Can cultural competence-based techniques help reduce existing racial and ethnic health disparities?

Can cultural competence-based techniques help reduce existing racial and ethnic health disparities?
This research has found the theoretical connections between cultural competence and health disparities frequently presented by scholars and policy-makers to be potentially unsound. An extensive literature review and policy analysis conducted indicates that the relationship between cultural competence-based techniques and documented racial and ethnic health disparities is predicated on select studies suggesting ‘patient satisfaction’ results from cultural competence-based programs and thus plays a crucial role in reducing health disparities (Betancourt et al., 2003; Baquet, 2005; Anderson, 2011; James et al,. 2011; Lie et. Al., 2011). These studies provide no evidentiary support for the increase of patient satisfaction alongside cultural competency-based efforts, or the reduction of health disparities alongside experienced patient satisfaction.My MA research has also elicited a number of critical issues pertaining to concepts of cultural competence,’ such as implicit power dynamics, paradoxes of ‘knowing’, problematic interpretations of ‘culture,’ and the reification of racial hierarchies. These concerns suggest that ‘achieving’ or even ‘working towards’ cultural competency-based frameworks may, in fact, be prejudicial.Collectively, this MA research prompts the question(s): Given the tenuous relationship between cultural competence and documented health disparities, and the potentially problematic nature of cultural competency frameworks, should cultural competencybased framework be utilized in medical education. There may be other advantages toutilizing cultural competence-based frameworks within medical education curricula, and these will be explored.
Principal Research Question:
My doctoral research will seek to address the following principal research question:
“Are cultural competency-based frameworks, which presently inform medical education curricula, ethically defensible?”The innovation of this research lies in the fact that such critical investigations of cultural competency and articulated implications for present medical education still remain in their infancy.
Research Design:
The initial exploration of cultural competence conducted within my MA research will largely substantiate two chapters concerning the present conception and purpose of cultural competency-based efforts.A number of specific questions will guide my research. In combination, the prior literature and its voids, together with my MA dissertation observations suggest the following issues will prove relevant in my investigation:What is articulated as the reason/justification for New Zealand’s current cultural competence-based medical education program(s)?
What is aim of cultural competence within the context of medical education?
What is the observed or implicit relationship between concepts of race, ethnicity and culture?– How are these concepts constructed/implicated?
Methodology:
My research design will involve the use of philosophical investigation, which includes reviewing the scholarly literature on cultural competence and medical education, and critically analyzing arguments in support, and in question, of cultural competency-based efforts. I will be extensively reviewing the current cultural competence-based programmes within both of New Zealand’s medical schools and speaking with key informants on the topic.
To critically address the concept of cultural competence, this thesis will introduce some of the methodological tools from the scholarship of Michel Foucault. This approach provides novel way of interpreting and problematizing knowledge systems, providing relevant but new questions, objects of enquiry and epistemological and ontological flexible dimensions of research analysis.
While the above speaks to the nature of this PhD most broadly, the research will be approached as an exploration that unveils and shapes itself as it progresses.
Reading List/ Bibliography:
Adams, V., & Kaufman, S. R. (2011). Ethnography and the Making of Modern Health Professionals. Culture, medicine and psychiatry, 35(2), 313–320.Anderson, J., Perry, J., Blue, C., Browne, A., Henderson, A., Khan, K. B., … Smye, V.(2003). “ Rewriting” Cultural Safety Within the Postcolonial and Postnational Feminist Project: Toward New Epistemologies of Healing. Advances in Nursing Science, 26(3), 196–214.
Antman, K., Abraido-Lanza, A. F., Blum, D., Brownfield, E., Cicatelli, B., Debor, M. D., …Gradishar, W. (2002). Reducing Disparities in Breast Cancer Survival: A Columbia University and Avon Breast Cancer Research and Care Network Symposium*. Breast cancer research and treatment, 75(3), 269–280.
