that consists of three key domains: activate consciousness, connect relations, and transform to true cultural care.
Conclusion:
This critical review provides an up-to-date synthesis of studies that conceptualise cultural competence frameworks and models in international medical and healthcare settings. The ACT cultural model provides a set of guiding principles for culturally appropriate care, to support high-quality educational interventions.
As educational systems emphasize and experiment with forms of online and remote learning, it is increasingly important to investigate the cultural competence of instructional designers. This chapter addresses the experiences of instructional designers in a 3D virtual learning environment designed for development of cultural competence. Design-based research (DBR) and user experience (UX) methodologies were employed to explore experience of six instructional designers in 3D virtual environment. A taxonomy of experience (ToE) established by Coxon guided qualitative data collection and analysis. Through examples and data, the chapter emphasizes the necessity for instructional designers to keep in mind the challenge of cultural diversity in the backgrounds of students and their own, and bring guidelines and principles into culturally sensitive and responsive instructional design processes. The authors recommend four future research directions, including cross-cultural instructional designer competencies along with research into cultural personas, avatars, and guest-host relations.
background: Being culturally competent overcomes the challenges medical professionals are experiencing when caring for their
culture diverse patients.
Objectives: To assess the cultural competency knowledge and the Challenges in Nursing Practice among nursing students in International
University of Africa.
Method: qualitative method was used to assess the knowledge of nursing students in IUA. Purposive sampling of (15) students from different
Africa countries were enrolled in the study. The data collected by interviewing students from second to fourth year in Faculty of Nursing. In
addition, three focus groups were conducted with students at second, third, and fourth level. The data were coded and thematic analysis
technique was used to analyze the transcripts of the focus groups. They were asked about their awareness on culture diversity and the challenges
they are facing in with Sudanese patients. Results: All the participants were female between the age of (21 -27)All were knowledgeable after
they came to Sudan but two third of participants were willing to learn more about Sudanese culture and a third were not willing to learn and
engage with Sudan culture. The main challenge facing the students is language barrier. Conclusion: The students are aware of cultural diversity,
have little knowledge about Sudanese culture and half of them are able to deal the challenges. Almost all of them are willing to engage in the
Sudanese culture.
Recommendation: The study recommended that the faculty of nursing science should include transcultural competency course in the curriculum.
In this study, we explored the notions of cultural learning from non-western perspectives by focusing on the experiences of Chinese undergraduate students from the field of Public Health in the United States of America. We used Weick’s (1995) Sensemaking theory to understand how Chinese undergraduate students made sense of their experiences of learning about other cultures in both personal and professional spaces. We applied a qualitative research design and used interviews, a focus group, and reflection papers for data collection. We found that Chinese undergraduate students focused on social behaviors and attitudes. They used comparison as a tool to make sense of new experiences. Their sensemaking process shifted from simple to complex concepts, and guided learning helped them understand complex social issues related to public health in the U.S. They did not consider learning related to public health knowledge, English language, or life skills as cultural learning.
Objectives
The purpose of this study was to investigate the relationship between two measures of cultural competence, one more widely used, the other designed for healthcare students. It was hypothesized that there would be strong correlations allowing educators to forgo one measure for the other based on utility, resources, and sustainability.
Design
Exploratory, cross sectional design
Setting
One US Doctor of Physical Therapy (DPT) academic program.
Participants
145 DPT students.
Main outcome measures
Intercultural Development Inventory® (IDI) and Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV).
Results
There were significant (negligible to low, rho = 0.16 to 0.28; p<.05) relationships between the IAPCC-SV total and three constructs with IDI Perceived Orientation scores, and the IAPCCSV total and two constructs with the IDI Developmental Orientation scores. There were significant (negligible to low, rho = 0.18 to 0.35; p<.05) relationships between IAPCC-SV total and construct scores with the IDI Acceptance and Adaptation orientation scores. Students with scores in an IDI DO of Acceptance or Adaptation were significantly more likely to have an IAPCC-SV score in the category of Culturally Competent (X2=3.70, p=0.05).
Conclusions
The discordance of the two measures suggests that the instruments measure unrelated constructs (worldviews, attributes or skills) of cultural competence that are exclusive to each measure and context dependent. Context specific measures may not be generalized to a greater worldview, and visa versa. Multimodal assessment that triangulates data and supports student learning outcomes may be the most effective strategy to capture the impact of curriculum and/or a global learning experience on students’ development of cultural competence.
