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Bias and Discrimination in
Health Care |
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Barr, D A and
Jacobs, E. A.
Racial differences in the use of cardiac catheterization. New
England Journal of Medicine 2001; 345(11), 839-840. This is a
comment on the study by Chen et al. in the issue of May 10, 2001
that found there was no difference between
the race of the patients and the race of the physicians
in the use of cardiac catheterization. Barr and Jacobs
made separate and perceptive criticisms of the study.
|
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Blendon, R. J., Schoen, C., DesRoches, C. M., Osborn, R.,
Scoles, K. L., & Zapert, K.
Inequities in health care: a five-country survey. Health Affairs
2002; 21 (3): 182-91. In this study comparing satisfaction in health
care in Australia, Canada, New Zealand, United Kingdom, and the United
States, lower income citizens in all five countries expressed less
satisfaction than those with higher incomes. Low income US citizens
encountered more difficulty with access to health care than did
counterparts from the other four countries. |
|
Bhopal, R.
Racism in medicine. British Medical Journal 2001; 322(7301):
1503-1504. This editorial argued that the interventions to respond to
health disparities in England must address racism along with equity in
health care delivery. One approach is to focus on improving services
based on patient satisfaction surveys. |
|
Boehmer, U., Kressin, N. R., Berlowitz, D. R.,
Christiansen, C. L., Kazis, L. E., & Jones, J. A.
Self-reported vs administrative race/ethnicity data and study results.
Am J Public Health 2002; 92(9): 1471-1472. In this study of whether
differences in reporting of race/ethnicity led to different results in
regard to use of therapeutic root canal therapy vs tooth extraction,
Further, data on race and ethnicity were more frequently wrong for
patients other than Whites. |
|
Katz, J. N.
Patient preferences and health disparities. JAMA 2001; 286(12):
1506-1509. This study found that managed care enrollees were more likely
than those with fee-for-service insurance to receive influenza
vaccination, with the adjusted racial disparity of vaccination in
fee-for-service vs. managed care being statistically significant.
|
|
Geiger, H. J.
Racial stereotyping and medicine: the need for cultural competence.
Canadian Medical Association Journal 2001; 164(12),
1699-1700. Author attributed most inadvertent bias and stereotyping
in health care to time constraints and cognitive complexity due to
multi-tasking. |
|
Gerbert, B.,
Berg-Smith, S., Mancuso, M., Caspers, N., Danley, D., Herzig, K., et
al.
Video study of physician selection: preferences in the face of
diversity. Journal of Family Practice 2003; 52(7):
552-559. Using videos of six physicians, approximately half of the study participants initially chose
a same-race video doctor. After viewing a video health promotion
message by the physicians, 57% of Asian Americans and
other-ethnicity participants chose a non-European American video
doctor. The authors concluded that many Americans will accept
physicians of a different ethnicity and gender. |
|
Green, A. R.
The human face of health disparities. Public Health Reports 2003;
118(4): 303-308. This article used photographs to demonstrate important
landmarks in research on racial/ethnic disparities in health.
|
|
Institute of Medicine.
Unequal Treatment: Confronting Racial & Ethnic Disparities
in Health Care. 2002. This is the landmark report
that demonstrated disparities in health care and health
status outcomes. There are links to the report summary and
slide presentation.
|
|
Katz, J. N.
Patient preferences and health disparities. JAMA 2001; 286(12):
1506-1509. This study found that managed care enrollees were more likely
than those with fee-for-service insurance to receive influenza
vaccination, with the adjusted racial disparity of vaccination in
fee-for-service vs. managed care being statistically significant.
|
|
Lane, W. G.,
Rubin, D. M., Monteith, R., & Christian, C. W.
Racial differences in the evaluation of pediatric fractures for
physical abuse. JAMA 2003; 288(13): 1603-1609. This
study found that while
minority children in this sample had higher rates of
abusive fractures, they were also more likely to be
evaluated and reported for suspected abuse, even after
controlling for the likelihood of abusive injury. The authors
concluded that there are racial differences in the evaluation and
reporting of pediatric fractures for child abuse,
particularly in toddlers with accidental injuries. |
|
LaVeist,TA, Rolley NC, & Diala
C.
Prevalence and patterns of discrimination among U.S. health care
consumers. International Journal of Health Services 2003, 33(2), 331-344. In this study
of perceived discrimination in health care settings, the variables
of interest were: age, race/ethnicity, gender, income and
self-reported health status. Investigators found that youth,
African-American and Hispanic race/ethnicity, low-income, female
gender and poor self-reported health status were significantly more
correlated with perception of discrimination. Authors note that
while perceived discrimination is not the same as validated
discrimination, perceptions are important because they impact
patient behavior.
|
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Manoach, S. M., & Goldfrank, L. R.
Social bias and injustice in the current health care system.
Academic Emergency Medicine 2002; 9(3): 241-247. A review of the
inequities in the health care system that result in health and health
care disparities from the point of view of an ER physician.
|
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Nelson, A. R.
Unequal treatment: report of the Institute of Medicine on racial and
ethnic disparities in healthcare. Annals of Thoracic Surgery 2003;
76(4), S1377-1381. The author, a member of the IOM Committee that
researched and wrote Unequal Treatment, described the committee process,
methods and findings.
|
|
Rathore, S. S., Lenert, L. A., Weinfurt, K. P., Tinoco,
A., Taleghani, C. K., Harless, W., et al.
The effects of patient sex and race on medical students' ratings of
quality of life. American Journal of Medicine 2002; 108(7):
561-566. This study found that medical students’ perceptions of health
states differ for a white male patient actor compared with a black
female patient actor. Their conclusion was that patient characteristics
do influence perceptions among medical students even before the start of
their clinical rotations and suggest the need for cross-cultural
educational programs at the earliest stages of medical training.
|
|
Schulman, K. A., Berlin, J.
A., Harless, W., Kerner, J. F., Sistrunk, S., Gersh, B. J., et al.
The effect of race and sex on physicians' recommendations for cardiac
catheterization. New England Journal of Medicine 1999;340(8):
618-626. In this study, a total of 720 physicians at two national
meetings of organizations of primary care physicians gave
recommendations on treatment of a hypothetical patient portrayed by
actors with particular characteristics in scripted interviews about
their symptoms. Analysis of race–sex interactions showed that black
women were significantly less likely to be referred for catheterization
than white men. The conclusion was that the race and sex of a patient
independently influenced how physicians managed chest pain |
|
Schulz, A. J.,
Williams, D. R., Israel, B. A., & Lempert, L. B.
Racial and spatial relations as fundamental determinants of health
in Detroit. Milbank Quarterly 2002; 80(4): 677-707. The
authors used the Detroit metropolitan area as a case study to
demonstrate how race-based segregation forcing African Americans to
live in deteriorating urban areas with little access to
economic, social,
and physical resources essential to health contributes to health
disparities. |
|
Snowden, L. R.
Bias in mental health assessment and intervention: theory and evidence.
American Journal of Public Health 2003; 93(2), 239-243. The article
reviewed when and how disparities in access, continuity and quality of
care can affect mental health assessments and interventions. More
research is needed to separate bias from other barriers to care, and
expose the bias at various levels in the health care system:
practitioner, practice network/program, or community so that it can be
effectively addressed. See comment by Cabassa L J. Integrating
cross-cultural psychiatry into the study of mental health disparities.
American Journal of Public Health 2003; 93 (7) 1034 and author’s reply
1034-5 |
|
Swartz, M. H.,
Colliver, J. A., & Robbs, R. S. (2001). The interaction of
examinee's ethnicity and standardized patient's ethnicity: an
extended analysis. Acad Med, 76(10 Suppl), S96-98. |
|
Racial and Ethnic
Health & Health Care Disparities |
|
Advisory
Committee on Training in Primary Care Medicine & Dentistry.
Health Disparities by State HRSA. Uses four indices to compare
health status by racial/ethnic group: 1. infant mortality; 2.
diabetes prevalence; 3. dental visits; 4. age adjusted death rates.
|
|
Agency for Healthcare
Research and Quality.
The
National Healthcare Disparities Report. First published
in 2003, this report was updated in 2005 to document trends in
socioeconomic, ethnic and racial disparities in health |
|
Becker, G.,
Beyene, Y., Newsom, E. M., & Rodgers, D. V.
Knowledge and care of chronic illness in three ethnic minority
groups. Fam Med 1998; 30(3): 173-178. This article
described a qualitative
study with participants from three ethnic groups: African American,
Latino and Filipino-American. Comparison of the three groups
revealed social and cultural differences and similarities that
affected the management of chronic illness and indicated differences
in their level of understanding of their illnesses as chronic.
|
|
Boudreaux, E.