Baquet, C. R., Bezuneh, M., & Mishra, S. I. (2005). Addressing health disparities through community-academic partnerships: the Maryland model. Different Paths for Different People: Reducing Health Disparities. Retrieved from
letin.pdf#page=4Betancourt, J. R., & Green, A. R. (2010a). Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Academic Medicine, 85(4), 583.Betancourt, J. R., & Green, A. R. (2010b). Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Academic Medicine, 85(4), 583.Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003a). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports, 118(4), 293.Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003b). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.Borau, K., Ullrich, C., Feng, J., & Shen, R. (2009). Microblogging for language learning:Using twitter to train communicative and cultural competence. In Advances in Web BasedLearning–ICWL 2009 (pp. 78–87). Springer. Retrieved fromhttp://link.springer.com/chapter/10.1007/978-3-642-03426-8_10Brach, C., & Fraserirector, I. (2000a). Can cultural competency reduce racial and ethnic healthdisparities? A review and conceptual model. Medical Care Research and Review, 57(4suppl), 181–217.Brach, C., & Fraserirector, I. (2000b). Can cultural competency reduce racial and ethnic healthdisparities? A review and conceptual model. Medical Care Research and Review, 57(4suppl), 181–217.Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annu.Rev. Public Health, 27, 167–194.Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of epidemiology andcommunity health, 57(4), 254–258.Carberry, C. (1998). Contesting competency: cultural safety in advanced nursing practice.Collegian: Journal of the Royal College of Nursing Australia, 5(4), 9–13.Carter-Pokras, O., & Baquet, C. (2002). What is a“ health disparity”? Public health reports,117(5), 426.Casas, J. M. (2013). Review of Multicultural care: A clinician’s guide to cultural competence.Cultural diversity & ethnic minority psychology, 19(2), 229–230. doi:10.1037/a0029610Casas-Zamora, J. A., & Ibrahim, S. A. (2004a). Confronting Health Inequity: The GlobalDimension. American Journal of Public Health, 94(12), 2055–2058.Casas-Zamora, J. A., & Ibrahim, S. A. (2004b). Confronting Health Inequity: The GlobalDimension. American Journal of Public Health, 94(12), 2055–2058.Chambers, D., Wharrad, H., Todhunter, F., Chambers, K., Nencini, D., & McGarry, J. (2011).PROMOTING CULTURAL AWARENESS IN HEALTH CARE STUDENTS WITHTHE USE OF VIRTUAL MOBILITY, COMMUNICATION TECHNOLOGIES ANDAUTHENTIC CASE STUDIES. ICERI2011 Proceedings, 5589–5594.Commission, J. (2010a). Advancing effective communication, cultural competence, andpatient-and family-centered care: A roadmap for hospitals. Joint Commission.Commission, J. (2010b). Advancing effective communication, cultural competence, andpatient-and family-centered care: A roadmap for hospitals. Joint Commission.Cooney, C. (1994). A comparative analysis of transcultural nursing and cultural safety.Nursing praxis in New Zealand inc, 9(1), 6.Cross, T. L. (2008). Cultural competence. Encyclopedia of social work, 20, 487–491.Désirée A. Lie MD, M., Elizabeth Lee-Rey MD, M. P. H., Md, A. G., Ms, S. B., & ClarenceH. Braddock III MD, M. P. H. (2011). Does Cultural Competency Training of HealthProfessionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithmfor Future Research. Journal of General Internal Medicine, 26(3), 317–325.doi:10.1007/s11606-010-1529-0Emmison, M. (2003). Social Class and Cultural Mobility Reconfiguring the CulturalOmnivore Thesis. Journal of sociology, 39(3), 211–230.Farr, C., & Virchow, K. (2009). Towards a common definition of global health. Lancet, 373,1993–95.Foucault, M. (1982). The subject and power. Critical inquiry, 8(4), 777–795.Gonzalez-Lee, T., & Simon, H. J. (1987). Teaching Spanish and cross-cultural sensitivity