Culture influences an individual's perception of “health” and “sickness”. Therefore, cultural competence assessment of healthcare professionals is very important. Existing assessment scales have limited application in India due to the nation's rich cultural diversity and heterogeneous healthcare streams. This study was undertaken to develop and validate a cultural competence assessment tool for healthcare professionals in India. A cross-sectional study using convenience sampling was conducted following all standard steps among 290 healthcare professionals in India. Item reduction was followed by estimation of validity and reliability. Responses were recorded on a five-point Likert scale, ranging from strongly disagree to strongly agree. The resultant tool, named Cultural Competence Assessment Tool–India (CCT-I) showed an acceptable internal consistency (Cronbach's alpha =0.734). Inter-rater agreement was 81.43%. Face, content, and construct validity were demonstrated. There was no statistically significant difference in cultural competence between the healthcare streams based on years of clinical experience. There was statistically significant difference between streams of healthcare (p-value =0.009) and also between dentistry and Ayurveda groups (p-value = 0.003). This comprehensive tool can be used as the first step toward designing cultural competence training of healthcare manpower and the establishment of culturally sensitive healthcare organizations.
Introduction
For occupational therapy students, international experiences and access to a global curriculum develops understanding of broad cultural and contextual determinants of health and wellbeing. International placements or study abroad opportunities are not possible for many students and many universities are developing alternative internationalisation opportunities. The aim of this review was to determine what is known from the existing literature on the use of online international student collaboration in occupational therapy curricula.
Method
A scoping review design was used to search relevant literature on online international student collaboration in occupational therapy education, following a methodological framework for conducting scoping reviews. Seven databases were searched. Search included all articles published up until November 2020.
Findings
The database searches yielded a total of 2011 results. Following screening and review of articles ten papers met the inclusion criteria and were included in the review. The studies were charted and discussed in the areas of format of the online interactions, reported outcomes of the online interactions, barriers and facilitators in implementation.
Conclusion
Findings inform curricula designers establishing online international learning and those conducting research in this area. Outcomes indicate the breadth of student learning including culture, diversity, as well as the social determinants of occupational engagement and participation.
Registration
Protocol Registered: 2020-07-06, available on Open Science Framework (OSF) at https://osf.io/wfkjy
Aim of this study: Was the calculation of the cost of the most common medical and nursing procedures to the intensive care unit.
Design/methods: Data were collected from 60 patients for 166 days of hospitalization. The study’s duration was about 5 months and the data collection started at 1/6/2005 and finished at 13/11/2005.The procedures which had been calculated were: the pressure ulcer care, the arterial line placement, the peripheral and central venous line placement, patient transportation for CT, the bronchoaspiration, the receipt of arterial blood gases, sputum and urine, the tracheostomy tube`s change, the Levin`s and the Swan-Ganz catheter placement.The statistical analyses were performed with SPSS 13 and ø2 tests.
Results: The patients had an average age of 53.62years. The cost of the procedures were found: central venous line placement 67.03±29.18 euro, arterial line placement 3.92±0.18 euro, tracheostomy tube`s change 17.23±0.33 euro, bronchoaspiration 3.32±0.03 euro, patient transportation for CT 0.49±0 euro, receipt of arterial blood gases 1.6±0 euro, sputum`s reception 3.46±0.56 euro, reception of urine 1.26±0.43 euro, pressure ulcer care 8.48±0.28 euro, peripheral venous line placement 1.71±0.28 euro, Levin`s
placement 5.81±0.62 euro ëáé placement of Swan-Ganz 265.94±0.86 euro.
Conclusions: The study show the cost of the most common medical and nursing procedures to an intensive care unit and the relation that the cost has with the experience of the health care providers.
Aim:
To determine the level of critical cultural competence (CCC) among Chinese clinical nurses and explore its influencing factors.
Background:
Previous research has only focused on the theoretical model of CCC and the development of assessment tools; however, no large-scale study has been conducted on the level of clinical nurses' critical cultural competence and its influencing factors.
Method:
Clinical nurses in 14 Level A tertiary hospitals (n=3858) were surveyed using Almutairi's Critical Cultural Competence Scale (CCCS). Descriptive, univariate, and multivariate analyses were performed.
Results:
The mean score of CCC was 4.44 (SD=0.33). Critical empowerment (M=4.85, SD=0.58) and critical awareness (M=3.57, SD=0.99) had the highest and lowest scores, respectively. Female nurses, nurses in the nursing department, and nurses with higher positions had higher CCC.
Conclusion:
The CCC of clinical nurses can be strengthened through targeted training, especially considering the fact that male and low-ranking nurses who had the lower level of CCC work in different departments. Implications for nursing management Hospital administrators should pay attention to the importance of culture and cultural differences among different countries or ethnic groups. Creating an equal and fair nursing environment and encouraging nurses to provide critical cultural nursing is important.
The article examines the ongoing paradigm shift on enhancing diversity climates in Swedish human services organizations. Traditional social policy arrangements based on a monocultural style of service provision has been challenged by the growing need for cultural competence and ethnic sensitivity. A study of cultural competence enhancement finds the recruitment of ethnic social workers to be the most efficient strategy for making social services more culturally sensitive. At both the operational and the managerial level, ethnic staff contribute to regular training and the updating of staff cultural competences, as well as to the strategic diversity plans of entire organizations.