D., Emond, S. D., Clark, S., & Camargo, C. A., Jr.
Acute asthma among adults presenting to the emergency department:
the role of race/ethnicity and socioeconomic status. Chest
2003; 124(3): 803-812. This study found that the management for
all
racial/ethnic groups was similar during the index visit. Hospital
admission rates were higher among black and Hispanic
patients after adjustment for confounding factors. The authors
attributed most observed acute asthma differences to socioeconomic
differences. |
|
Burroughs, V.
J., Maxey, R. W., & Levy, R. A.
Racial and ethnic differences in response to medicines: towards
individualized pharmaceutical treatment. Journal of the
National Medical Association 2002; 94(10 Suppl): 1-26. This
article reviewed causes of variability in response to medication,
pharmogenetics of drug metabolism, examples of drugs to which racial
and ethnic groups respond different, implications of these
differences for formulary decisions, and recommendations for
policy. |
|
Caetano, R.
Alcohol-related health disparities and treatment-related
epidemiological findings among whites, blacks, and Hispanics in the
United States. Alcoholism: Clinical & Experimental Research
2003; 27(8): 1337-1339. This article presented a brief review
of the evidence on health disparities for alcohol abuse among these
three groups. |
|
Chen, A. Y., &
Escarce, J. J. (2004).
Quantifying income-related inequality in
healthcare delivery in the United States. Medical Care, 42(1),
38-47. The authors used an “index of inequality” to compare the
relation of medical expenditures to income by age. Inequalities in
care received were found highest in the oldest adults, in spite of
Medicare. |
|
Christian, J.
B., Lapane, K. L., & Toppa, R. S. (2003).
Racial disparities in receipt of secondary stroke prevention agents
among US nursing home residents. Stroke, 34(11),
2693-2697. This study found that
only half of the
elderly population studied received any pharmacological
agent for secondary prevention of stroke. The authors
concluded that interventions are needed to improve the
pharmacological management of recurrent stroke regardless
of race are needed in nursing homes.
|
|
Cohen, J. J.
Disparities in health care: an overview. Academic Emergency
Medicine 2003; 10(11): 1155-1160.
his article
summarized the data demonstrating health disparities documented in
the Institute of Medicine’s, Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care. The author
supported the key recommendations of the IOM Report: raising
awareness of the health disparities, developing training strategies
for students in training, and recruiting more minorities into the
physician workforce. |
|
Degenholtz, H.
B., Arnold, R. A., Meisel, A., & Lave, J. R.
Persistence of racial disparities in advance care plan documents
among nursing home residents. Journal of the American
Geriatrics Society 2002; 50(2): 378-381. This study found a low
overall rate for advance plan documents among nursing home residents
(20%), as well as an association between race and lack of these
documents. |
|
Egede, L. E.,
& Zheng, D. (2003).
Racial/ethnic differences in adult vaccination among individuals
with diabetes. American Journal of Public Health 2003; 93(2):
324-329. This study found that rates of influenza and pneumococcal
vaccination were correlated with race, independent of access to
care, health care coverage and SES. |
|
Fiscella, K.,
Franks, P., Gold, M. R., & Clancy, C. M.
Inequality in quality: addressing socioeconomic, racial, and ethnic
disparities in health care. JAMA 2000; 283(19):
2579-2584. This article proposed
principles to address and track health disparities
through modifications in quality performance measures:
clinical performance measures should be stratified by
race/ethnicity and socioeconomic position for public
reporting; population-wide monitoring should incorporate
adjustment for race/ethnicity and socioeconomic position; and
strategies to adjust payment for race/ethnicity and
socioeconomic position should be considered to reflect
the known effects of both on morbidity.
|
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Flores, G.,
Fuentes-Afflick, E., Barbot, O., Carter-Pokras, O., Claudio, L.,
Lara, M., et al. (2002).
The health of Latino children: urgent priorities, unanswered
questions, and a research agenda. JAMA 2002; 288(1),
82-90. Latinos compose the largest group of minority children, and
suffer from many health disparities.
This article suggested areas in which more
research is needed and ways to improve the health of Latino
children. |
|
Gadegbeku C,
Freeman M, Agodoa L.
Racial disparities in renal replacement therapy. Journal of
the National Medical Assocociation 2002; 94(8 Suppl): 45S-54S.
This article briefly summarized the excess burden among
African-American,
Hispanic, Native Americans, and Asian/Pacific Islanders
of end-stage
renal disease (ESRD),
evidence of racial and ethnic disparities in renal
replacement therapy (RRT), and disparities (biologic and
socioeconomic) that limit use of kidney transplantation in certain
minority populations. |
|
Garner, E. I.
Cervical cancer: disparities in screening, treatment, and survival.
Cancer Epidemiology, Biomarkers & Prevention 2003; 12(3),
242s-247s. This article gave a comprehensive review of the evidence
on racial and ethnical disparities in cervical cancer. One section
focused on strategies for reducing these disparities. |
|
Green, C. R.,
Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S.,
Fillingim, R. B., et al.
The unequal burden of pain: confronting racial and ethnic
disparities in pain.[see comment]. Pain Medicine 2003; 4(3):
277-294. This literature review found that causes of
pain
disparities among racial and ethnic minorities were complex,
involving patient (e.g., patient/health care provider communication,
attitudes), health care provider (e.g., decision making), and health
care system (e.g., access to pain medication) factors. They
concluded that health care providers need improved training,
patients need education on pain interventions, and that a
comprehensive pain research agenda is necessary to address pain
disparities among racial and ethnic minorities. |
|
Greenberg, G.
A., & Rosenheck, R. A.
Change in mental health service delivery among blacks, whites, and
Hispanics in the Department of Veterans Affairs.
Administration & Policy in Mental Health 2003; 31(1): 31-43.
The
authors, analyzing changes in access to and use of mental health
services by minorities in the Veterans Health Administration during
a period of major system change (1995–2001), found racial and ethnic
disparities. Blacks had poorer outpatient access than Whites
although their access did not further deteriorate, and improved on
some measures. For Hispanics, the trend was decreased access to
outpatient mental health care. These results supported a need to
monitor and address the differential impact on minorities of changes
in mental health service delivery. |
|
Karter, A. J.,
Ferrara, A., Liu, J. Y., Moffet, H. H., Ackerson, L. M., & Selby, J.
V.
Ethnic disparities in diabetic complications in an insured
population. JAMA 2002; 287(19), 2519-2527. This study
assessed racial and ethnic care disparities for diabetes care in a
PPO, confirmed the excess morbidity suffered by racial and ethnic
minorities. They reported the patterns of complications for each
ethnic group, finding inconsistent patterns of ethnic differences
for the various complications. The authors concluded
ethnic disparities after adjustment suggested the possible causes as
genetic, due to unmeasured environmental factors, or a
combination of these factors. |
|
Krieger N. et
al.
Painting a Truer Picture of US Socioeconomic and Racial/Ethnic
Health Inequalities: The Public Health Disparities Geocoding
Project. American Journal of Public Health 2005; 95(2):
312-323. The article described use of geocoding, linking public
health surveillance data with census tracts, to monitor
socioeconomic health disparities. Authors reported that 50% of all
health events were associated with low socioeconomic level. |
|
Kritek, P. B.,
Hargraves, M., Cuellar, E. H., Dallo, F., Gauthier, D. M., Holland,
C. A., et al. Eliminating health disparities among minority women: a
report on conference workshop process and outcomes. American
Journal of Public Health 2002; 92(4): 580-587. This article
described the process and recommendations from a national conference
of largely minority women on strategies to eliminate health
disparities. Themes emerged and priorities focused on access
and cultural incompetence as deterrants to eliminating health
disparities and on education, funding, and
community-based/community driven research as tools for change. |
|
Lasser KE, Himmelstein DU, Woolhandler SJ., McCormick D & Bor DH.
Do minorities in the United States receive fewer mental health
services than whites? International Journal of Health Services
2002; 32(3):567-578. The authors conclusion in this study was
that Blacks and Hispanics receive half as much outpatient mental
health care as do Whites. |
|
Marin, M. G.,
Johanson, W. G., Jr., & Salas-Lopez, D.
Influenza vaccination among
minority populations in the United States. Preventive Medicine
2002; 34(2): 235-241. This study found racial disparities in
influenza vaccination, with African Americans significantly less
likely than Whites and Hispanics to have had the vaccination. |
|
Miranda J &
Cooper L.
Disparities in Care for Depression Among Primary Care Patients.
Journal of General Internal Medicine 2004; 19: 120 – 26.
