Mandy Truong

Interventions to improve cultural competency in healthcare: a systematic review of reviews

BackgroundCultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.MethodsA systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong.ResultsNineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes.ConclusionThis review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs.

Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis

BackgroundRacism is increasingly recognized as a key determinant of health. A growing body of epidemiological evidence shows strong associations between self-reported racism and poor health outcomes across diverse minority groups in developed countries. While the relationship between racism and health has received increasing attention over the last two decades, a comprehensive meta-analysis focused on the health effects of racism has yet to be conducted. The aim of this review protocol is to provide a structure from which to conduct a systematic review and meta-analysis of studies that assess the relationship between racism and health.MethodsThis research will consist of a systematic review and meta-analysis. Studies will be considered for review if they are empirical studies reporting quantitative data on the association between racism and health for adults and/or children of all ages from any racial/ethnic/cultural groups. Outcome measures will include general health and well-being, physical health, mental health, healthcare use and health behaviors. Scientific databases (for example, Medline) will be searched using a comprehensive search strategy and reference lists will be manually searched for relevant studies. In addition, use of online search engines (for example, Google Scholar), key websites, and personal contact with experts will also be undertaken. Screening of search results and extraction of data from included studies will be independently conducted by at least two authors, including assessment of inter-rater reliability. Studies included in the review will be appraised for quality using tools tailored to each study design. Summary statistics of study characteristics and findings will be compiled and findings synthesized in a narrative summary as well as a meta-analysis.DiscussionThis review aims to examine associations between reported racism and health outcomes. This comprehensive and systematic review and meta-analysis of empirical research will provide a rigorous and reliable evidence base for future research, policy and practice, including information on the extent of available evidence for a range of racial/ethnic minority groups

How Australian and New Zealand schools of optometry prepare students for culturally competent practice

Background This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity. Methods All Australian and New Zealand schools of optometry were invited to participate in the study. Data were collected with two surveys: a curriculum survey about the content of the optometric courses in relation to cultural competency issues and a survey for second year optometry students containing questions in relation to cultural awareness, cultural sensitivity and attitudes to cultural diversity. Results Four schools of optometry participated in the curriculum survey (Deakin University, Flinders University, University of Melbourne and University of New South Wales). Sixty-three students (22.3 per cent) from these four schools as well as the University of Auckland participated in the student survey. Cultural competency training was reported to be included in the curriculum of some schools, to varying degrees in terms of structure, content, teaching method and hours of teaching. Among second year optometry students across Australia and New Zealand, training in cultural diversity issues was the strongest predictor of cultural awareness and sensitivity after adjusting for school, age, gender, country of birth and language other than English. Conclusion This study provides some evidence that previous cultural competency-related training is associated with better cultural awareness and sensitivity among optometric students. The variable approaches to cultural competency training reported by the schools of optometry participating in the study suggest that there may be opportunity for further development in all schools to consider best practice training in cultural competency.This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity.

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

Introduction Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006–2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia. Methods and analysis This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1–4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe). Ethics and dissemination Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Optometrists' perspectives on cross-cultural encounters in clinical practice: a pilot study

Background:  There is growing awareness that cultural background influences health beliefs and practices and can impact on the patient–practitioner encounter. However, in relation to optometry there is little known about the implications of cultural diversity for clinical decision‐making and how optometrists address culturally based understandings of health. This pilot study examines how culturally based differences in health practices and beliefs impact on patient–optometrist interactions and how optometrists negotiate and manage these differences.

There are people in Australia who have poor vision or eye disease that is avoidable. What more can we do

Are we doing all we can to identify andprovide eye care to those individualsand groups in our community who havepoor vision and eye disease? It has beenalmost twenty years since two significantpopulation-based surveys of eye diseaseand visual loss were conducted inAustralia, namely, the Melbourne VisualImpairment Project and the Blue Moun-tains Eye Study. The accumulated data ofthese two major surveys estimated that in2004, there were 480,300 Australians withlow vision, including 50,600 Australianswho were blind. About 9.4 per cent of Aus-tralians aged 55 years and over have lowvision and about 1.2 per cent are blind.

A Cultural Competence Organizational Review for Community Health Services: Insights From a Participatory Approach

Cultural competence is an important aspect of health service access and delivery in health promotion and community health. Although a number of frameworks and tools are available to assist health service organizations improve their services to diverse communities, there are few published studies describing organizational cultural competence assessments and the extent to which these tools facilitate cultural competence. This article addresses this gap by describing the development of a cultural competence assessment, intervention, and evaluation tool called the Cultural Competence Organizational Review (CORe) and its implementation in three community sector organizations. Baseline and follow-up staff surveys and document audits were conducted at each participating organization. Process data and organizational documentation were used to evaluate and monitor the experience of CORe within the organizations. Results at follow-up indicated an overall positive trend in organizational cultural competence at each organization in terms of both policy and practice. Organizations that are able to embed actions to improve organizational cultural competence within broader organizational plans increase the likelihood of sustainable changes to policies, procedures, and practice within the organization. The benefits and lessons learned from the implementation of CORe are discussed.

Advancing cultural competence in optometry: Cultural competence in optometry Truong and Selig

According to the 2011 Australian Census, over 26 per cent of the population were born overseas. Sixty-seven per cent of recent arrivals and 49 per cent of longerstanding migrants speak a language other than English at home. In New Zealand, 25.2 per cent of the population in 2013 were born overseas. It is widely acknowledged within Australia, New Zealand and internationally that consideration of cultural and linguistic issues is important in meeting the health needs of people from culturally and linguistically diverse (CALD) backgrounds. In multicultural countries such as Australia, optometrists and their patients are often from different cultural backgrounds and may hold different understandings about ocular health and health-care. As such, the recently updated Optometry Australia Entry-level Competency Standards for Optometry included greater reference to cultural competence. Cultural competence refers to ‘a set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in crosscultural situations’. A pilot study by Truong and Fuscaldo found that cultural background can impact patient-optometrist clinical encounters, making culturally based differences, beliefs and values (related to ocular health) difficult to negotiate. Additionally, further development of cultural competence training in preregistration education of optometrists was recommended following the finding that Australian and New Zealand schools of optometry had variable approaches to cultural competency training. This study also found some evidence indicating that students’ previous exposure to cultural competency-related training was associated with better cultural awareness and sensitivity among optometric students. While there is a paucity of research related to cultural issues within the field of optometry, research in other health professions, such as medicine and nursing, has shown the significance of cultural background on clinical encounters and health outcomes. This article will outline the significance of culture in health-care and provide a rationale for cultural competence in optometric practice, and additionally, suggest key action areas for advancing cultural competence in optometry.

Cultural competence in the community health context: ‘we don’t have to reinvent the wheel’

Health and social service agencies need to be responsive to the healthcare requirements of culturally and linguistically diverse (CALD) groups in the community. This is a challenging proposition, particularly due to shifting demographics in developed Western countries such as Australia. Organisations that strive for cultural competence can potentially reduce the barriers associated with inequitable access to services by CALD groups. Community health services play a vital role in the provision of culturally competent health services to people from CALD groups. Additional research related to cultural competence in the community health context is needed. Thus, the aim of this paper is to explore the positioning of cultural competence within community health from multiple perspectives using a qualitative case study of a community health service located in Victoria, Australia. The findings suggest that if the essential needs of clients are met, regardless of cultural background (e.g. able to communicate with staff, trust and a respectful and caring environment), then issues related to cultural background may be of less significance for some clients.