Cultural competence: identifying and addressing an essential element for healthcare services
Creators: name: Nkhoma, Gloria
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420399
subject: Health services and systems not elsewhere classified

description: Background: CALD (Culturally and Linguistically Diverse) populations are known to have poorer health outcomes in comparison to host populations. CALD populations may encounter challenges accessing community mainstream healthcare services due to lack of capacity and capabilities by healthcare services providers to address their cultural and linguistic needs, therefore Cultural competence is an essential driver for healthcare services uptake and intervention compliance for CALD populations. 

Attainment of cultural competence is not an immediate process but is continuous, commencing the journey as a student is appropriate. The ultimate goal in developing cultural competence is to promote the building of a culturally safe healthcare environment for both patients and healthcare professionals. Culturally safe healthcare services are cognisant of the cultural needs of the patients and promote positive therapeutic relationships between patients and healthcare workers. 

The overall aim of the thesis was to identify and address an essential element for healthcare services for CALD populations in Australia. The work undertaken in this thesis was originally focused on asylum seekers but during the course of the thesis moved to encompass CALD populations. 

Research Methods: A mixed method approach was employed in this research where both qualitative and quantitative data collection methods were used. 

Initially a narrative review was conducted to determine what was conducive for promoting health and self-care in asylum seekers as a specific CALD population through identifying and evaluating policies and initiatives/ programmes that existed in high income host countries.

Expert views and recommendations form healthcare workers who engaged with CALD populations were then undertaken.

Interviews and a survey were used to explore and determine the existing knowledge base of pharmacy students on cultural competence and their attitudes and perceptions / views on asylum seekers.  

A systematic review was conducted to identify what was available in literature on cultural competence teaching and learning interventions and evaluation of their impact in healthcare profession students. 

The systematic review informed the development, implementation and evaluation of a cultural competence intervention for pharmacy students. The intervention was an online self-learning cultural competence module utilising vignettes-story telling methods to teach cultural competence. The module entailed short narratives which elicited responses from case scenarios for the purpose of gathering attitudes, beliefs and actions through the use of a hypothetical persons in a cultural competence context. A validated survey was used pre-and post- intervention as a self-report outcome measure of cultural competence. 

Results: The narrative review’s main findings on what comprised initiatives/ programmes that promoted health and self-care asylum seekers were; (1) Scarcity of well documented health models which address the needs of asylum seekers with CNCDs living in high income nations; (2) poor health outcomes due to healthcare services restrictions and (3) Paucity of research on CNCDs in this populace which could inform the development of  effective self-care models.

Recommendations from interviews with healthcare professionals, who engaged with asylum seekers, were as following: (1) Enhancing cultural competence in healthcare workers, health promotion, English language proficiency and food and pharmacy waiver programmes; (2) Building cultural competence capacity in community non-asylum seekers’ services; (3) Unrestrictive healthcare access; (4) Lifting working restrictions to enable medication and food affordability and (5) Robust screening for CNCDs similar to screening for infectious diseases and mental health conditions. 

The survey with pharmacy students identified that a substantial number of students showed high cultural competence in the domains of cultural awareness and desires while fewer students showed high cultural competence in the domain of cultural encounters. Low scores on the cultural competence domain of encounters may be attributed to insufficient cultural competence learning exposure. 

The Interview with students identified the current curriculum as insufficient in preparing them as culturally competent future healthcare professionals. Their main recommendations for an appropriate cultural competence curriculum were: (1) more hands on learning approaches; (2) use of interactive methods such as simulations, vignettes, workshops; and (3) lived experience speakers.

The systematic review identified cultural competence curriculum approaches such as, simulation, didactic teaching, role play, community activities and international clinical placements. There was paucity of research on gauging cultural competence interventions efficacy and the optimum intervention exposure duration.

Researcher designed self-directed online interactive cultural competence teaching module was effective for teaching cultural competence. The use of vignettes-story telling as a method of teaching cultural competence was informed by literature and students improved cultural competence, where pre-to-post mean scores improved significantly (p &lt; .0005). There was no significant association observed between any of the demographic groups with changes in all the three domains (cognitive, practical and affective). Students’ feedback was positive on the learning of cultural competence and understanding its importance in health practice. 

Conclusion: Early stages of the thesis identified that additional research is needed on cogent health models that are effective in promoting health in asylum seekers with CNCDs living in communities of high-income nations and address bridging the gap of inequalities in asylum seekers and the host population.

A systematic approach (narrative review, engaging with key professionals with expert knowledge, literature inquiry-systematic review and engagement with pharmacy students to inform on the design, implementation and evaluation of cultural competence intervention) was utilised to rationalise cultural competence as an essential healthcare element in CALD populations. Cultural competence has the potential to shape the healthcare services uptake and interventions landscape where healthcare services that are short of adequately addressing the needs of CALD populations inhibit the uptake of interventions such as vaccinations and health promotion programmes /initiatives.

Using vignettes as a method for teaching transcultural skills and cultural competence was effective as shown by the students’ overall improvement in cognitive, practical and affective mean scores from pre-to post-intervention. The greatest positive mean score change was evidenced in the practical domain and least in the affective domain. Further research is needed to determine why most cultural competence teaching methods produce little or no meaningful change in enhancing the affective domain.

Cultural competence curriculum designs require continuous evaluation to ascertain that they are appropriate for the rapidly evolving needs of culturally diverse populations.