Cultural competence training for health care professionals

Cultural competence training for health care professionals focuses on skills and knowledge that value diversity, understand and respond to cultural differences, and increase awareness of providers’ and care organizations’ cultural norms. Trainings can provide facts about patient cultures or include more complex interventions such as intercultural communication skills training, exploration of potential barriers to care, and institution of policies that are sensitive to the needs of patients from culturally and linguistically diverse (CALD) backgrounds (Govere 2016*, Cochrane-Horvat 2014*).

Expected Beneficial Outcomes (Rated)

  • Increased cultural understanding and skills

Other Potential Beneficial Outcomes

  • Increased patient satisfaction

  • Improved health outcomes

Evidence of Effectiveness

There is strong evidence that cultural competence training for health care professionals improves providers’ knowledge, understanding, and skills for treating patients from culturally, linguistically, and socio-economically diverse backgrounds (Govere 2016*, Gallagher 2015*, Truong 2014, Renzaho 2013, Like 2011, Patel 2019*, Horky 2017*, Cruz-Oliver 2017*, Fox 2016*). Additional evidence is needed to determine effects on patient care and health outcomes (Butler 2016, Cochrane-Horvat 2014*, Truong 2014, Like 2011, Shepherd 2019).

Caring for Women Veterans, a cultural competence training program for Veterans Affairs (VA) health care providers, improved providers’ gender sensitivity and knowledge and increased training uptake more when delivered in in-person groups compared to a standard web-based training (Fox 2016*). A Florida-based study of an online, cross-cultural curriculum-based training increased cultural knowledge, skills, and attitudes for pediatric residents caring for children with chronic respiratory conditions and their families (Horky 2017*). A video-based telenovela style seminar improved health care professionals’ knowledge and skills at providing culturally sensitive end of life care for Hispanic elders and increased awareness of caregivers’ burdens (Cruz-Oliver 2017*). In a Massachusetts-based study, cultural competence training increased provider awareness of racial disparities in diabetes care (Like 2011).

Cultural competence training can improve patient satisfaction (Govere 2016*, Truong 2014, Renzaho 2013, Like 2011, Clifford 2015*). In some circumstances, patients whose providers completed training report better opinions of their clinicians or participate longer in mental health counseling than patients whose providers did not (Cochrane-Horvat 2014*).

When preparing cultural competence trainings, experts recommend considering an organization’s strengths and weaknesses and the particular needs of its patients, in conjunction with systemic changes to accommodate patient culture for better patient outcomes (Truong 2014). For safety net providers, trainings in integrated care settings are recommended with the support of leadership within hospitals, clinics, and government agencies (McGregor 2019*). Experts also suggest that cultural competency training begin in medical and nursing schools and continue throughout professional practice (Young 2016a).

In some cases, educational trainings for providers treating lesbian, gay, bisexual, and transgender (LGBT) patients may not change providers’ comfort with or stigma toward this population (Butler 2016). Experts suggest that systemic cross-cultural approaches can foster cultural safety and help providers recognize their own racism, power imbalances, and culture biases (Shepherd 2019a). Connecting cultural competency to professional values rather than legal or organizational requirements, nurturing a safe and respectful learning environment, cultivating cultural humility, and avoiding stereotypes throughout trainings are also recommended (Like 2011).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Washington, California, Connecticut, New Jersey, and New Mexico require cultural competence training for health professionals (US DHHS-Think cultural health). New Jersey also requires such training for medical and dental school graduation and continuing medical education for physicians, dentists (NJ Health-CLAS policy), and podiatrists (Like 2011).

The federal Office of Minority Health offers cultural competence training resources and publishes the National Culturally and Linguistically Appropriate Services (CLAS) standards which, as of 2016, 32 states are actively implementing through strategic planning, training and technical assistance, and dissemination of the National CLAS Standards (US DHHS OMH-CLAS 2016). Think Cultural Health, a program of the US Department of Health and Human Services, offers a free, online continuing education training course for behavioral health professionals to improve cultural competency (US DHHS-Think cultural health training).

American medical schools also have cultural competence accreditation requirements (Like 2011). The Association of American Medical Colleges and its hundreds of member institutions are committed to preparing an inclusive and culturally competent health care workforce that provides culturally responsive, quality care for a multicultural society (AAMC-Diverse workforce).

Implementation Resources

US DHHS-Think cultural health - US Department of Health and Human Services (US DHHS). Think cultural health.

US DHHS-Cultural competence - US Department of Health and Human Services (US DHHS). Health Resources and Services Administration (HRSA). Culture, language and health literacy.

