1. 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/