This article reported that primary
care providers do recognize depression and recommend treatment for
Latino and African-American patients, at equal rates as for White
patients. However, Latino and African-American patients were less
likely to obtain appropriate care, such as antidepressant
medications or specialty care, and that new approaches to improving
access to appropriate care for Latino and African-American primary
care patients are needed. |
|
Murthy VH,
Krumholz HM, Gross CP.
Disparities in participation in cancer clinical trials. JAMA
2004; 291 (22): 2720 – 6. The authors described a
population-based analysis of all participants in therapeutic
non-surgical National Cancer Institute Clinical Trial Cooperative
group breast, colorectal, lung, prostate cancer clinical trials in
2000 – 02. They used a tool called the enrollment fraction (the
number of trial enrollees divided by the estimated US cancer cases
in each race and age subgroup. Their findings were that while
participation in cancer trials was low for all groups, racial and
ethnic minorities and the elderly were less likely to enroll than
were whites, men, younger patients respectively. They also noted
that the proportion of black trial participants has declined in
recent years. |
|
Office of
Minority Health US Department of Health and Human
Services. Website for Data/Statistics on minority
populations and Cultural Competence standards and other
links. |
|
Office of the
Surgeon General.
Mental Health- Culture, Race, Ethnicity, A supplement to the
Surgeon General’s Report 2001. See chapter on “The Influence of
culture & society on mental health and mental illness.” |
|
Sambamoorthi,
U., & McAlpine, D. D.
Racial, ethnic, socioeconomic, and access
disparities in the use of preventive services among women.
Preventive Medicine 2003; 37(5): 475-484. This study of racial
and ethnic variations in receipt of preventive care by adult women
21 – 64 found that the vast majority had received age appropriate
care. Lack of care was best associated with low SES, lack of
insurance, and lack of usual source of care. |
|
Schootman M, Jeffe DB, Reschke AH, & Aft RL. Disparities related to
socioeconomic status and access to medical care remain in the United
States among women who never had a mammogram. Cancer Causes &
Control 2003; 14(5): 419-425. This study found that the
percentage of women who had never had a mammogram declined sharply
over the study period, 1992 - 2000. Racial and ethnic disparities disappeared
while disparities by socioeconomic status remained. |
|
Shavers VL,
Brown ML.
Racial and Ethnic Disparities in the Receipt of Cancer Treatment.
Journal of the National Cancer Institute 2002; 94 (5) 334
– 357. This article described a literature review
on access/use of
specific cancer treatment procedures, trends in patterns
of use, or survival studies. Authors found evidence of
racial disparities in treatment, that could not be completely
explained by racial/ethnic variation in clinically
relevant factors. In order to determine how to target reduction of
non-clinical factors on the receipt of cancer treatment,
the authors recommend directions for further research and study
design. |
|
Siegel, S, Moy
E, Burstin H.
Assessing the Nation’s Progress Toward Elimination of Disparities in
Health Care. Journal of General Internal Medicine 2004;
19: 195 – 200. This article reported on the importance, scope and
challenges of the first National Health Disparities Report. It
challenges primary care physicians to become involved in making this
national report relevant for developing and targeting local
interventions that address disparities. |
|
Skinner, J.,
Weinstein, J. N., Sporer, S. M., & Wennberg, J. E.
Racial, ethnic,
and geographic disparities in rates of knee arthroplasty among
Medicare patients. New England Journal of Medicine 2003; 349(14):
1350-1359. This study found that in the
Medicare population, there was dramatic variation for rates of
surgical treatment for osteoarthritis of the knee by sex,
race or ethnic group, and region. (see comment by Lavizzo-Mourey R,
Knickmen JR. Racial Disparities –The Need for Research and Action in
the same issue. Their comment discussed implications of the
Skinner article for a research agenda, education of patients
and providers, and health system reforms.) |
|
Stewart, S.
H., & Silverstein, M. D. (2002).
Racial and ethnic disparity in
blood pressure and cholesterol measurement. J Gen Intern Med, 17(6),
405-411. This study found no disparity in these cardiovascular
screenings between non-Hispanic blacks and whites. The disparity
between Hispanics and non-Hispanic whites was associated with lack
of health insurance, lack of usual source of care, and low
education. |
|
U.S.
Department of Health and Human Services.
Healthy People 2010.
2nd ed. With understanding and improving health and
objectives for improving health. 2 vols. Washington, DC: U.S.
Government Printing Office. Presented specific goals and objectives
for to improve the health of the entire U.S. population, including
racial and ethnic minorities, implementation strategies, leading
health indicators, and progress reviews. |
|
Vaccarino V et al.
for the National Registry of Myocardial Infarction Investigators.
Sex and
Racial Differences in the Management of Acute Myocardial Infarction,
1994 - 2002. New England Journal of Medicine 2005; 353
(7): 671 - 682. |
|
Washington, D.
L., Harada, N. D., Villa, V. M., Damron-Rodriguez, J., Dhanani, S.,
Shon, H., et al.
Racial variations in Department of Veterans Affairs
ambulatory care use and unmet health care needs. Military
Medicine 2002; 167(3): 235-241. This study of racial and ethnic
variations
in Department of
Veterans Affairs (VA) ambulatory care use found that VA ambulatory
care use diminished the disparity in inability to get needed care
between American Indian/Eskimo or Hispanic veterans and white
veterans, and also eliminated the disparity between black and white
veterans. |
|
Weech-Maldonado,
R., Morales, L. S., Spritzer, K., Elliott, M., & Hays, R. D.
Racial
and ethnic differences in parents' assessments of pediatric care in
Medicaid managed care. Health Serv Res 2001; 36(3): 575-594.
Racial and ethnic minorities, especially Hispanics and Asians with
little English proficiency, reported less satisfaction with care
than did Whites, indicating that managed care systems need to
implement strategies to give linguistically appropriate services.
|
|
Williams, D.
R., Lavizzo-Mourey, R., & Warren, R. C. (1994).
The concept of race and health status in America. Public
Health Rep, 109(1), 26-41.
The authors argued that race is an unscientific, social construct with limited
biological significance. Racial or ethnic variations in health
status result primarily from variations among races in exposure or
vulnerability to behavioral, psychosocial, material, and
environmental risk factors and resources. Research needs to focus on
the specific factors that contribute to group differences in
disease, as well as gathering data that includes subgroup
identifiers among the Asian and Pacific Islander population, Native
Americans, and subgroups of the Hispanic population is still a major
problem. |
|
Zuvekas, S.
H., & Taliaferro, G. S. (2003). Pathways to access: health
insurance, the health care delivery system, and racial/ethnic
disparities, 1996-1999. Health Affairs, 22(2), 139-153. This
study identified other factors in addition to insurance status that
contribute to racial and ethnic health disparities in access to
care: employment, job characteristics, and marital status.
|
|
Theoretical Framework
for Cultural Competence |
|
Betancourt JR
et al.
Cultural Competence and Health Care Disparities: Key Perspectives
and Trends. Health Affairs 2005; 24: 499 – 505. This
article presented a review of recent trends concerning cultural
competence in health care policy, service delivery and education. |
|
Betancourt,
J.R.
Cultural competence—Marginal or Mainstream Movement? New
England J Med 2004; 351 (10): 953-955. Author predicted that
cultural competence will be a mainstream movement that building on
the patient-centered care model by exploring negotiating care with
patients to overcome non-compliance and misunderstanding.
|
|
Betancourt, J.
R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O., 2nd.
Defining cultural competence: a practical framework for addressing
racial/ethnic disparities in health and health care. Public
Health Reports 2003; 118(4): 293-302.
The changing US population demographics will increase the importance
of addressing racial/ethnic disparities in health and health care.
This article supported interventions at the organizational
(leadership/workforce), structural (processes of care) and clinical
levels (patient provider encounter) to help eliminate health
disparities through training in cultural competence. |
|
Brach, C., &
Fraser, I.
Can cultural competence reduce racial and ethnic health disparities?
A review and conceptual model. Medical Care Research and
Review 2000; 57(Supplement 1): 181-217.
These authors
concluded that while research evidence does support that cultural
competency should work to eliminate health disparities, health
systems have little evidence about which cultural competency
techniques are effective and less evidence on when and how to
implement them properly. |
|
Chin, M. H., & Humikowski, C. A.
When is risk stratification by race or ethnicity justified in
medical care? Academic Medicine 2002; 77(3): 202-208.
Authors rejected use of race or ethnicity as a proxy for
socioeconomic status and behavior, but acknowledged that using a “culturally
cognizant but individual-specific approach”
the physician
can use knowledge of the patient’s (group) history, language,
culture and health beliefs as a beginning for dialogue and
exploration of the patient’s beliefs. |
|
Cohen, E., &
Goode, T. D.
