Cultural competency in health care: Web sites for health care providers and educators

Karen Gilbert; Michelyn W. Bhandari


As the United States becomes more culturally diverse, inequities in health care have been identified. It is a sad truth that, for Americans, the quality of health care received varies greatly depending on race, ethnicity, ability to speak English, socioeconomic group, or place of residence (especially if it is rural). One organization bridging this gap is the Agency for Healthcare Research and Quality, which for the past eight years has published the National Healthcare Disparities Report detailing trends in health care equity and identifying inequalities. In it, for example, readers can find that Blacks, American Indians, and Alaska Natives received worse care than whites for 40% of the evaluating standards, and that the poor generally received worse care than higher income people in 80% of these standard measures.1

Other U.S. government agencies, educational institutions, and organizations also participate in the effort to disseminate information enabling health care providers to acquire and use cultural competency skills in their practice. Many of these groups make their presence and information available online.

This article points to these online educational resources, Web sites, and blogs to assist librarians and their patrons, as well as educators, with information to address health care disparities.

U.S. government

  • Culture, Language and Health Literacy. The Health Resources and Services Administration provides links to materials intended to improve communication between providers and clients with diverse cultural, language, and health literacy backgrounds. Resources can be accessed in these categories: General, Race/Ethnicity, Gender, Age, Special Populations, and Research and Education. One key feature is a section on Essential Health Literacy Tools, with advice on how to produce clear and understandable health education materials. Access: http://www.hrsa.gov/culturalcompetence/index.html.
  • Minority Health Surveillance – REACH U.S. 2009. The Centers for Disease Control and Prevention administer annual surveys in minority communities to monitor the local health status. Called The Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Survey, this study evaluates health conditions for the following groups: Black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian. Results are compared with data for the general population derived from the “Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan and micropolitan statistical area (MMSA),”2 in these same communities. This data comparison assists in the development of intervention programs for minority groups. Access: http://www.cdc.gov/Features/dsREACHUS.
  • Minority Women’s Health. From the U.S. Department of Health and Human Services Office on Women’s Health, this site identifies government programs that act to improve the health of minority women. It distinguishes particular health risks faced by women of certain ethnic groups (African-Americans, Latinas, Asian-Americans, Native Hawaiians/Pacific Islanders, American Indians/Alaska Natives, and immigrants) and provides links to information resources and organizations that may assist in dealing with these risks. Access: http://www.womenshealth.gov/minority-health/governmentin-action/index.cfm.
  • National Healthcare Disparities Report, 2010. The eighth annual report from the Agency for Healthcare Research and Quality seeks to identify the “progress and opportunities for improving health care quality and reducing health care disparities.”3 It presents data for significant health care categories and comparisons in chart form with text explanations. This report provides data on the following health issues: Effectiveness of Care, Patient Safety, Timeliness, Patient Centeredness, Care Coordination, Efficiency, Health System Infrastructure, Access to Health Care, and Priority Populations. Effectiveness of Care is measured specifically for these health topics: Cancer, Diabetes, End Stage Renal Disease, Heart Disease, HIV and AIDS, Maternal and Child Health, Mental Health and Substance Abuse, Respiratory Diseases, Lifestyle Modification, Functional Status Preservation and Rehabilitation, and Supportive and Palliative Care. Methodology is explained in the introduction and in four appendices. The 2010 report’s priority population research emphasis includes analysis of heath care in inner-city and rural communities. Noting that the quality of health care varies across the country, this report directs readers to a “snapshot” of health by state.4 Each state’s health care strengths or weaknesses, and opportunities for improvement, are detailed in key categories as compared to states in their region and to the nation. Access: www.ahrq.gov/qual/nhdr10/nhdr10.pdf.
  • The Office of Minority Health, Cultural Competency (OMH). The OMH’s mission is to improve “the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.”5 The site aims to be an encompassing source of cultural and linguistic competency information and resources. Among the many significant features included here are the National Standards on Culturally and Linguistically Appropriate Services (CLAS), 14 standards of which four are mandatory for any organization receiving federal funds. The Guides and Resources page offers wideranging content, such as “A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations.” The Training Tools for Physicians and Others page contains useful links such as “Culturally Competent Nursing Care: A Cornerstone of Caring.” There is also a page of relevant Policies, Initiatives and Laws. Users may wish to browse OMH’s offerings outside of the Cultural Competency tab. Pages on Data and Statistics, Minority Populations, Publications, and a searchable Knowledge Center all support OMH’s effort to improve health care for disadvantaged populations. The Think Cultural Health: Advancing Public Health at Every Point of Contact pages offer Continuing Education and Communication Tools. Much of this site’s content is available in Spanish. Access: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3.

