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Cultural Competence: A Systematic Review of Health Care Provider Educational Interventions

Beach, Mary Catherine MD, MPH*†‡§; Price, Eboni G. MD†; Gary, Tiffany L. PhD*¶; Robinson, Karen A. MSc†; Gozu, Aysegul MD†; Palacio, Ana MD, MPH†; Smarth, Carole MD∥; Jenckes, Mollie W. MHS, RN†; Feuerstein, Carolyn BA†; Bass, Eric B. MD, MPH†‡¶; Powe, Neil R. MD, MPH, MBA*†‡¶; Cooper, Lisa A. MD, MPH*†‡

Medical Care:
Original Article
Abstract

Objective: We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals.

Design: This was a systematic literature review and analysis.

Methods: We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria.

Main Outcome Measures: We sought evidence of the effectiveness and costs of cultural competence training of health professionals.

Results: Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs).

Conclusions: Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

Author Information

From the *Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University; the †Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine; the ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; the §Phoebe R. Berman Bioethics Institute, Johns Hopkins University; the ¶Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; and the ∥Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.

Reprints: Mary Catherine Beach, MD, MPH, Assistant Professor of Medicine and Health Policy and Management, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287. E-mail: mcbeach@jhmi.edu.

© 2005 Lippincott Williams & Wilkins, Inc.