Policy Brief I: Rationale for Cultural Competence in Primary Health
Care. 1999; Washington, DC: National Center for Cultural
Competence. Article briefly explained the reasons supporting the
need for and likely outcome for cultural competence: demographic
trends, health status disparities, quality improvement expectations,
accreditation and regulatory mandates, marketplace advantages, and
expectation for reduced malpractice claims. |
|
Hixon, A. L.
Beyond cultural competence. Academic
Medicine 2003; 78(6): 634.
Hixon
advocated that the concept of “cultural humility” (proposed by
Tervalon and Murray-Garcia, 1998) should become part of the
important discussion of cross-cultural medical practice and
education. Cultural humility fosters communication skills built upon
the self-reflection, flexibility, and willingness to be responsive
to the patient and community groups around health care. |
|
Kagawa-Singer,
M.
Improving the validity and generalizability of studies with
underserved U.S. populations expanding the research paradigm.
Annals of Epidemiology 2000; 10(8 Suppl): S92-103.
Incidence and mortality of cancer in racial and ethnic minority
populations has remained the same or increased. Using references to
existing cancer research, the author argued for a 7 step paradigm
change in cancer research to reduce these disparities. |
| Leininger, M.
Culture
care theory: a major contribution to advance transcultural nursing
knowledge and practices. J Transcult Nurs. 2002 Jul;
13(3): 189-92, discussion 200-1. This article is a brief summary of
the culture care theory with its unique features and major
contributions to support transcultural nursing. The theory is known
for its broad, holistic yet culture-specific focus to discover
meaningful care to diverse cultures.
|
|
Lu, M. C., &
Halfon, N.
Racial and ethnic disparities in birth outcomes: a
life-course perspective. Maternal & Child Health
Journal 2003; 7(1): 13-30. This study used a literature review
of racial disparities in birth outcomes to develop a new model, as
they found risk factors in pregnancy alone cannot explain the
disparities. They proposed the “life course model” and recommended
that future research on birth outcomes to examine different exposure to risk and
protective factors over the life course of mothers studied. |
|
Tervalon, M.,
& Murray-Garcia, J.
Cultural humility versus cultural competence: a critical distinction
in defining physician training outcomes in multicultural education.
Journal of Health Care for the Poor Underserved 1998; 9(2):
117-125. The authors proposed the use of the concept “cultural
humility” as the goal in physician education
as opposed to
cultural competence which suggests a finite body of knowledge.
Cultural humility incorporates a lifelong commitment to
self-assessment, to redressing the power imbalances in the
patient-physician relationship, and to developing clinical and
advocacy partnerships with communities to the benefit of individuals
and defined populations. |
|
van Ryn, M.
Research on the provider contribution to race/ethnicity disparities
in medical care. Medical Care 2002; 40(1 Suppl): I140-151.
The author presented a model to show the possible ways that provider
behavior might contribute to racial and ethnic health care
disparities. |
|
Washington, A.
E., Napoles-Springer, A., Forte, D. A., Alexander, M., &
Perez-Stable, E. J. (2002).
Establishing centers to address
treatment effectiveness in diverse ethnic groups: the MEDTEP
experience. Ethnicity & Health 2002; 7(4): 231-242. This
article described an approach to end health care disparities
through: improving diagnosis and treatment, support for ethnic
minority health researchers, training researchers, and disseminating
health information to ethnic minority patients and their providers.
|
|
Weisse, C. S.,
Sorum, P. C., Sanders, K. N., & Syat, B. L.
Do gender and race
affect decisions about pain management? J Gen Intern Med 2001 16(4):
211-217. This study found that racial and gender differences in
pain treatment were associated with physician gender. |
|
Williams, D.
R.
Racial/ethnic variations in women's health: the social embeddedness of health. American Journal of Public Health 2002;
92(4): 588-597. This article presented a summary of the complex
interactions of SES, race and ethnicity on women’s health, as well
as other relevant factors: migration and acculturation, location,
access, and racism. The author supported the “life course approach”
to women’s health, which seeks to find the variabilities in exposure
to stressors and protective factors. |
|
Training and Curricula |
|
Albritton, T.A.
& Wagner, P.J.
Linking cultural competency and community service: a partnership
between students, faculty, and the community. Acad Med 2002;
77(7): 738-739.
This article
described development of a migrant health initiative and
infrastructure for a cultural competency educational program in the
first two years of medical school within an essentials of clinical
medicine course (ECM). The course allowed first-year students to
volunteer to work in the program, while second-year students
participate in at least one migrant health clinic. Students from
nursing and public and allied health also participate. |
Association of American Medical Colleges:
Cultural Competence Education for Medical Students
Using TACCT
Tool for Assessing Cultural Competence Training (TACCT)
|
|
Beatty, C. F.,
& Doyle, E. I. (2000). Multicultural curriculum evaluation of a
professional preparation program. American Journal of Health
Studies, 16(3), 124-132. The authors evaluated a curriculum for
professionals in health education to determine the extent of content
and skills for developing cultural competence. |
|
Betancourt, J.
R.
Cross-cultural medical education: conceptual approaches and
frameworks for evaluation. Academic Medicine 2003; 78(6):
560-569. Article promoted a three-pronged approach to cultural
competence that includes requisite knowledge, skills, and attitudes,
then discussed appropriate strategies for assessing each educational
approach. |
|
Betancourt J
et al. for
National Project Advisory Committee. Teaching Cultural Competence in
Health Care: A Review of Current Concepts, Policies and Practices.
Office of Minority Health, Department of Health & Human Services
2002. |
|
Campinha–Bakote
J.
Many Faces: Addressing Diversity in Health Care. Online Journal
of Issues in Nursing 2003; 8 (3). Camphina-Bakote presented her
model for delivery of culturally competent care and a mnemonic for
trainees: Have I ASKED myself the right questions (Awareness,
Skill, Knowledge, Encounters, Desire.) |
|
Carrillo, J.
E., Green, A. R., & Betancourt, J. R..
Cross-cultural primary care: a patient-based approach. Annals
of Internal Medicine 1999; 130(10): 829-834. Description of a
cross cultural curriculum for residents and medical students that
gives a patient-centered framework for eliciting and analyzing a
patient’s social context and cultural beliefs and behaviors. The
model uses five modules taught over four 2-hour sessions, using case
analysis, physician-actor interviews and videotaped patients.
|
|
Culhane-Pera,
K. A., Reif, C., Egli, E., Baker, N. J., & Kassekert, R.
A curriculum for multicultural education in family medicine.
Fam Med 1997; 29(10): 719-723. A three year residency curriculum
on cultural competency focused on 1. increase self-awareness of
one’s own cultural influences, 2. increasing awareness of cultural
influences on patients, 3. improving multicultural communication in
clinical settings. Residents’ and faculty assessments of residents’
achievement in cultural competence correlated significantly.
|
|
Cultural
Competency- Medical University of South Carolina
This is an online curriculum outline ocultural competence for
students.
|
|
Department of
Health & Human Services.
A Family Physician’s Guide to Culturally Competent Care Nine
free curriculum modules using video clips based on case studies are
available on this website. Select online program or order DVD.
Registration is required.
|
|
Dogra, N., &
Karnik, N.
First-year medical students' attitudes toward diversity and its
teaching: an investigation at one U.S. Medical School.
Academic Medicine 2003; 78(11): 1191-1200. This article
reported a study of first year medical students showing that they
generally held open attitudes about multiculturalism, they were
unfamiliar with terms concerning race and culture and perceived
ethnic groups as very discrete. There were contrasting views of
race and color between groups of students. Students favored a
“cultural sensibility” approach to cultural competence training that
would emphasize self-awareness and reflection. |
|
Fernandez VM,
Fernandez KM.
Transcultural Nursing: Basic Concepts, Case Studies, Cultural
competence, third world nursing. Topics include the difference
between a stereotype and a generalization; case studies from 6
cultures: Hispanic, Middle Eastern, Deaf, Asian, Afro-American, and
Migrant Worker Communities |
|
Flores, G.,
Gee, D., & Kastner, B. (2000).
The teaching of cultural issues in
U.S. and Canadian medical schools. Acad Med 2000; 75(5):
451-455. The authors surveyed medical schools about the teaching of
cultural issues, format, content and timing of course. Their
findings were that there was inadequate instruction, especially
specific aspects of culture for the largest minority racial and
ethnic groups in the region. See comment by Kwan, C. Y. Medically
related cultural issues can be learned outside the classroom.
