Providers’ Cultural Competence Training and Abilities to Deliver Care to Patients with

Low Health Literacy and Limited English Proficiency Ambra Palushi

Tanjala Purnell, PhD MPH University of Maryland College Park, Johns Hopkins School of Medicine

Methods

Results and Discussion

•  The Johns Hopkins Cultural Competency Needs Assessment Study •  The primary study goal was to assess the need for additional cultural

competence training among practicing physicians at the Johns Hopkins School of Medicine to enhance their delivery of patient-centered care.

•  Ten clinical departments (Medicine, Surgery, Pediatrics, Psychiatry, Neurology, OB/GYN, Dermatology, Anesthesiology, Radiology, and Emergency Medicine) were included in the study

•  Survey development team led by Dr. Lisa Cooper, Vice President for Healthcare Equity at Johns Hopkins Medicine

Design: Cross-sectional survey Population: 2,614 faculty, fellows, and residents in 10 departments

Medicine, Surgery, Pediatrics, Neurology, OB/GYN, Dermatology, Anesthesiology, Radiology, Emergency Medicine

Survey Administration •  15-30 minute, web-based survey conducted from May 23, 2011 through

December 31, 2011 •  Participants sent emails inviting them to participate in the survey after an initial

email was sent by Department Chairs •  Voluntary participation

Background

Characteristic n (%) Characteristic n (%)

Race-ethnicity Medical school training

Caucasian 643 (53) US medical school grad 728 (60)

Asian 212 (17) Non-US medical school grad 317 (26)

African American 102 (8) Primary specialty

Hispanic 42 (3) Medicine 839 (69)

Professional status Surgery 288 (24)

Faculty 565 (46) Other 80 (6)

Resident or fellow 476 (39) Mean Age (SD), years 39.8 (10.7)

Gender Linguistic skills

Female Male

672 (55) 548 (45)

Able to speak a non-English language

650 (53) 7%

18%

39%

10%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

None

Very little

Some

A lot

Providers Who Received Prior Training

Adapted Framework

References

Acknowledgements v  Johns Hopkins Study Team

v Tanjala Purnell, PhD MPH v Lisa Cooper, MD MPH v Amanda Bertram, MS v Lenny Feldman, MD v Brian K. Gibbs, PhD MPA v Steve Sisson, MD v Rosalyn Stewart, MD MS MBA v Rochelle Brown, MD MS v Jessie Kimbrough-Sugick, MD

v  Johns Hopkins Center to Eliminate Cardiovascular Health Disparities

Hypothesis

.

Pearson chi2(12) = 67.6853 Pr = 0.000

0.22 4.72 25.91 50.49 18.66 100.00 Total 2 43 236 460 170 911 0.00 1.61 13.71 45.97 38.71 100.00 A lot 0 2 17 57 48 124 0.00 3.75 25.21 55.83 15.21 100.00 Some 0 18 121 268 73 480 0.91 7.73 31.36 46.82 13.18 100.00 Very little 2 17 69 103 29 220 0.00 6.90 33.33 36.78 22.99 100.00 None 0 6 29 32 20 87 competence? Very unpr Somewhat Somewhat Well prep Very well Total cultural limited health literacy?received in How prepared do you feel to care for patients: With ever have you training How much

A chi-square analysis was conducted to assess whether prior training is associated with differences in how prepared providers are to care for patients with limited English proficiency and limited heath literacy. Based on the data, providers with prior cultural competence training feel more prepared to care for patients with limited English proficiency or limited health literacy.

Structure •  Prior cultural

competence training

•  Availability of pre-prepared resources (medical interpreters or written translations)

Process •  Interaction

between patients and providers

•  Delivery of proper resources

Outcome • Differences in patient

health outcomes • Receive appropriate

services • Differences in health

status, patient satisfaction, and patient adherence

• Differences by patient factors including characteristics that are associated with disparities (SES, low health literacy, LEP)

Donabedian

Providers who have received prior cultural competence training feel more prepared in providing high quality patient care to low health literacy and limited English proficiency patients.

US Department of Health and Human Services, Office of Minority Health: •  Cultural and linguistic competence is a set

of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

•  Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

•  Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

National Institutes of Health: •  Cultural competency is critical to reducing

health disparities and improving access to high-quality health care, health care that is respectful of and responsive to the needs of diverse patients.

•  Because a number of elements can influence health communication—including behaviors, language, customs, beliefs, and perspectives—cultural competence is also critical for achieving accuracy in medical research.

•  When developed and implemented as a framework, cultural competence enables systems, agencies, and groups of professionals to function effectively to understand the needs of groups accessing health information and health care.

Results

1. http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11 2. http://www.nih.gov/clearcommunication/culturalcompetency.htm 3. McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun.

(Technical Reviews, No. 9.7.) 5, Conceptual Frameworks and Their Application to Evaluating Care Coordination I nterventions. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44008/