tomedical students. Western Journal of Medicine, 146(4), 502–504.Goode, T., Jones, W., & Mason, J. (2012). A guide to planning and implementing culturalcompetence organization self assessment. Published 2002.Hernandez, M., Nesman, T., Mowery, D., Acevedo-Polakovich, I., & Callejas, L. (2009).Cultural competence: a literature review and conceptual model for mental health services.Psychiatric Services, 60(8), 1046–1050.Horowitz, S. (2005). Cultural Competency Training in US Medical Education: TreatingPatients from Different Cultures. Alternative & Complementary Therapies, 11(6), 290–294.Horton, S. (2006). The double burden on safety net providers: Placing health disparities in thecontext of the privatization of health care in the US. Social Science & Medicine, 63(10),2702–2714.Ikemoto, L. C. (2003). Racial disparities in health care and cultural competency. . Louis ULJ,48, 75.Imel, Z. E., Baldwin, S., Atkins, D. C., Owen, J., Baardseth, T., & Wampold, B. E. (2011).Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study ofcultural competence. Journal of counseling psychology, 58(3), 290.Jacob, J., Gray, B., & Johnson, A. (2013). The asian american family and mental health:implications for child health professionals. Journal of pediatric health care: officialpublication of National Association of Pediatric Nurse Associates & Practitioners, 27(3),180–188. doi:10.1016/j.pedhc.2011.08.006James, L., Smith, C., & Laird, L. (2011a). Cultural Competence in Action: An Analysis ofCultural Competency Outcome Assessment in the Behavioral Health Field. RetrievedfromJames, L., Smith, C., & Laird, L. (2011b). Cultural Competence in Action: An Analysis ofCultural Competency Outcome Assessment in the Behavioral Health Field. RetrievedfromJeffreys, M. (2010a). Teaching cultural competence in nursing and health care. SpringerPublishing Company. Retrieved fromhttp://books.google.co.nz/books?hl=en&lr=&id=Pu07C7jjqn4C&oi=fnd&pg=PP2&dq=%22health+disparities%22+%22cultural+competence%22&ots=xsE7qni1UT&sig=Y0hi_dsveXUYavRozB34Ma5hwCUJeffreys, M. (2010b). Teaching cultural competence in nursing and health care. SpringerPublishing Company. Retrieved fromhttp://books.google.co.nz/books?hl=en&lr=&id=Pu07C7jjqn4C&oi=fnd&pg=PP2&dq=cultural+competence&ots=xsE7qng9NX&sig=Ynr8TAtls-kHkJ27AL3JqCr9EtwJeffreys, M. R. (2005). Clinical nurse specialists as cultural brokers, change agents, andpartners in meeting the needs of culturally diverse populations. Journal of MulticulturalNursing and Health, 11(2), 41.Kapoor, R., Dike, C., Burns, C., Carvalho, V., & Griffith, E. E. H. (2013). Culturalcompetence in correctional mental health. International journal of law and psychiatry.doi:10.1016/j.ijlp.2013.04.016Karmali, K., Grobovsky, L., Levy, J., & Keatings, M. (2011a). Enhancing cultural competencefor improved access to quality care. Healthcare quarterly (Toronto, Ont.), 14, 52.Karmali, K., Grobovsky, L., Levy, J., & Keatings, M. (2011b). Enhancing cultural competencefor improved access to quality care. Healthcare quarterly (Toronto, Ont.), 14, 52.Keppel, K. G. (2007). Ten largest racial and ethnic health disparities in the United Statesbased on Healthy People 2010 objectives. American Journal of Epidemiology, 166(1),97–103.Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006).Advancing health disparities research within the health care system: a conceptualframework. Journal Information, 96(12). Retrieved fromhttp://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2005.077628Kirmayer, L. J. (2012a). Cultural competence and evidence-based practice in mental health:epistemic communities and the politics of pluralism. Social Science & Medicine.Retrieved fromKirmayer, L. J. (2012b). Cultural competence and evidence-based practice in mental health:epistemic communities and the politics of pluralism. Social Science & Medicine.Retrieved fromKrieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2005).Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: thePublic Health Disparities Geocoding Project. Journal Information, 95(2). Retrieved fromhttp://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2003.032482Kumagai, A. K., & Lypson, M. L. (2009a). Beyond cultural competence: criticalconsciousness, social justice, and multicultural education. Academic Medicine, 84(6),782–787.Kumagai, A. K., & Lypson, M. L. (2009b). Beyond cultural competence: criticalconsciousness, social justice, and multicultural education. Academic Medicine, 84(6),782–787.Lasser, K. E., Himmelstein, D. U., & Woolhandler, S. (2006). Access to care, health status,and health disparities in the United States and Canada: results of a cross-nationalpopulation-based survey. Journal Information, 96(7). Retrieved fromhttp://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2004.059402Lavizzo-Mourey, R. J., & MacKenzie, E. (1996). Cultural competence–an essential hybrid fordelivering high quality care in the 1990’s and beyond. Transactions of the AmericanClinical and Climatological Association, 107, 226–237.Lee, S. S.-J., Mountain, J., & Koenig, B. A. (2001). Meanings of Race in the New Genomics:Implications for Health Disparities Research, The. Yale J. Health Pol’y L. & Ethics, 1,33.Lie, D. A., Elizabeth Lee-Rey MD, M. P. H., Gomez, A., Bereknyei, S., & Braddock III, C. H.(2011). Does cultural competency training of health professionals improve patientoutcomes? A systematic review and proposed algorithm for future research. Journal ofgeneral internal medicine, 26(3), 317–325.Lie, D., Carter-Pokras, O., Braun, B., & Coleman, C. (2012). What do health literacy andcultural competence have in common? Calling for a collaborative health professionalpedagogy. Journal of Health Communication, 17(sup3), 13–22.Lloyd, L. L. J., Ammary, N. J., Epstein, L. G., Johnson, R., & Rhee, K. (2006). Atransdisciplinary approach to improve health literacy and reduce disparities. HealthPromotion Practice, 7(3), 331.Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: a life-courseperspective. Maternal and child health journal, 7(1), 13–30.Lynch, E. W., & Hanson, M. J. (2004). Developing cross-cultural competence: A guide forworking with children and their families. ERIC. Retrieved fromhttp://www.eric.ed.gov/ERICWebPortal/recordDetail?accno=ED491776Moore, M. L., Moos, M. K., & Callister, L. C. (2010). Health disparities and culturalcompetence in the 21st century. White Plains, NY: March of Dimes Foundation.[ContextLink].Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care.Journal of the National Medical Association, 94(8), 666.Nylund, D. (2006). Critical multiculturalism, whiteness, and social work: Towards a moreradical view of cultural competence. Journal of Progessive Human Services, 17(2), 27–42.Pacquiao, D. F. (2008). Nursing care of vulnerable populations using a framework of culturalcompetence, social justice and human rights. Contemporary nurse, 28(1-2), 189–197.Papps, E., & Ramsden, I. (1996). Cultural safety in nursing: The New Zealand experience.International Journal for Quality in Health Care, 8(5), 491–497.Peek, M. E., Wilson, S. C., Bussey-Jones, J., Lypson, M., Cordasco, K., Jacobs, E. A., …Brown, A. F. (2012). A study of national physician organizations’ efforts to reduce racialand ethnic health disparities in the United States. Academic Medicine, 87(6), 694–700.Polaschek, N. R. (1998). Cultural safety: A new concept in nursing people of differentethnicities. Journal of Advanced Nursing-Institutional Subscription, 27(3), 452–457.Ramsden, I. (1993). Cultural safety in nursing education in Aotearoa (New Zealand). Nursingpraxis in New Zealand inc, 8(3), 4.Ramsden, I. (1997). Cultural safety: Implementing the concept. The social force of nursingand midwifery. In: Te Whaiti P, McCarthy M, Durie A, eds. Mai i Rangiatea: Maoriwellbeing and development. Auckland, New Zealand: Auckland University Press andBridget Williams Books, 113–125.Ramsden, I. (2002). Cultural safety and nursing education in Aotearoa and Te Waipounamu.Victoria University of Wellington.Reich, S. M., & Reich, J. A. (2006). Cultural competence in interdisciplinary collaborations: Amethod for respecting diversity in research partnerships. American Journal of CommunityPsychology, 38(1-2), 51–62.Rowan, M. S., Rukholm, E., Bourque-Bearskin, L., Baker, C., Voyageur, E., & Robitaille, A.