Acad Med 2001; 76(1):1-3. Kwan critiqued the article by Flores
et al. pointing out that one would expect different results when
asking deans what was taught than asking medical students what they
have learned. |
|
Freeman, J.,
Loewe, R., & Benson, J.
Training family medicine faculty to teach in underserved settings.
Fam Med 1998; 30(3): 168-172. The article briefly described
a faculty development program that aggressively recruited minority
fellows in order to enhance its ability to train students in
underserved communities. |
|
Godkin, M. A.,
& Savageau, J. A.
The effect of a global multiculturalism track on cultural competence
of preclinical medical students. Family Medicine 2001; 33(3):
178-186. This study compared cultural competence of medical
students in the Global Multicultural Track with non-Track students.
|
|
Green, A. R.,
Betancourt, J. R., & Carrillo, J. E.
Integrating social factors into cross-cultural medical education.
Academic Medicine 2002; 77(3): 193-197.
The authors
emphasized the importance of expanding the role of the social
history in cross-cultural medical education. They presented a
patient-based approach to social analysis covering four major
domains--(1) social stress and support networks, (2) change in
environment, (3) life control, and (4) literacy. |
|
Gupta R,
Farmer PE.
International Electives: Maximizing the Opportunity to Learn and
Contribute. Medscape General Medicine 2005; 7 (2). Authors
presented suggestions on using international medical electives as
part of one’s medical training, based on their experience in
facilitating utilization of trainees as a part of long term health
interventions overseas. |
|
HRSA Transforming the Face of Health Professions
Through Cultural & Linguistic Competence Education: Role of
HRSA Centers of Excellence This curriculum guide
was developed by a multi-disciplinary group of health
professionals and educators for use by educators and health
care providers in large and small institutions. |
|
Kai, J.,
Bridgewater, R., & Spencer, J. 'Just
think of TB and Asians', that's all I ever hear": medical learners'
views about training to work in an ethnically diverse society.
Med Educ 2001; 35(3): 250-256. Medical students in this
study felt their training in multicultural issues was inadequate and
limited largely to ethnic patterns of
disease. They considered communication skills and working with
interpreters as most helpful in the current curriculum. The authors
were critical of the focus on specific cultural beliefs and
practices rather than a more self-reflective and flexible approach
to teaching cultural competence. |
|
Like, R. C., &
Steiner, R. P. (1986).
Medical anthropology and the family physician. Fam Med 1986;
18(2): 87-92. The authors summarized the
activities of the STFM Task Force on Skills and Curriculum
Development in Cross-Cultural Experiences, and discuss three
clinical case vignettes that illustrate how cultural issues can
become critical in the care of patients and their families.
|
|
Mutchnick, I.
S., Moyer, C. A., & Stern, D. T.
Expanding the boundaries of medical education: evidence for
cross-cultural exchanges. Academic Medicine 2003; 78(10
Suppl), S1-5. In this literature review of cross-cultural medical
school experiences, all articles reported beneficial results for the
medical students (professional and personal development, the medical
school, and the host population. Authors recommend development of
more rigorous evaluation criteria. |
|
Nunez, A. E.
Transforming cultural competence into cross-cultural efficacy in
women's health education. Academic Medicine 2000; 75(11),
1071-1080. Nunez proposed “cultural efficacy” rather than cultural
competence to focus on the flexibility of the provider in
communicating effectively with individuals from many different
cultures. She presented a model for integrating knowledge, skills
and awareness (cross-cultural efficacy) in women’s health
throughout the four-year medical school curriculum. A particular
focus of this model is on the evaluation component through
self-awareness assessments. |
|
Office of Minority Health US Department of Health and
Human Services.
A Family Physician's Practical Guide to Culturally Competent Care.
Training modules and case studies include free CME and CNE.
Requires registration. |
|
Paasche-Orlow,
M.
The ethics of cultural competence. Acad Med 2004; 79(4):
347-350. This author, comparing cultural competence with ethical behavior,
concluded that cultural competence promotes (1) acknowledgement of
the importance of culture in people's lives, (2) respect for
cultural differences, and (3) minimization of any negative
consequences of cultural differences, and is supportive of Western
medical ethics. He predicted that some medical students may
experience conflicts when applying cultural competence leads to
ethical relativity. |
|
Shapiro, J., &
Lie, D. Using
literature to help physician-learners understand and manage
"difficult" patients. Acadademic Medicine 2000; 75(7):
765-768. This article described a residency training course on
managing difficult patients that uses short stories, poems and
patient narratives as educational tools. |
|
Tervalon, M.
Components of culture in health for medical students' education.
Academic Medicine 2003; 78(6): 570-576. The author presented
a longitudinal curriculum model for teaching the impact of culture
on health care. The key themes include: 1. rationale, 2. culture
basics, 3. health status, 4. knowledge, skills and tools for the
clinical encounter, 5. provider focus on attitudes and behaviors, 6.
communication participation, and 7. institutional culture and
policies. |
|
Turbes, S.,
Krebs, E., & Axtell, S.
The hidden
curriculum in multicultural medical education: the role of case
examples.
Academic Medicine
2002; 77(3):
209-216.
This study analyzed the 983 case studies used in the
first two years of a medical curriculum for patterns of
demographics. The findings revealed that
cases featuring males out-numbered those featuring females; sexual
orientation was specified infrequently (usually only in the context
of risk assessment for particular diseases (e.g., HIV infection),
and most cases did not provide racial or ethnic descriptions. The
results suggest a hidden curriculum that is not consistent with the
formal multicultural medical curriculum. |
|
Xakellis, G.,
Brangman, S. A., Hinton, W. L., Jones, V. Y., Masterman, D., Pan, C.
X., et al.
Curricular framework: core competencies in multicultural geriatric
care. Journal of the American Geriatrics Society 2003; 52(1),
137-142. This article presented core competencies in attitudes,
knowledge and skills for medical providers caring for elders from
diverse populations. It specifies also a variety of teaching
strategies. |
|
Zweifler, J.,
& Gonzalez, A. M.
Teaching residents to care for culturally diverse populations.
Acad Med 1998; 73(10): 1056-1061.
This article
presented a historical look at efforts to train residents to deliver
culturally competent care to diverse and underserved populations:
the Core Curriculum Guidelines on Culturally Sensitive and Competent
Health Care created by the Society of Teachers of Family Medicine;
community-oriented primary care (COPC), and the various services and
orientations of public health. They described their residency
program’s approach to cultural competence training emphasizing the
importance of such training for primary care residents. |
|
Recruiting a Diverse
Health Care Workforce |
|
Adams VW,
Price-Lea PJ.
A Critical Need for a More Diverse Nursing Workforce. NC Med
J 2004; 65 (2): 98 – 100. Authors present the rationale behind
recruiting a diverse nursing workforce. |
|
Beal A.
Health Care Diversity: Developing Physician Leaders. Testimony
before the Sullivan Commission 2003. The Commonwealth Fund.
|
|
Cantor, J. C.,
Miles, E. L., Baker, L. C., & Barker, D. C.
Physician service to the underserved: implications for affirmative
action in medical education. Inquiry 1996; 33(2):
167-180. This study reports on findings from two large physician
surveys that found minority and women physicians are significantly
more likely to serve minority, poor, and Medicaid populations than
other physicians. These physicians’ service patterns remain stable
over time. |
|
Komaromy, M.,
Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., et al.
The
role of black and Hispanic physicians in providing health care for
underserved populations. N Engl J Med 1996; 334(20):
1305-1310. This study found that Black physicians cared for
significantly more black patients and Hispanic physicians for
significantly more Hispanic patients than did other
physicians. Black physicians cared for more patients
covered by Medicaid and Hispanic physicians for more uninsured
patients than did other physicians. |
|
Moy, E., &
Bartman, B. A.
Physician race and care of minority and medically
indigent patients. JAMA 1995;273 (19): 1515-1520. This study
found that nonwhite
physicians are more likely to care for minority, medically indigent,
and sicker patients, and that caring for less affluent and sicker
patients may financially penalize nonwhite physicians and make them
particularly vulnerable to capitation arrangements. |
|
Murray-Garcia,
J. L., Garcia, J. A., Schembri, M. E., & Guerra, L. M. The
service patterns of a racially, ethnically, and linguistically
diverse housestaff. Acad Med 2001; 76(12): 1232-1240.
This study found that
African-American, Asian, and Latino pediatric residents
disproportionately served more patients from their own
racial or ethnic backgrounds. When adjusted for
residents' second-language proficiencies, Latino patients
remained more likely to visit Latino residents and Asian
patients remained more likely to see Asian residents.
|
|
Terrell C.
Testimony before the Sullivan Commission:
Role of Professional Associations in Ensuring a Diverse Health-Care
Workforce 2003. Association of America Colleges of Medicine.
