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Organizational characteristics associated with the provision of cultural competency training in home and hospice care agencies

AbuDagga, Azza; Weech-Maldonado, Robert; Tian, Fang

doi: 10.1097/HMR.0000000000000144

Background: Despite the increasing interest in community-based health care, little information exists on cultural competency training (CCT) and its predictors in this setting.

Purpose: We examined the associations between six organizational characteristics and the provision of CCT in home health care and hospice agencies.

Methodology: We used cross-sectional data from the agency component of the 2007 National Home and Hospice Care Survey. The CCT provision composite was composed of three items: whether the agency provides mandatory cultural training to understand cultural differences/beliefs that may affect delivery of services to (a) all administrators, clerical, and management staff; (b) all direct service providers; and (c) all volunteers. Organizational characteristics were volume, ownership status, chain membership, teaching status, Joint Commission accreditation status, and formal contracts.

Principal Findings: The weighted sample (n = 14,469) had a mean CCT provision score of 1.75 (range = 0–3). Our ordinal logistic regression model showed that Joint Commission accreditation increased CCT provision odds in the home health (odds ratio [OR] = 2.07, 95% confidence interval [CI] [1.01, 4.24]) and hospice (OR = 4.40, 95% CI [2.07, 9.38]) settings. Teaching status increased CCT provision odds (OR = 2.71, 95% CI [1.19, 6.17]) in the home health setting. Formal contracts increased CCT provision odds (OR = 4.03, 95% CI [1.80, 9.00]), whereas not-for-profit ownership decreased CCT provision odds (OR = 0.19; 95% CI [0.07, 0.50]) in the hospice setting.

Practice Implications: Home health care and hospice agencies need to increase their CCT practices to overcome health disparities in an increasingly diverse and aging population.

Azza AbuDagga, PhD, MHA, is Health Services Researcher, Health Research Group, Public Citizen, Washington, DC. E-mail:

Robert Weech-Maldonado, PhD, MBA, is Professor and L.R. Jordan Endowed Chair, Department of Health Services Administration, University of Alabama at Birmingham.

Fang Tian, PhD, MS, is Research Manager, Government and Academic Research, HealthCore, Inc., Alexandria, Virginia.

AA and FT received no funding to conduct or publish this study. RWM was supported in part by Grant Number P30AG031054 from the Deep South Resource Center for Minority Aging Research (RCMAR).

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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