Educational institutions

  • National Center for Cultural Competence (NCCC). The National Center for Cultural Competence is hosted by Georgetown University’s Center for Child and Human Development. This site offers a very rich array of resources for individuals and organizations interested in developing cultural competency practice. NCCC describes its mission as “to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity.”6 NCCC’s site provides an abundant range of publications and other resources organized alphabetically or by type (for example, Guides and Planning Tools). Additionally, these resources may be accessed by target audience: Organizations and Programs, Providers and Practitioners, Faculty and Trainers, and Families and Communities. The Family and Youth Perspectives link leads to articles designed to increase awareness of the cultural challenges families may face in seeking care, and some of the personal stories are very affecting. Self-assessment tools for organizations and individuals wanting to gauge sensitivity to, and knowledge of, cultural competence are available on a page with links to assessment resources, notably the Cultural Competence Health Practitioner Assessment (CCHPA). NCCC partners with government agencies, foundations, and organizations in providing resources and services. Current HRSA- and SAMHSA-Funded Projects and Initiatives include Children and Youth with Special Health Care Needs, the National SUID/SIDS Project, the Division of Research, Training and Education, and the Child and Adolescent Mental Health Initiative. NCCC can connect organizations with consultants to assist them with training and technical support. Consultants are available either geographically or by specialty. The Links to Other Resources is a valuable index of cultural competency information sources. Much of this site’s content is presented in Spanish. Access: http://nccc.georgetown.edu/.

Associations and private or nonprofit organizations

  • The Cross Cultural Health Care Program (CCHCP). Located in Seattle, CCHCP offers training and consultation in the area of health care cultural and linguistic competency. Their outreach on a national level includes cultural competence train-the-trainers programs, as well as medical interpreting education. CCHCP sells a range of moderately priced bilingual medical glossaries, books, videos, and articles on the subject of cultural and linguistic competency. In particular, their Resource Center/Resource Guides contain an extensive group of links to information sources and organizations in the fields of cultural competence, health disparities, language access, medical interpreter services, the Culturally and Linguistically Appropriate Services (CLAS) standards and strategies for addressing CLAS, as well as a glossary of terms. Access: http://www.xculture.org/about.php.
  • Cultural Competency in Nursing Education. On this site, the American Association of Colleges of Nursing publishes recommendations on Cultural Competency in Baccalaureate Nursing Education and Cultural Competencies for Graduate Nursing Students. Each document includes a rationale for inclusion of cultural competency in nursing education and identifies specific end-of program competencies enabling provision of culturally competent care. Both are accompanied by a toolkit of resources to assist educators implementing these objectives. Access: http://www.aacn.nche.edu/Education/cultural.htm.
  • Diversity RX. A nonprofit organization, DiversityRX focuses on improving accessibility and quality of health care for minority, immigrant, and indigenous populations. The site is highly interactive, building affinity groups through such innovations as the Your Voice Initiative, which facilitates networking and collaboration online, monthly Webinars, communities of practice, and peer learning networks. Readers may choose to take advantage of a free membership, which enables them to network with others on the site’s blog. This membership also allows readers to suggest new resources, comment on resources they have used, or participate in one of the communities of practice or peer learning networks. DiversityRX offers a searchable resource and organization database, and also features information resources on their Topics tab. Key topics and issues include: Organizational Cultural Competence, Culturally Competent Care, Cultural Competence Training, Language Access, Policy, and Research. Access: http://www.diversityrx.org.
  • National Alliance for Hispanic Health (NAHH). Organized in 1973, NAHH is a network of providers whose mission is to provide health and human services to the Hispanic population. It advocates for health care reform supporting health care equity and for culturally inclusive medical research. NAHH has developed programs that promote community education and improved health in the areas of arthritis, cancer, community outreach, depression, diabetes, environmental health, heart health, physical activity, science and education, and women’s health. It also offers a Resource Library with health publications and access to help lines. Access: http://www.hispanichealth.org.