Terrell identified the poor quality of pre-college education
experienced by many students from underrepresented groups in
medicine as a major barrier to recruitment. He discussed advantages
and promising strategies to improve
recruitment of minorities.
|
|
Cultural Competence in
Health Service Delivery |
|
American
Student Medical Association (AMSA).
Cultural Competence in Medicine Includes assessment questions to
elicit the patient’s explanatory model of the disease. |
|
Andersen, R.
M., Yu, H., Wyn, R., Davidson, P. L., Brown, E. R., & Teleki, S.
Access to medical care for low-income persons: how do communities
make a difference? Medical Care Research & Review 2002; 59(4):
384-411. Examined community level variables beyond income that
impact access to health care. |
|
Avery, R.
Immigrant women's health: Infectious diseases - Part 2. West
J Med 2001; 175(4): 277-279. Article gave a brief
recommendation on wording of questions to aid cross cultural
communication. |
|
Bertakis, K.
D.
Does race have an influence on patients' feelings toward physicians?
J Fam Pract 1981; 13(3): 383-387.
This study found
that patients most wanted the physician to be caring, competent and
a good listener, and that physician’s race did not affect these
qualities. Patients did not seem to have a racial preference for
their physician. |
|
Blanchard J, Lurie N. R-E-S-P-E-C-T:
Patient reports of disrespect in the health care setting.
The Journal of Family Practice 2004; 53 (9): 721 – 30. In this
study, minorities were more likely to report the perception of
disrespect in healthcare settings than others. Those who reported
that they felt a person of another race would have received better
care than they did were less likely to receive optimal screening,
and were more likely to have put off care or reject medical advice.
|
|
Camphina-Bacote J.
Transcultural CARE Associates Selected References 2001 -
2007 An excellent list of references on cultural
competence, many with hyperlinks by Dr. Josephine
Campinha-Bacote, developer of the Culturally Competent Model
of CARE. |
|
Center on an
Aging Society Georgetown University.
Cultural Competence in Health Care: Is it important for people with
chronic conditions? Issue brief February 2004. This article
presented a comprehensive summary of care issues related to cultural
competence in treating chronic illnesses. |
|
Crawley L et
al for the End-of-Life Care Consensus Panel.
Strategies for Culturally Effective End of Life Care: Case studies
and basic concepts of culturally competent end of life care. Annals of
Internal Medicine 2002; 136: 673-679. Article emphasizes the need
to inquire about patient and family preferences as a strategy, and
presents cases for discussion.
|
|
Cross Cultural
Health Care Program (CCHCP).
Special expertise in interpreter services and Medical Interpreter
Training: Ethics, Models of Service, and Office of Civil Rights
Guidelines; Handbooks on cultural competence and reports of research
on culturally competent health systems. |
|
Czaja, R.,
Manfredi, C., & Price, J.
The determinants and consequences of information seeking among
cancer patients. Journal of Health Communication 2003; 8(6):
529-562. This study found that
the desire for
information and the desire for involvement in medical care decisions
are independent variables, and that the patient’s preferences have
implications for both their own care and their providers.
|
|
Ells, C., &
Caniano, D. A.
The impact of culture on the patient-surgeon relationship.Journal of the American College of Surgeons 2002; 195(4):
520-530. Article explored the question “What does it mean to respect the
patient’s culture?” using a discussion of case studies. |
|
Flores, G.,
Abreu, M., Schwartz, I., & Hill, M.
The importance of language and culture in pediatric care: case
studies from the Latino community. Journal of Pediatrics
2000; 137(6), 842-848. This article presented three cases to
demonstrate some of the serious health care consequences of
inadequate interpreter services: poor quality of care, unnecessary
expense, and dissatisfied families. |
|
Flores, G., &
Association of Medical Pediatric Department Chairs, I.
Providing culturally competent pediatric care: integrating
pediatricians, institutions, families, and communities into the
process. Journal of Pediatrics 2003; 143(1): 1-2. The
author referred to the poor health outcomes documented by care that
is not sensitive to the culture of patients and families. He
proposed a collaborative process for health care institutions,
providers, and communities to make the health care system more
effective and culturally sensitive. Every aspect of the institution
should be reviewed collaboratively, from medical interpreters and
prescription labels to cuisine and patient handouts. |
|
Flores, G.,
Rabke-Verani, J., Pine, W., & Sabharwal, A.
The importance of
cultural and linguistic issues in the emergency care of children.
Pediatr Emerg Care 2002; 18(4): 271-284. In a review of the
literature, the authors found that lack of cultural competence in
pediatric emergency care could lead to:
difficulties with informed consent, miscommunication, inadequate
understanding of diagnoses and treatment by families,
dissatisfaction with care, preventable morbidity and mortality,
unnecessary child abuse evaluations, lower quality of care,
clinician bias, and ethnic disparities in prescriptions, analgesia,
test ordering, and diagnostic evaluations. |
|
Fortin, A. H.
6th.
Communication skills to improve patient satisfaction and quality
of care. Ethnicity & Disease 2002; 12(4),: S3-58-61. This
article emphasized patient centered communication skills to improve
care and dialog with patients from diverse cultures. |
|
Georgetown University
National Center for Cultural Competence, This website is
dedicated to culturally competent service delivery to children and
youth with special health needs and their families. It contains
self-assessment tools for an organization and for a health care
provider.
|
|
Gilligan, T.
D., Carrington, M. A., Sellers, T. P., Casal, L., Schnipper, L. E.,
& Li, F. P.
Cancer survivorship issues for minority and underserved populations.
Cancer Epidemiology, Biomarkers & Prevention 2003; 12(3):
284s-286s. A report
on cancer survivorship in minority and underrepresented communities.
Themes included strategies to build
trust between members of minority communities and their
healthcare providers, most of whom are Caucasian. |
|
Health Research & Education Trust
(HRET) Disparities Toolkit. How-to easily and quickly collect
race, ethnicity, and primary language information from patients: why
and how, legal, and staff training issues. Link to
Other HRET Initiatives on Patient Centered Communication for
Vulnerable Populations and Hospitals and Language and Culture: A
Snapshot of the Nation. |
|
Jacobs, E. A.,
Lauderdale, D. S., Meltzer, D., Shorey, J. M., Levinson, W., &
Thisted, R. A. (2001).
Impact of interpreter services on delivery of
health care to limited-English-proficient patients. J Gen Intern
Med, 16(7), 468-474. This two year retrospective cohort study
showed that introduction of professional interpreter services
resulted in increased office visits, prescriptions written and
filled, and preventive care screenings for the interpreter service
group compared with a similar control group. |
|
Jenakovich M
et al. for LTG Associates.
Cultural Competence Works: Using cultural competence to improve
the quality of health care for diverse populations and add value to
managed care arrangements. U.S. Department of Health & Human
Services, 2001. Enumerated successful practices and profiled award
winning health care organizations. |
|
Johnson, P.
A., & Fulp, R. S.
Racial and ethnic disparities in coronary heart disease in women:
prevention, treatment, and needed interventions. Women’s
Health Issues 2002; 12(5), 252-271. A very thorough summary of
the topic with special emphasis on the interaction between SES, race
and ethnicity, and health. There are well considered
recommendations for data collection, research, access to
cardiologist care, leadership, and building on successful strategies
at the local level. |
|
Kaiser HJ &
Johnson RW Foundations
Help Understand Why. This website, a joint foundation
initiative, aims to raise physician awareness about evidence on
racial/ethnic differences in health care starting with the topic of
cardiac care. It includes guidelines for cardiac care, and
resources for confronting and eliminating disparities in health
care. |
|
Kagawa-Singer,
M., & Kassim-Lakha, S.
A strategy to reduce cross-cultural miscommunication and increase
the likelihood of improving health outcomes. Academic
Medicine 2003; 78(6): 577-587. Authors described the RISK
Assessment (Resources, Identity, Skills, Knowledge) to determine the
level of influence of the patient’s culture. For each step of the
RISK Assessment there is guidance of questions and strategies to use
for eliciting that information.
|
|
Kaufert, J.
M., & Putsch, R. W.
Communication through interpreters in
healthcare: ethical dilemmas arising from differences in class,
culture, language, and power. J Clin Ethic 1997; 8(1):
71-87. The authors presented two models of interpreters in
healthcare: the neutral translator and the cultural broker and
discuss the shortcomings of the current models. They illustrate
with a discussion of two case studies of end-of-life care.
|
|
Kleinman A.
