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Report: Setting the Agenda for Research on Cultural Competence in Health Care

This project looks at the question of what impact cultural competence interventions have on the delivery of health care and health outcomes, and investigates the opportunities and barriers that affect how further research in this area might be conducted.

We have divided each section of the report into Adobe Acrobat documents. You will need the Adobe Acrobat reader to view these files. If you wish to download the entire document click here. Below please find the Table of Contents for each section. Clicking on the main section title will open the report to that section.

Table Of Contents

PART ONE: Introduction and key findings 1
I. Introduction 3
Context of Diversity and Cultural Competence in Health Care 3
The CLAS Standards and Cultural Competence Research Agenda Projects 3
Objectives of Cultural Competence Research 4
II. Overview of the Cultural Competence Research Agenda Project 7
Project Goals and Objectives 7
Project Methodology 7
Highlights of Literature Review Findings 9
Highlights of the Research Agendas 10
Summary of Methodological and Practical Considerations 14


PART TWO: Cultural Competence Research Agendas
 15
I. Overview 17
Categories 17
Format 18
II. Category A: Culturally Sensitive Interventions 19
Research Agenda on Cultural Competence Education and Training 19
Research Agenda on Racial, Ethnic, and Linguistic Concordance 24
Research Agenda on Community Health Workers 27
Research Agenda on Culturally Competent Health Promotion 30
Research Agenda on Family/Community Inclusion in Health Care Delivery 32
Research Agenda on Coordination of Conventional Medicine
and Traditional Practices/Healers
 34
III. Category B: Language Assistance 36
Research Agenda on Language Barriers, Bilingual Services, Oral Interpretation, and Translated Written Materials 36
IV. Category C: Organizational Supports for Cultural Competence 42
State of the Literature 42
Research Agenda on Management, Policy and Implementation Strategies to Institutionalize Cultural Competence Activities 43
Research Agenda on Community Involvement in Cultural Competence Program Planning, Design, Implementation, Governance, Training, and Research 44
Research Agenda on Design and Use of Surveys and Profile Instruments to Plan for Services, and Measure Satisfaction and Quality 45
Research Agenda on Cultural Competence Self-Assessments and Ethnic Data Collection/Community Profiles 46
Research Agenda on Culturally Appropriate Ethics, Conflict, and Grievance Resolution Processes 47
Research Agenda on Public Information about CLAS Standards Performance 47
Research Agenda on Implementation of all the CLAS Standards as a Comprehensive Organizational Strategy 48
Methodological and/or Policy Considerations Influencing Future Research 48


PART THREE: Methodological and Practical Considerations Related to Conducting Research on Cultural Competence
 

49
I. Methodological Challenges to Conducting Cultural Competence Research 51
Definitions of Cultural Competence in Health Care 51
Study Design 53
II. Data Challenges 55
Universal Issues 55
Institutional Issues 55
Community/Individual Issues 56
III. Better Links Between Researchers and Cultural Competence Experts 57
IV. Funding and Publication Issues 58
Funding 58
Publication 58
Dissemination 59


Appendix One: Key Words Used in Literature Review
 

61
I. Keywords Used for Category A: Culturally Sensitive Interventions 63
II. Keywords Used for Category B: Language Assistance 63
III. Keywords Used for Category C: Organizational Supports for Cultural Competence 64


Appendix Two: Literature Reviews and Matrices
 

65
I. Format of Appendix Two 67

II. Category A: Culturally Sensitive Interventions
 
68
Cultural Competence Education and Training 68
Literature Summary Matrices 71

Racial, Ethnic and Linguist Concordance
 
77
Literature Summary Matrices 79

Community Health Workers
 
85
Literature Summary Matrices 87

Culturally Competent Health Promotion
 
91
Literature Summary Matrices 94

Family/Community Inclusion in Health Care Delivery
 
108
Literature Summary Matrices 110

Coordination of Conventional Medicine and Traditional Practices/Healers
 
113
Literature Summary Matrices 114

III. Category B: Language Assistance
 
120
Language Barriers, Bilingual Services and Oral Interpretation,and Translated Written Materials 120
Literature Summary Matrices 125

IV. Category C: Organizational Supports for Cultural Competence
 
142
Management, Policy and Implementation Strategies to Institutionalize Cultural Competence Activities 142
Design and Use of Surveys and Profile Instruments to Plan for Service and Measure Satisfaction and Quality  142
Other Organizational/Administrative Supports Not Part of this Literature Review 143
Research Considerations 143
Literature Summary Matrices 144


Appendix Three: Select Research Advisory Committee (RAC) Meeting Materials
 

151
I. Research Advisory Committee Participant Roster 153
II. Research Advisory Committee Meeting agenda 155
III. Research Advisory Committee Meeting Goals 156


References
 

157


Appendix Four: Abstracts
 

173
Preface 175
Cultural Competence Education and Training 177
Racial, Ethnic and Linguist Concordance 182
Community Health Workers 185
Culturally Competent Health Promotion 188
Family/Community Inclusion in Health Care Delivery 197
Coordination of Conventional Medicine and Traditional Practices/Healers 199
General 203
Language Assistance 203
Organizational Supports 215

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