Development and evaluation of a cultural competency training curriculum.

BACKGROUND: Increasing the cultural competence of physicians and other health care providers has been suggested as one mechanism for reducing health disparities by improving the quality of care across racial/ethnic groups. While cultural competency training for physicians is increasingly promoted, relatively few studies evaluating the impact of training have been published. METHODS: We recruited 53 primary care physicians at 4 diverse practice sites and enrolled 429 of their patients with diabetes and/or hypertension. Patients completed a baseline survey which included a measure of physician culturally competent behaviors. Cultural competency training was then provided to physicians at 2 of the sites. At all 4 sites, physicians received feedback in the form of their aggregated cultural competency scores compared to the aggregated scores from other physicians in the practice. The primary outcome at 6 months was change in the Patient-Reported Physician Cultural Competence (PRPCC) score; secondary outcomes were changes in patient trust, satisfaction, weight, systolic blood pressure, and glycosylated hemoglobin. Multiple analysis of variance was used to control for differences patient characteristics and baseline levels of the outcome measure between groups. RESULTS: Patients had a mean of 2.8 + 2.2 visits to the study physician during the study period. Changes in all outcomes were similar in the "Training + Feedback" group compared to the "Feedback Only" group (PRPCC: 3.7 vs.1.8; trust: -0.7 vs. -0.2 ; satisfaction: 1.9 vs. 2.5; weight: -2.5 lbs vs. -0.7 lbs; systolic blood pressure: 1.7 mm Hg vs. 0.1 mm Hg; glycosylated hemoglobin 0.02% vs. 0.07%; p = NS for all). CONCLUSION: The lack of measurable impact of physician training on patient-reported and disease-specific outcomes in the current has several possible explanations, including the relatively limited nature of the intervention. We hope that the current study will help provide a basis for future studies, using more intensive interventions with different provider groups.

Bioterrorism and Emergency Preparedness in Aging (BTEPA): HRSA-funded GEC collaboration for curricula and training.

Frail elders living alone or in long-term care settings are particularly vulnerable to bioterrorism and other emergencies due to their complex physical, social and psychological needs. This paper provides an overview of the recent literature on bioterrorism and emergency preparedness in aging (BTEPA); discusses federal initiatives by the health resources and services administration (HRSA) to address BTEPA; describes the collaborative efforts of six HRSA-funded geriatric education centers (GECS) to develop BTEPA geriatric curricula and training; and offers recommendations for BTEPA education and training, clinical practices, policy, and research. The GEC/BTEPA collaboration has produced model curricula, including emergency planning for diverse groups of older persons; enhanced networking among stakeholders in a fast paced environment of information sharing and changing policies; and developed interdisciplinary educational resources and approaches to address emergency preparedness for various settings in the elder care continuum.

African American and Asian American elders: an ethnogeriatric perspective.

By 2030, ethnic minority elders are expected to increase by 12%. Research about this highly diverse population is gaining momentum. This chapter summarizes selected research articles published after 1996 on access and utilization of services and resources by African American and Asian American elders. Computerized searches were made using PubMed and CINAHL (Cumulative Index of Nursing and Allied Health Literature) with the following terms used individually or combined: health care, aging, older adults, ethnicity, access, disparities, chronic illness, community health care, health beliefs, health practices, and ethnogeriatrics. Citations for 456 articles on two ethnic groups were retrieved; 155 were reviewed, and 84 citations were used for this chapter. The publications focus on African Americans (45%), Asian Americans (41%), and both groups (14%). Descriptive, exploratory, cross-sectional studies dominate the research effort, identifying unmet needs, and a limited number are on culturally appropriate and acceptable interventions. Results are discussed in the context of ethnogeriatrics, and recommendations for future studies are proposed.

Harnessing technology and collaboration for an online ethnogeriatric educational resource.

The paper describes the development and testing of a Web-based educational resource for usability and acceptability by health care providers who care for ethnic older adults. The work was undertaken as a dissertation project. The purpose of the Website is to provide on-demand ethnogeriatric information to enhance provider-patient interaction. Focus groups of clinicians and ethnic older adults were used in order to identify content relevant to the care of frail ethnic older adults. Collaboration with the Stanford Geriatric Education Center, On Lok SeniorHealth Services, Inc., Pepperdine University Graduate School of Education, and a network of virtual consultants provided support to the project. The site contains information on 15 cultures, 12 religions, and 6 ethnic minority cohort groups. Testing by snowball sampling generated survey data from 96 respondents, consisting of general practitioners (24%), pediatric specialists (20%), and geriatric specialists (18%). The Website was considered useful for provider-patient communication (77%) and would be recommended to others (99%). The Web-based information resource, called "Diversity, Healing, and Healthcare," currently exists as a resource rather than as a defined learning module and can be accessed at http://www.gasi. org/diversity.htm.

Comparison of methods for identifying a population-based sample of Filipina women for a health survey.

This paper describes and compares 2 random-digit dialing (RDD) methods that have been used to select minority subjects for population-based research. These methods encompass the census-based method, which draws its primary sampling units from census tracts with a high proportion of minority persons, and the registry-based method, which derives its primary sampling units from a population-based cancer registry. Our study targeted Filipinos living in 10 Northern California counties, where they constitute 4% of the total population. Eligible participants (Filipina women, at least aged 20, who spoke 1 of 4 interview languages) were asked to complete a short telephone interview. Both the census and registry methods located Filipino households with comparable efficiency and with a higher yield than would be expected in a non-targeted population survey, such as the Mitofsky-Waksberg RDD method. No systematic pattern of responses was evident that would indicate that either method sampled women who were systematically less acculturated or less likely to use cancer screening tests. Although both methods offer substantial gains in efficiency, their utility is limited by generating samples that tend to over-represent high-density areas. The degree to which these methods are considered viable depends on further refinement to limit, or eliminate, their inherent selection biases without sacrificing their increased efficiency to locate minority populations.