(2013). Cultural competence and cultural safety in canadian schools of nursing: a mixedmethods study. International journal of nursing education scholarship, 10(1), 1–10.doi:10.1515/ijnes-2012-0043Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient Centeredness, Cultural Competenceand Healthcare Quality. Journal of the National Medical Association, 100(11), 1275–1285.Seeleman, C., Suurmond, J., & Stronks, K. (2009). Cultural competence: a conceptualframework for teaching and learning. Medical education, 43(3), 229–237.Sequist, T. D., Fitzmaurice, G. M., Marshall, R., Shaykevich, S., Marston, A., Safran, D. G., &Ayanian, J. Z. (2010). Cultural Competency Training and Performance Reports toImprove Diabetes Care for Black PatientsA Cluster Randomized, Controlled Trial.Annals of Internal Medicine, 152(1), 40–46.Smye, V., & Browne, A. J. (2002). “Cultural safety”and the analysis of health policy affectingaboriginal people. Nurse researcher, 9(3), 42.Somnath Saha MD, M. P. H., P Todd Korthuis MD, M. P. H., Cohn, J. A., Sharp, V. L.,Moore, R. D., & Mary Catherine Beach MD, M. P. H. (2013). Primary care providercultural competence and racial disparities in HIV care and outcomes. Journal of generalinternal medicine, 1–8.Tavallali, A. G., Kabir, Z. N., & Jirwe, M. (2013). Ethnic Swedish Parents’ experiences ofminority ethnic nurses’ cultural competence in Swedish paediatric care. Scandinavianjournal of caring sciences. doi:10.1111/scs.12051Taylor, B. A., Gambourg, M. B., Rivera, M., & Laureano, D. (2006). Constructing culturalcompetence: Perspectives of family therapists working with Latino families. TheAmerican Journal of Family Therapy, 34(5), 429–445.Thom, D. H., & Tirado, M. D. (2006). Development and validation of a patient-reportedmeasure of physician cultural competency. Medical care research and review, 63(5),636–655.Thom, D. H., Tirado, M. D., Woon, T. L., & McBride, M. R. (2006). Development andevaluation of a cultural competency training curriculum. BMC medical education, 6(1),38.Vaughn, L. M. (2009). Families and cultural competency: where are we? Family &Community Health, 32(3), 247–256.Washington, D. A. (2009). Critical race feminist bioethics: telling stories in law school andmedical school in pursuit of “cultural competency.” Albany Law Review, 72(4), 961+.Wepa, D. (2005). Cultural Safety in Aotearoa New Zealand. Pearson Education New Zealand.Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice inmental health services: A complementary perspective. American Psychologist, 62(6),563.Whitfield, K. E., Bogart, L. M., Revenson, T. A., & France, C. R. (2013). Introduction to theSecond Special Section on Health Disparities. Annals of Behavioral Medicine, 45(1), 1–2.Willen, S. S., & Carpenter-Song, E. (2013). Cultural Competence in Action: “Lifting theHood” on Four Case Studies in Medical Education. Culture, medicine and psychiatry.doi:10.1007/s11013-013-9319-xWilliams, R. (1999). Cultural safety—what does it mean for our work practice? Australianand New Zealand Journal of Public Health, 23(2), 213–214.Zambrana, R. E., & Carter-Pokras, O. (2010). Role of acculturation research in advancingscience and practice in reducing health care disparities among Latinos. JournalInformation, 100(1). Retrieved fromhttp://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2008.138826