Health Care Issues and Cultural Effects
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Research on to the health disparities has shown that, patients who receive culturally sensitive care show an increased adherence to medical advice and report higher satisfaction with the services. Therefore, with the increased growth in the cultural diversity and related health disparities in society, the rise in academic interest in examining the interrelationship between health and culture has also increased. This has led to the realization of the benefits of cultural competency program.
The cultural competency training program produces measurable changes in the knowledge and skills of the health practitioners (Khanna, Cheyney, & Engle, 2009, p. 886). Although the debate still continues on its effectiveness, a general agreement among the scholars is that, it improves the patient-provider communication, and in the long term, it improves on the patient satisfaction and compliance. This has led to many health care organizations, medical schools and providers integrating the cultural competency training into their training programs or curricula. In one study conducted on the 43 healthcare professionals, participants indicated an enhanced understanding of the healthcare experiences of patients with diverse backgrounds. This study involved health care providers and health administrators for a four (4) hour cultural competency workshop. In addition to the enhanced understanding of health care experiences these health care professionals, reported improvement in their cross-cultural working skills (Khanna, Cheyney, & Engle, 2009, p. 886). According to them, the post then pre method of evaluation used is reliable, innovative, and time-saving.
According to them, these training programs should be implemented so as to inform the health care providers on the role of culture in service delivery. Factors like, ethnic medical beliefs, use of folk medicine, health beliefs and worldview, cultural values and norms influence the offering and perception of the services. In addition, gender and religion also play a vital role. The Health Resources and Services Administration (HRSA) advocates for the inclusion of the cultural and linguistic competency training and assessment protocols in health care systems (Khanna, Cheyney, & Engle, 2009, p. 887). The Office of Minority Health has been on the forefront in advocating for the National Standards for culturally and Linguistically Appropriate Services (CLAS) in the Health Care Systems. These standards take into account the social context and interaction and thus, form the benchmarks in the provision of the competent services to patients from all cultural backgrounds. This arises from the fact that, the cultural characteristics of the patient and the health care provider influences the manner in which different people seek, access, and utilize these services (Khanna, Cheyney, & Engle, 2009, pp. 887-888).
The study used post then pre method to evaluate the outcomes of the training. In a typical pre then post evaluation, participants subject themselves to a set of questions before and after the training program. Post then pre method helps in controlling response shift bias got in the traditional pre then post method. In the post then pre method, gauging of the respondent’s perceptions occur at the end of training. This reduces the respondents’ perspective on the construct measured between pre-test and post-test situation. In addition, use of the post then pre reduces the problems of over and ideal reporting associated with pre then post reporting (Khanna, Cheyney, & Engle, 2009, p. 889). The limitation of this evaluation method is the inability recall knowledge and skills before the instruction accurately. The social desire of the respondents to fulfill the expectations of the training programs also manifests itself among the respondents. At the end of training, all participants had a choice of completing a 29-item Cultural Competency Assessment (CCA). Of the sixty that had originally joined the training, only forty-three (n=43) completed the test without errors. The CCA developed reflected on intercultural and intra-cultural diversity. It involved 3 parts- demographic data (5 items), knowledge (19 items) and skills (5 items).
The results indicated that the participants indicated a positive change in their knowledge and skills in the cross-cultural provision of health care. They acquired a more nuanced understanding of individual terms associated with culture, race and ethnicity. They also self-reported improvements in the role of cultural factors in the patient-provider communication, and importance of nonverbal clues in patient-provider interaction. These results indicated the need to raise awareness regarding the importance of cultural learning. The health beliefs and cultural healing practices involvement in the collection of the case histories are essential. This helps in the conducting of the clinical examinations and development of culturally based care plans with the patients from diverse cultural backgrounds (Khanna, Cheyney, & Engle, 2009, p. 890).
This study indicated that, for cultural competency to be successful, it needs to go beyond the racial and ethnic differences. It should incorporate issues pertaining to sexual orientation, socioeconomic status, health insurance status and type/ timing of care in the provision of health care services. It is also a dynamic process rather than 1-time, structured training endeavor lending itself to rigorous, quantitative analysis. It should be expanded to include multiple markers of differences (Khanna, Cheyney, & Engle, 2009, p. 891).
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