US DHHS OMH-CLAS 2016 - US Department of Health and Human Services (US DHHS), Office of Minority Health (OMH). National standards for culturally and linguistically appropriate services (CLAS) in health and health care: Compendium of state-sponsored national CLAS Standards implementation activities. 2016.

AAMC-TACCT - Association of American Medical Colleges (AAMC). Tool for assessing cultural competence training (TACCT).

AHRQ-CCT CA - Agency for Healthcare Research and Quality (AHRQ). State legislation requires inclusion of cultural and linguistic competence in continuing medical education, increasing acceptance of their importance by educational programs and clinicians. Rockville: AHRQ Agency Healthcare Innovations Exchange.

NJ Health-CC resources - State of New Jersey Department of Health (NJ Health), Minority and Multicultural Health. Cultural competency resources.

Citations - Evidence

* Journal subscription may be required for access.

Govere 2016* - Govere L, Govere EM. How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews on Evidence-Based Nursing. 2016;13(6):402-410.

Gallagher 2015* - Gallagher RW, Polanin JR. A meta-analysis of educational interventions designed to enhance cultural competence in professional nurses and nursing students. Nurse Education Today. 2015;35(2):333-40.

Truong 2014 - Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research. 2014;14(1):99.

Renzaho 2013 - Renzaho AMN, Romios P, Crock C, Sønderlund AL. The effectiveness of cultural competence programs in ethnic minority patient-centered health care — a systematic review of the literature. International Journal for Quality in Health Care. 2013;25(3):261–269.

Like 2011 - Like RC. Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions. 2011;31(3):196-206.

Patel 2019* - Patel MR, Song PXK, Bruzzese JM, et al. Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial. Journal of Asthma. 2019;56(3):273-284.

Horky 2017* - Horky S, Andreola J, Black E, Lossius M. Evaluation of a cross cultural curriculum: Changing knowledge, attitudes and skills in pediatric residents. Maternal and Child Health Journal. 2017;21(7):1537-1543.

Cruz-Oliver 2017* - Cruz-Oliver DM, Malmstrom TK, Roegner M, Yeo G. Evaluation of a video-based seminar to raise health care professionals’ awareness of culturally sensitive end-of-life care. Journal of Pain and Symptom Management. 2017;54(4):546-554.

Fox 2016* - Fox AB, Hamilton AB, Frayne SM, et al. Effectiveness of an evidence-based quality improvement approach to cultural competence training: The veterans affairs’ “Caring for Women Veterans” program. Journal of Continuing Education in the Health Professions. 2016;36(2):96-103.

Butler 2016 - Butler M. Improving cultural competence to reduce health disparities for priority populations. Effective Health Care Program. 2016;(170):1-19.

Cochrane-Horvat 2014* - Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals: Review. Cochrane Database of Systematic Reviews. 2014;(5):CD009405.

Shepherd 2019 - Shepherd SM. Cultural awareness workshops: Limitations and practical consequences. BMC Medical Education. 2019;19(1):1-10.

Clifford 2015* - Clifford A, McCalman J, Bainbridge R, Tsey K. Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: A systematic review. International Journal for Quality in Health Care. 2015;27(2):89-98.

McGregor 2019* - McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & Disease. 2019;29:359-364.

Young 2016a - Young S, Guo KL. Cultural diversity training: The necessity of cultural competence for health care providers and in nursing practice. Health Care Manager. 2016;35(2):94-102.

Shepherd 2019a - Shepherd SM, Willis-Esqueda C, Newton D, Sivasubramaniam D, Paradies Y. The challenge of cultural competence in the workplace: Perspectives of healthcare providers. BMC Health Services Research. 2019;19(1):1-11.

Citations - Implementation Examples

* Journal subscription may be required for access.

US DHHS-Think cultural health - US Department of Health and Human Services (US DHHS). Think cultural health.

NJ Health-CLAS policy - State of New Jersey Department of Health (NJ Health), Minority and Multicultural Health. Human resources services circular: Cultural competence CLAS policy and practice. 2018.

Like 2011 - Like RC. Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions. 2011;31(3):196-206.

US DHHS OMH-CLAS 2016 - US Department of Health and Human Services (US DHHS), Office of Minority Health (OMH). National standards for culturally and linguistically appropriate services (CLAS) in health and health care: Compendium of state-sponsored national CLAS Standards implementation activities. 2016.

US DHHS-Think cultural health training - US Department of Health and Human Services (US DHHS). Think cultural health. Improving cultural competency for behavioral health professionals: Free, online training.

AAMC-Diverse workforce - Association of American Medical Colleges (AAMC). Creating and sustaining a diverse and culturally responsive workforce.

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