The Relationship of Provider Cultural Competence and Utilization of Prenatal Care in the Hmong of Minnesota

The Relationship of Provider Cultural Competence and Utilization of Prenatal Care in the Hmong of Minnesota by Cynthia J. Larson M.S.P.H. , Walden University, 2007 B.A., Metrostate University, 2005 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University February 2012 ABSTRACT Experts suggest that the cultural competence of healthcare providers is a critical factor impacting healthcare services to the ethnically diverse patient populations in the U. S. and that it may play a role in improving outcomes and reducing health disparities; however, the association between cultural competence and health outcomes remains unclear. This study used a cross-sectional quantitative design grounded by cultural competency constructs and the ethnic origins theory to explore the relationships between provider cultural competence, adequacy of prenatal care, and neonatal health outcomes in Hmong women, a population whose cultural beliefs affect their use of early and adequate prenatal care. Patient perception and provider self-reported cultural competence data were collected from 80 patients and their 19 corresponding providers. No correlation was found between the patient and provider total cultural competency scores, nor were they predictive of adequacy of prenatal care or neonatal outcomes in multiple regression analyses. However, 3 specific constructs related to physicians’ ability to communicate and demonstrate culturally competent behaviors predicted adequacy of prenatal care. There was a moderate but negative correlation between patient and provider cultural competence subscores and a significant difference in 6 of 13 survey questions suggesting discordance between patient and provider perceptions regarding communication during the healthcare encounter. Implications for positive social change include new prenatal care delivery models that incorporate Hmong health beliefs that may increase the number of Hmong women who receive adequate prenatal care, thus potentially improving birth outcomes. This can lead to reduced health disparities experienced by the Hmong.Experts suggest that the cultural competence of healthcare providers is a critical factor impacting healthcare services to the ethnically diverse patient populations in the U. S. and that it may play a role in improving outcomes and reducing health disparities; however, the association between cultural competence and health outcomes remains unclear. This study used a cross-sectional quantitative design grounded by cultural competency constructs and the ethnic origins theory to explore the relationships between provider cultural competence, adequacy of prenatal care, and neonatal health outcomes in Hmong women, a population whose cultural beliefs affect their use of early and adequate prenatal care. Patient perception and provider self-reported cultural competence data were collected from 80 patients and their 19 corresponding providers. No correlation was found between the patient and provider total cultural competency scores, nor were they predictive of adequacy of prenatal care or neonatal outcomes in multiple regression analyses. However, 3 specific constructs related to physicians’ ability to communicate and demonstrate culturally competent behaviors predicted adequacy of prenatal care. There was a moderate but negative correlation between patient and provider cultural competence subscores and a significant difference in 6 of 13 survey questions suggesting discordance between patient and provider perceptions regarding communication during the healthcare encounter. Implications for positive social change include new prenatal care delivery models that incorporate Hmong health beliefs that may increase the number of Hmong women who receive adequate prenatal care, thus potentially improving birth outcomes. This can lead to reduced health disparities experienced by the Hmong. The Relationship of Provider Cultural Competence and Utilization of Prenatal Care in the Hmong of Minnesota by Cynthia J. Larson M.S.P.H. , Walden University, 2007 B.A., Metrostate University, 2005 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University February, 2012 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 1346 UMI 3494420 Copyright 2012 by ProQuest LLC. UMI Number: 3494420 DEDICATION I would like to dedicate this Doctoral dissertation to my family and friends for their steadfast support and encouragement.