This will help you to lead with understanding and empathy, rather than judgment, which is an incredibly important shift. This is particularly important in , when a lack of cultural sensitivity is leading to growing displays of intolerance, both here in the U.
The adventure of being in a new place, surrounded by people who in many cases have had vastly different life experiences from your own, is an undeniably special one. It opens your mind and heart to those who you may not previously have shared an understanding with.
Gaining an insight into the cultures of others is an important step toward developing cultural sensitivity and awareness. More and more schools are utilizing travel experiences to formally instill these values in their students. This is exciting news, because it will lead to the next generation of global citizens being more culturally sensitive, aware, and understanding in their interactions with others.
We can only hope that the distrust and skepticism currently being aimed at minority ethnic groups will be replaced with respect and acceptance. Because we believe that open-minded travelers of all ages, backgrounds, and belief systems will be the people who ultimately help change our world for the better. In addition to writing for The Volunteer Traveler, she has directed international programming for various travel organizations.
Yes, well said! This article could persuade people to travel more and visit places very different from their own background. Thank you for reading Natalia! For example, while access is important to all priority populations, people from the disability culture may face multiple levels or forms of access barriers, such as transportation to facilities and whether the exam room and its contents is physically accessible. Similarly, linguistic competence means something different to a provider treating a person for whom English is a second language than to a provider treating a transgendered person.
Comparative effectiveness reviews evaluate the evidence for both benefits and harms, or adverse effects, of interventions in order to provide decisionmakers with the balance of net benefits. In the case of cultural competence interventions, harms may include unintended consequences of an intervention.
For example, while cultural competence interventions often aim to improve cultural sensitivity by reducing stereotyping and stigma, there remains the possibility that some interventions may inadvertently induce different stereotyping behaviors by inducing a provider to create new scripts, or ways of categorizing people, that result in negative consequences.
In addition, the consideration of cultural competence is usually focused on racial or ethnic minority adults, thus creating a gap in evidence-based information in racial or ethnic minority children, persons with disabilities, and LGBTQI people. As noted previously, cultural competence is challenging to isolate as a concept.
The concept of cultural competence overlaps with several other concepts related to providing high-quality, appropriate care. Figure 1 provides an illustration of a few of these overlapping concepts. When conducting systematic review, clarity in discriminating between interventions within the scope of cultural competence versus those outside is important. Some public health outreach activities, such as community-based HIV education in underserved, African American neighborhoods or school-based empowerment programs for young people with disabilities , may address an unmet need.
However, such studies will not be included in this review, as our focus is on the patient-provider interaction and the system of care surrounding that interaction. Within the clinical context, interventions aimed at improving care for all patients such as patient-centered care, patient-centered medical home, health literacy , are excluded unless the intervention is specifically tailored to one of the populations of interest in this review.
This review is focused on interventions that promote equity, the primary outcomes of interest are reductions in disparities between populations for a given health outcome measure. Includable interventions that lie within the Cultural Competence circle in Figure 1 are defined as:.
In response to comments provided, we made several changes. Outcomes of interest were expanded and specified for each priority population. Key Question 5 was rewritten to better fit systematic review methods focused on interventions targeted at the organization and structure level, which can include the built environment. What models have been used to conceptualize cultural competence and culturally appropriate care in health contexts, and how do those models compare? What is the effectiveness of interventions to improve culturally appropriate care for LGBTQI adolescents ages , young adult , and adults?
What is the effectiveness of interventions to improve culturally appropriate health care for children and adults with disabilities? What is the effectiveness of organizational or structural interventions for promoting culturally appropriate care for each of the priority populations across providers? Studies will be included in the review based on the PICOTS framework outlined in Table 1 and the study-specific inclusion criteria described in Table 2. Our search strategy, which appears in Appendix A , was created by staff and a biomedical librarian, and reviewed by a second independent librarian.
Our search strategy included relevant medical subject headings and natural language terms for each of the priority populations and the concept of cultural competence. The concept terms were combined with filters to select relevant RCTs, observational studies, and systematic reviews.
Given the lack of specific and agreed-upon terms that capture cultural competence and the priority populations, and the diffused state of the literature, we will approach the search process strategically, using both inductive and deductive approaches. We will also iteratively return to bibliographic databases to search the literature as new terms are uncovered or new relevant interventional approaches are discovered. As bibliographic database searches are completed for each priority group, we will review the search results for studies relevant to our PICOTS framework and study-specific criteria.
The literature set identified at this phase will be examined from a content analysis perspective for emerging themes. Focused searches will then be developed to specifically search for further examples of that intervention theme in the literature.
Search results will be downloaded to EndNote. All studies identified as relevant by either investigator will undergo full-text screening. Two investigators will independently screen full text to determine if inclusion criteria are met. Differences in screening decisions will be resolved by consultation between investigators, and, if necessary, consultation with a third investigator. We will document the inclusion and exclusion status of citations undergoing full-text screening.
Throughout the screening process, team members will meet regularly to discuss training material and issues as they arise to ensure consistency of inclusion criteria application.
Bibliographic database searches will be supplemented with backward citation searches of highly relevant systematic reviews.
We will also share search results with the TEP for ask for themes which may have been missed in the initial searches. We will conduct additional grey literature searching to identify other search efforts into the priority populations or cultural competence for further MeSH or natural language keyword search terms. Relevant grey literature resources include trial registries and governmental or research organizations.