Culture and Depression. New England Journal of Medicine
2004; 351 (10): 951 – 3. Depression, one of the most prevalent
diseases in the world, has varied patterns of symptoms among and
within ethnic groups. The author described the steps in culturally
competent care for depression, including the ways that cultural
factors may impact the diagnosis, patient’s explanation of illness,
use of alternative therapies, stressor sand support systems,
patient’s expectation of the doctor’s style, and avoidance of
stigmatization.
|
|
Lavizzo-Mourey,
R., & Mackenzie, E. R.
Cultural competence: essential measurements
of quality for managed care organizations. Ann Intern Med, 124(10),
919-921. The authors presented a model for cultural competence in
healthcare for managed care organizations that integrates three
aspects: 1. culturally sensitive health care delivery, 2.
epidemiologic consideration of disease prevalence, and 3. treatment
efficacy in diverse populations.
|
|
Merrill, R.
M., & Allen, E. W.
Racial and ethnic disparities in satisfaction
with doctors and health providers in the United States. Ethnicity
& Disease 2003; 13(4): 492-498. This study of satisfaction with
physicians and health care providers found that except for
listening, race and ethnicity were not associated with variables
considered in the satisfaction survey. |
|
National Conference of State
Legislatures, Resources for Cross Cultural Health Care,
Henry J. Kaiser Family Foundation. Diversity Rx Definitions
and basics on cultural competency, essentials on
interpreting & interpreter training, best practice models,
immigration, laws and legal issues. |
|
Niemeier, J.
P., Burnett, D. M., & Whitaker, D. A. Cultural competence in the
multidisciplinary rehabilitation setting: are we falling short of
meeting needs? Archives of Physical Medicine & Rehabilitation
2003; 84(8):1240-1245. The authors discussed challenges of
cultural competence within the field of rehabilitation, using two
case studies for illustration, and recommended ways for the
rehabilitation professional to increase cultural competence.
|
|
Lavizzo-Mourey,
R. J., & MacKenzie, E.
Cultural competence--an essential hybrid for delivering high quality
care in the 1990's and beyond. Trans Am Clin Climatol Assoc
1995; 107: discussion 236-227. Authors recommended that to
ensure health care that is both effective and cost effective in all
populations, researchers and funders of research need to
aggressively
pursue: the
validation of existing quality indicators in minority populations,
and the development of new quality indicators that assess the
organization's ability to develop culturally competent care.
|
|
Ngo-Metger Q,
Legendza A, & Phillips R.
Asian Americans’ Report of Their Health Care Experiences.
Journal of General Internal Medicine 2004; 19; 111-19.
This national random digit telephone survey found that
Asian Americans were less likely to
receive counseling on lifestyle issues related to health and were
less likely to report positive interactions with their doctors than
white respondents.
|
|
Office of
Minority Health
National Standards for Culturally and Linguistically Appropriate
Services in Health Care Health and Human Services, 2000.
Description of the final CLAS (Culturally and Linguistically
Appropriate Services) standards for health care organizations.
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Owen, W. F.,
Jr., Szczech, L. A., & Frankenfield, D. L.
Healthcare system
interventions for inequality in quality: corrective action through
evidence-based medicine. J Natl Med Assoc 2002; 94(8 Suppl):
83S-91S. In this study, the authors documented improvement in
hemodialysis outcomes for African Americans from 1992 – 1997 through
the use of evidence-based clinical practice guidelines developed by
the Centers for Medicare and Medicaid Services.
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Park HL.
Enabling Services at Health Centers: Eliminating Disparities and
Improving Quality. New York Academy of Medicine. September 2005.
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Richardson, L.
D.
Patients' rights and professional responsibilities: the moral case
for cultural competence. Mt Sinai J Med 1999; 66(4):
267-270. This ER physician discussed the responsibilities of health
professionals in ending the race based health disparities by
building skills that engender trust and satisfaction in the
provider-patient encounter, and changing institutional and public
policies that perpetuate care and access inequalities. |
|
Robertson, R.
M.
Partnerships for the health of the public. Circulation 2001;
103(24): 2870-2872.
The American Heart Association sought to increase
its improve its effectiveness in reaching populations who need heart
and stroke-related preventive, acute, and rehabilitative
services, by partnering with organizations that represent
the interests of racial and ethnic minorities, for example, the
National Council of La Raza, and the Congressional Black
Caucus Foundation.
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Saha, S.,
Arbelaez, J. J., & Cooper, L. A.
Patient-physician relationships and racial disparities in the
quality of health care. American Journal of Public Health
2003; 93(10): 1713-1719. This study examined whether
racial differences in inpatient doctor-physician relationships
resulted in health disparities. They compared ethnicity,
satisfaction with the physician-patient interaction, use of health
services, and receipt of age and condition appropriate health
services. |
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Schulz, A. J.,
Israel, B. A., Parker, E. A., Lockett, M., Hill, Y., & Wills, R.
(2001).
The East Side Village Health Worker Partnership: integrating
research with action to reduce health disparities. Public Health
Rep, 116(6), 548-557. This article described an approach to
reducing health disparities through a university-community
partnership in research and a community intervention using lay
health advisors.
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Suarez-Almazor
ME et al.
Ethnic Variation in Knee Replacement. Archives of Internal
Medicine 2005; 165 (10): 1117 – 1124. This
study found that ethnic minority patients with knee osteoarthritis
were less likely to consider total knee replacement and
that these differences were not related to physician
recommendation biases. The authors discuss reasons for ethnic
variation in preferences for this surgery. |
|
The Commonwealth Fund- Underserved Populations a
searchable site with information on health quality,
including national surveys and data, charts, publications,
policies and grants. |
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Youdelman M,
Perkins J.
Providing Language Services in Small Health Care Provider Settings:
Examples from the Field. Commonwealth Fund 2002.
This article described several specific strategies that small health
care providers are using to provide culturally and linguistically
appropriate services.
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Wynia, R. H.
(2003).
Working to eliminate racial disparities. Health Forum
Journal, 46(1), 34-35. This article described the initiative
by the Health Research and Educational Trust (HRET), an affiliate of
the American Hospital Association, to develop a program to eliminate
disparities. Key elements are: 1. developing a uniform framework
for collecting data on race, ethnicity and primary language; 2.
developing a training strategy for providers on the importance of
collecting this data; 3. implementing a clinical intervention; 4.
assessing cultural competency of the organization; 5. assessing
community perceptions of their care and needs; and 6. reducing
health disparities. |
| Cultural
Profiles for
Specific Cultural and Linguistic Groups
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Coughlan J.
Culturedmed. Bibliographies of print resources
Culturally Competent Care for for many cultural groups.
Accessed at SUNYIT (State University of NY Institute of
Technology) |
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Management Sciences for Health
The Providers Guide to Quality & Care. Full of
information for providers on patient-centered cultural
competence, including cultural profiles for a few broad
racial/ethnic groups (African American, American Indian,
Asian, Hispanic/Latino, East Europeans, Sub-Sahara
Africans.. See the very important section on the
distinction between a cultural generalization and
stereotyping. |
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University of Michigan, Program for Multi-Cultural Health
Multicultural Health Generalizations. Indexed by
culture, with a new cultural profile biweekly.
University of Michigan tool for training their staff in cultural competence.
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| African American |
| Eiser AR, Ellis G.
Cultural Competence and the African American Experience with
Health Care: The Case for Specific Content in Cross Cultural
Education. Academic Medicine.
February 2007; 82 (2). |
|
Be Safe Workbook: A Cultural Competency Model for African
Americans HRSA grantee publication for AIV-AIDS
providers. |
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Howard, D. L.
Culturally competent treatment
of African American clients among a national sample of
outpatient substance abuse treatment units.
Journal of Substance Abuse Treatment 2003; 24(2):
89-102. This article defined culturally competent treatment
of African Americans and presented a profile of outpatient
substance abuse clinics that fit this definition. |
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| American Indian/Alaska Native |
| Flowers DL.
Culturally Competent Nursing Care for American Indian
Clients in a Critical Care Setting. Critical Care Nurse February 2005; 25 (1): 45 - 50. |
| Satter DE et al.
Communicating
respectfully with American Indian and Alaska natives:
Lessons from the California Health Interview Survey.
J Cancer Education. 2005 Spring; 20 (1): 49 - 51.
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| Asian |
| Beller T et al.
Korean-American Health Beliefs accessed at <http://www3.baylor.edu/~Charles_Kemp/korean.htm> |
| Bhungalia S et al.
Asian Indians Health Care Beliefs and Practices accessed at
<http://www3.baylor.edu/~Charles_Kemp/indian_health.htm> |
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Hirsh University Health Sciences Library.