  • Transcultural C.A.R.E. Associates. Originated by Josepha Campinha-Bacote, Transcultural C.A.R.E. Associates is a private organization specializing in the provision of training and consultation in cultural competence, transcultural health care, and mental health. Campinha-Bacote maintains an active presentation schedule, as well as publishes considerably in the field. Her site features Models of Cultural Competence and Assessment Tools, some of which explicitly reflect a Christian viewpoint. The author offers books and assessment instruments for sale on the site. She also provides a series of useful links to other cultural competence information and resources. Access: http://www.transculturalcare.net.
  • Transcultural Nursing Society (TCNS). TCNS was founded in 1975 by the nursing theorist Madeleine Leininger, who is called on her Web site the founder of the worldwide Transcultural Nursing movement.7 This society aims to provide nurses and other health care professionals with the tools to ensure equity in health care on an international basis, by supporting and providing standards on culturally congruent health care research, education, practice, and administration. TCNS publishes the peer-reviewed Journal of Transcultural Nursing (JTCN). It also offers a page on related theories of cultural competence. Since 1987, TCNS has offered a Certification in Transcultural Nursing for practitioners. Access: http://www.tcns.org.

Blogs

  • Andromeda Transcultural Health. Andromeda Transcultural Health is a community health organization located in Washington, D.C. Founded by Ricardo Galbis in 1970, it originally targeted Washington’s Hispanic community. Its mission is to provide access to quality health care for underserved populations, regardless of cultural or linguistic background or ability to pay. This blog is of interest particularly as it demonstrates creative outreach to the community. Access: http://athdc.wordpress.com.
  • Bringing Health Information to the Community (BHIC). From the National Network of Libraries of Medicine, this blog contains information on health issues in underserved communities. Information is organized by topic, such as Minority Health Concerns, Rural Health, or Health Literacy. Information can also be accessed by month of posting. BHIC provides information on relevant conferences, as well as scholarships and grants. Users must register to post a reply to any entry. Access: http://nnlm.gov/bhic/2010/12/20/cultural-competencyresources-2.

Notes
1. Agency for Healthcare Research and Quality, 2011 , “2010 National Healthcare Disparities Report,”. retrieved from www.ahrq.gov/qual/nhdr10/nhdr10.pdf (accessed November 9, 2011).
2. Centers for Disease Control and Prevention, 2011 , “Minority Health Surveillance–REACH U.S. 2009,”. retrieved from www.cdc.gov/Features/dsREACHUS/ (accessed November 9, 2011).
3. Agency for Healthcare Research and Quality, 2011 , “2010 National Healthcare Disparities Report,”. retrieved from www.ahrq.gov/qual/nhdr10/nhdr10.pdf (accessed November 9, 2011).
4. See http://statesnapshots.ahrq.gov/snaps10/index.jsp.
5. U.S. Department of Health & Human Services, The Office of Minority Health, 2010 , “Cultural Competency,”. retrieved from minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3 (accessed November 9, 2011).
6. Georgetown University Center for Child and Human Development, n.d., “Cultural Competence,”. retrieved http://gucchd.georgetown.edu/67212.html (accessed November 9, 2011).
7. Madeleine Leininger, 2011 , “Home Page – Madeleine Leininger,”. retrieved from www.madeleine-leininger.com/en/index.shtml (accessed November 9, 2011).
Copyright © 2011 Karen Gilbert and Michelyn W. Bhandari

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