We will search ClinicalTrials. Studies meeting inclusion criteria will be distributed among investigators for data extraction. One investigator will extract relevant study, population demographics, and outcomes data. Data fields to be extracted will be determined based upon proposed summary analysis. These fields will include author, year of publication; setting, author definition of cultural competence, subject inclusion and exclusion criteria, intervention and control characteristics intervention definition and components, timing, frequency, duration, fidelity , followup duration, participant baseline demographics, enrollment, descriptions and results of primary outcomes and adverse effects, and study funding source.
Relevant data will be extracted into extraction forms created in Excel. Evidence tables will be reviewed and verified for accuracy by a second investigator. We will use data from relevant comparisons in previous systematic reviews to replace the de novo extraction process when the comparison is sufficiently relevant.
Data elements abstracted from included systematic reviews, whether the elements are at the individual study or systematic review levels, will depend on how the systematic review will be used.
Use may range using individual elements to updating a review, to using the review without modification. Only systematic reviews that assess included study risk of bias will be assessed for review quality. Systematic reviews with fair or good methodology will be used. Systematic reviews that are deemed to have potential author conflict of interest, such as due to reviewing a body of literature to which the authors had substantially contributed, will be subjected to random quality checks of 10 percent of included study data abstraction.
Risk of bias of eligible studies will be assessed using instruments specific to study design. The seven domains included in this tool include sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data i. Additional items will be developed to assess potential risk-of-bias not addressed by the Cochrane tool. Outcomes measurement issues inherent in the psychometric properties of the questionnaires used to measure outcomes and assessment methods used to detect change in those questionnaire results will be specifically evaluated for detection bias.
Additional items may be necessary to evaluate potential risk-of-bias associated with treatment definition and implementation treatment fidelity. Specific study methodology or conduct will be used to judge potential risk of bias with respect to each domain following guidance in the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.
The preliminary risk of bias assessment form is provided in Appendix B. The form will be tested by investigators, with particular attention to project term definitions, using an initial sample of included studies and will be finalized by full team input.
Two investigators will independently assess risk of bias for all included studies. Investigators will consult to reconcile any discrepancies in overall risk of bias assessments. When the two investigators disagree, a third party will be consulted to reconcile the summary judgment. Outcomes in studies assessed as having a high risk of bias will be compared to synthesized evidence as a means of sensitivity analysis.
Contradictions will be investigated in further depth. Since AMSTAR was not originally created as a quality review tool, an additional question regarding whether the review findings logically follow from the contributing studies will be added. We will summarize the results into evidence tables and synthesize evidence for each unique population, comparison, and outcome combination.
When a comparison is adequately addressed by a previous systematic review of acceptable quality and no new studies are available, we will reiterate the conclusions drawn from that review.
When new trials are available, previous systematic review data will be synthesized with data from additional trials. We will summarize included study characteristics and outcomes in evidence tables. We do not expect pooling to be appropriate due to lack of comparable studies or heterogeneity; qualitative synthesis will be conducted in these instances. Observational literature examining treatment benefits will be used for subgroups not covered by published RCTs.
The following matrixes provide a basic framework by which intervention population targets and general categories of measures may be assessed. Each of the cells may be exploded into another matrix of relevant details. Likewise, each of the outcome categories listed here may be exploded for finer detail. For example, we will distinguish between medical and mental health services, for patient intermediate outcomes.
Provider types, if information is available in the literature, may be another useful way to contrast information, particularly for ethnicity- or gender-based care providers.
Individual provider versus team approaches will be examined separately. We will explore second order interactions if literature is identified allowing such examination. We will also separate analyses by subgroups within the priority populations, such as different LGBT identities, if the literature provides such information.
Should there be sufficient literature available for possible pooling, decisions for pooling will be based on the homogeneity of study populations based on inclusion criteria, specific interventions, and the ability to treat outcome measures as similar. Data will be analyzed in RevMan 5. Using a random effects model, we will calculate risk ratios RR and absolute risk differences RD with the corresponding 95 percent confidence intervals CI for binary primary outcomes.
We will assess the clinical and methodological heterogeneity and variation in effect size to determine appropriateness of pooling data. A report from the American Psychological Association indicates that people with low incomes and from racial or ethnic minority groups are more likely to experience severe stress than high-income or white counterparts.
This stress leads to poorer mental and physical health outcomes for people who are then less likely to pursue medical care because of financial access or fear of discrimination from a provider. Cultural sensitivity requires a set of skills for affirming diversity and embracing the values of people from different social or cultural backgrounds. Their needs and experiences continue long after they leave a social work or medical office. Expressing cultural sensitivities is part of addressing the continuum of care.
Becoming educated about different cultures can help providers make more accurate medical or mental health diagnoses and build long-lasting, trusting relationships with clients or patients. Service providers and caregivers can actively engage in behaviors that show clients they are valued, heard and understood.
This includes looking inward to reflect on biases, according to a report on cultural awareness published in the Journal of Medical Ethics. Clinicians can also make use of empowering strategies for helping clients feel understood and accepted. In any professional organization, always talk to managers and human resources professionals to better understand best practices that are endorsed by the company. Learn more on supporting immigrants and refugees in our collected resources guide.
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