SPIRAL Selected Patient Information Resources in Asian
Languages. |
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Keovilay L., Kemp C. Laotians Health Care
Beliefs accessed at
<http://www3.baylor.edu/~Charles_Kemp/laotian_health.html> |
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McBride M. Health & Health Care of
Filipino American Elders. Stanford University School
of Medicine. Accessed at
<http://www.stanford.edu/group/ethnoger/filipino.html> |
|
Rasbridge LA. Vietnamese Health Beliefs
accessed at
<http://www3.baylor.edu/~Charles_Kemp/vietnamese_health.htm> |
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Tanabe MKG. Health & Health Care of
Japanese-American Elders. University of Hawaii
accessed at <http://www.stanford.edu/group/ethnoger/japanese.html> |
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Wang C. Traditional Chinese Medicine in
Chinese American Communities. Chinese American Society
accessed at <http://www.camsociety.org/issues/Attitudes.htm> |
| Deaf |
|
Iezzoni LI et al.
Communicating about Health Care: Observations from Persons
Who are Deaf or Hard of Hearing. Annals of Internal
Medicine 2004. 140 (5): 356 – 365. Report on results
from focus group of deaf people eliciting their concerns
about communication in health care. They presented two
suggestions: the clinician should ask about their preferred
method of communicating and should request the patient to
repeat critical health information to determine
understanding. |
| GLBT |
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Massachusetts Department of Public Health.
Community Standards of Practice for the Provision of Quality
Health Care Services to Lesbian, Gay, Bisexual, and
Transgender Clients. GLBT Health Access Project.
Downloadable standards for practice. |
|
Seattle & King County Public Health District.
Gay, Lesbian, Bisexual, Transgender Health. Tips on
culturally competent health care for GLBT people including
the patient interview, avoiding assumptions, and creating a
welcoming office culture. |
| Hispanic/Latino/Spanish |
|
Agency for Healthcare Research and Quality.
Informacion en espanol Searchable site for health
education and information materials in Spanish. Department
of Health & Human Services |
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National Alliance for Hispanic Health.
A primer for proficiency: towards quality health services
for Hispanics.
Estrella Press 2001. Washington, D.C.: This primer discussed
cultural competence for the individual provider and the
health care system. It supported the concept of developing
“cultural proficiency” – holding culture in high esteem,
emphasizing the diversity of Hispanic culture, and getting
to know the preferences of the particular community being
served. |
| Reys C. Van de Putte L,
Falcon AP, Levy RA.
Genes, culture and medicines: bridging gaps in treatment for
Hispanic Americans. National Alliance for Hispanic
Health. Washington DC; February 2004 |
| Immigrant and Refugee
Populations |
|
Center for International Rehabilitation Research
Information Exchange.
The Rehabilitation Providers Guide to Cultures of the
Foreign Born. Detailed, consistent format of profiles
covering customs and significant issues for 11
cultural/linguistic groups, from Chinese and Dominican to
Haitian and Vietnamese. |
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University of Washington Medical Center.
Culture CluesTM
The website contains copyrighted tip sheets on
several cultural groups, with conditions for copyright
permission to reprint material. Includes culturally
specific tips on end of life care. |
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University of Washington, Harborview Medical Center.
Ethnomed Culture specific tips covering immigrant
populations in the Seattle area from Amharic to Vietnamese. |
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| Islamic and Arab
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Hammad
A et al.
Guide to Arab Culture: Health Care Delivery to the Arab
American Community Arab Community Center for Economic &
Social Services 1999. A discussion of Arab culture, society
and religion with references to their impact on health care
delivery, written by a team led by the director of a
community health center serving a largely Arab-American
community. |
| Hammoud MM, White CB, Fetters
MD.
Opening cultural doors: Providing culturally sensitive
healthcare to Arab American and American Muslim patients.
American Journal of Obstetrics & Gynecology
October 2005; 193 (4): 1307-11. |
|
Rashidi A, Rajaram SS.
Culture Care Conflicts Among
Asian-Islamic Immigrant Women in US Hospitals.
Holistic Nursing Practice 2001; 16 (1) 55- 64. The
authors briefly presented the basic beliefs of Islam and
their relevance to health care practice. |
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Low Literacy Populations |
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McKinney,
J, Kurtz-Rossi, S,
Culture, Health and Literacy: A guide to health education
materials for adults with limited English literacy skills.
Rich resources for use with low English proficiency (LEP)
populations. Many but not all are free. |
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| Evaluation Tools and
Issues in Evaluation |
Association of American Medical Colleges:
Cultural Competence Education for Medical Students
Using TACCT
Tool for Assessing Cultural Competence Training (TACCT)
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Camphinha-Bacote J.
Inventory for Assessing the Process of Cultural Competence (IAPCC)
Among Health Care Professionals. Cincinnati OH 1998L
Transcultural C.A.R.E. Associates. The IAPCC is a self-administered
tool for assessing cultural competence. It measures
Camphinha-Bacote’s five constructs of cultural competence:
self-awareness, cultural knowledge, cultural skills, cultural
encounters, and cultural desire. |
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Kehoe, K. A.,
Melkus, G. D., & Newlin, K. Culture within the context of care: an
integrative review. Ethnicity & Disease 2003; 13(3):
344-353. The authors critiqued the body of research on culturally
competent health interventions: that the research does not identify
the particular aspects that are associated with favorable outcomes
and that their long term impact is not known. |
|
Like, R. C.,
Steiner, R. P., & Rubel, A. J. (1996). STFM Core Curriculum
Guidelines. Recommended core curriculum guidelines on culturally
sensitive and competent health care. Fam Med, 28(4),
291-297. A tool for evaluating Family Practice Residents in
knowledge, skills, and attitudes requisite for culturally competent
practice. |
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Mason JL.
Cultural Competence Self-Assessment Questionnaire: A Manual for
Users. Portland State University, Research and Training Center
on Family Support and Children’s Mental Health 1995. Mason’s manual
contains two versions of the questionnaire: one for direct service
providers and one for administrative staff. |
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Pena Dolhun,
E., Munoz, C., & Grumbach, K. (2003). Cross-cultural education in
U.S. medical schools: development of an assessment tool. Academic
Medicine, 78(6), 615-622. These authors used information from a
survey of US medical schools to develop a medical school curricula
assessment tool to assess the teaching methods, skill sets, and
content areas for cross-cultural education. |
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Richardson, L.
D.
Patients' rights and professional responsibilities: the moral case
for cultural competence. Mt Sinai J Med 1999; 66(4):
267-270. This ER physician discussed the responsibilities of health
professionals in ending the race based health disparities by
building skills that engender trust and satisfaction in the
provider-patient encounter, and changing institutional and public
policies that perpetuate care and access inequalities. |
|
Office of
Cultural Affairs Videos - to reserve,
call 45906 |
| American College of Physicians, National
Medical Association and The Congress of National Black
Churches, Inc. Celebrating Life: A guide to
Depression for African Americans. Presents
insights from Dr. David Satcher and two African-Americans
who have succeeded through dealing with their depression.
|
| American College of Physicians, The
Congress of National Black Churches, Inc. Astra Zeneka.
Awareness is Power: Cancer and the African American.
Presents cancer survivor stories by inspiring African
Americans. 30 minutes |
| American College of Physicians, Aventis.
Diabetes prevention and Control. A Guide for
Hispanic Americans. Advice from diabetes experts
and several Hispanic Americans with diabetes. 30
minutes. |
| ABC News. True Colors.
Corvision 1991. Two men, one white and one
black, use hidden camera to test the discriminatory
practices in a shopping center, a car dealership and a
record store in a Midwestern city. 19 minutes |
| CRM Learning, Patient Diversity:
Beyond the Vital Signs. Illustrates the importance
of learning about your particular patient population.
18 minutes |
| CRM Learning, The Power of Words.
A brief, thought provoking opener for a training session on
communication, diversity or teamwork. 3 minutes. |
|
Grainger-Mosen
M, Haslett J.
World’s Apart: A Four-Part Series on Cross-Cultural Health Care.
Fanlight Productions 2004. Case studies on DVD and VHS with a
teaching guide. Cases vary from 10 to 14 minutes.
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| Madden MC. The Debilitator.
Millennium Filmworks, Inc 2004 Nordisk. Explores the
emotional aspects of living with diabetes and its
complications. 33 minutes. |
| Stewart AJ. Disparities in Use
of Atypical Antipsychotics in Racial and Ethnic Minority
Populations. University of Florida Colleges of
Medicine and Pharmacy. Demonstrates information on
racial and ethnic disparities in psychiatric symptoms and
treatment. 1 hour. |
| Time, Inc. Writing Across Cultures.
Explores the influence of multiculturalism on writing.
25 minutes |
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