Social science differs from the other basic medical sciences in that its perspective for understanding illness is not centered on processes within the individual. For this reason the relevance of social science knowledge to clinical practice is not obvious to many medical educators and students. Initial efforts at the University of North Carolina to develop a social science curriculum that is obviously relevant are described. Strategies include the use of small-group seminars taught by social-scientist/clinician teams and an organizing framework which links social science knowledge to clinical practice. Response to the curriculum from faculty and students has been encouraging.
Only within the last few years have social service professionals shown any considerable interest in cultural differences among their clients. There have always been a few individuals, usually from minority groups, who have been concerned with the significance of cultural variations for social work and its intervention programs. But more recently, words and phrases such as "culture," "cross cultural," "extended family," and "personal network" have caught on with the profession as a whole. The language of "cultural awareness" and "cultural sensitivity" has begun to permeate social service training, both in classrooms and on the job.
Outlines and challenges some prevalent myths and misunderstandings that have made it difficult to develop appropriate curricula and relevant counseling/therapy competencies for the different cultures in the US. Cross-cultural counseling/therapy is defined, and the adoption by the American Psychological Association of specific cross-cultural counseling and therapy competencies is recommended as a guideline for accreditation criteria. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Today a new generation of nurses with different cultural insights and a deeper appreciation of human life and values are developing a sensitivity for culturally appropriate individualized care. Although literature on clinical approaches in cultural diverse situations is mushrooming, relatively few theories on transcultural nursing provide a systematic method for comprehensive nursing assessment, which is necessary for both the nursing practitioner and the researcher to provide appropriate nursing care tailored for each client. Below an outline of the areas that need to be assessed when working with clients from multicultural populations.
Percutaneous entry into the distal radial artery and selective coronarography using a French 5 sheath and preshaded catheters were attempted in 100 patients with a normal Allen test. Cannulation of the radial artery was not possible in ten patients, and selective catheterization of the coronary arteries was unsuccessful in two. Manipulation of catheters presented no problem, and arterial spasm was rarely observed, only before the use of a 23-cm-long sheath. Only two complications without symptoms were observed: arterial dissection of the brachial artery in one patient and occlusion of the radial artery in another. With experience, this approach may become as effective and possibly safer than the transbrachial entry.
Social science differs from the other basic medical sciences in that its perspective for understanding illness is not centered on processes within the individual. For this reason the relevance of social science knowledge to clinical practice is not obvious to many medical educators and students. Initial efforts at the University of North Carolina to develop a social science curriculum that is obviously relevant are described. Strategies include the use of small-group seminars taught by social-scientist/clinician teams and an organizing framework which links social science knowledge to clinical practice. Response to the curriculum from faculty and students has been encouraging.
This article presents a conceptual model for enhancing cultural competence in psychiatric nursing. The model, The Culturally Competent Model of Care, views cultural awareness, cultural knowledge, cultural skill, and cultural encounter as critical components of cultural competence. In this dynamic model, cultural competence is viewed as a process, not an end-point in which the psychiatric nurse continuously strives to effectively work within the cultural context of individuals, families, and/or communities from diverse cultural/ethnic backgrounds. The Culturally Competent Model of Care encourages psychiatric nurses to see themselves as always in the process of becoming culturally competent, rather than being culturally competent.
Demographic changes are occurring in some states at a faster rate than in others; yet it is projected that these changes will be mirrored throughout the United States in the coming half-century. In California, persons of Hispanic origin now constitute more than 25 per cent of the population, and noncaucasian racial groups total 31 per cent. As a health care discipline, it is critical that nursing recruit individuals into the profession who reflect the population that nurses serve, and the curriculum and clinical learning opportunities should be culturally relevant. Moreover, federally funded research is now required to generate knowledge about all groups, regardless of ethnicity, race, or gender. Current demographic data provide information about the emerging ethnic and racial composition of the population, birthrates, and types of health care services that are likely to be needed. Implications of these trends can guide goal setting for educational programs, research, and clinical practice to ensure that academic nursing addresses the public need.
Blochs assessment guide for ethnic/cultural variations
- B Bloch
Clinical guidelines in cross-cultural mental health
- F Jacobsen
Beyond cultural sensitivity
- J Campinha-Bacote
A culturally competent model of nursing management
- J Campinha-Bacote
Transforming health care through cultural competence training
- N Chrisman
- P Schultz
Nichols' model of the philosophical aspects of cultural difference
- E Nichols
Social work practice and people of color: A process-stage approach
- D Lum
Annotated bibliography for assessing cultural competence in healthcare settings: Models for application
- J Campinha-Bacote
Cultural competence: An interlocking paradigm
- B Warren