Price Eboni G, Beach Mary Catherine, Gary Tiffany L, Robinson Karen A, Gozu Aysegul, Palacio Ana, Smarth Carole, Jenckes Mollie, Feuerstein Carolyn, Bass Eric B, Powe Neil R, Cooper Lisa A
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Acad Med. 2005 Jun;80(6):578-86. doi: 10.1097/00001888-200506000-00013.
To systematically examine the methodological rigor of studies using cultural competence training as a strategy to improve minority health care quality. To the authors' knowledge, no prior studies of this type have been conducted.
As part of a systematic review, the authors appraised the methodological rigor of studies published in English from 1980 to 2003 that evaluate cultural competence training, and determined whether selected study characteristics were associated with better study quality as defined by five domains (representativeness, intervention description, bias and confounding, outcome assessment, and analytic approach).
Among 64 eligible articles, most studies (no. = 59) were published recently (1990-2003) in education (no. = 26) and nursing (no. = 14) journals. Targeted learners were mostly nurses (no. = 32) and physicians (no. = 19). Study designs included randomized or concurrent controlled trials (no. = 10), pretest/posttest (no. = 22), posttest only (no. = 27), and qualitative evaluation (no. = 5). Curricular content, teaching strategies, and evaluation methods varied. Most studies reported provider outcomes. Twenty-one articles adequately described provider representativeness, 21 completely described curricular interventions, eight had adequate comparison groups, 27 used objective evaluations, three blinded outcome assessors, 14 reported the number or reason for noninclusion of data, and 15 reported magnitude differences and variability indexes. Studies targeted at physicians more often described providers and interventions. Most trials completely described targeted providers, had adequate comparison groups, and reported objective evaluations. Study quality did not differ over time, by journal type, or by the presence or absence of reported funding.
Lack of methodological rigor limits the evidence for the impact of cultural competence training on minority health care quality. More attention should be paid to the proper design, evaluation, and reporting of these training programs.
系统审查将文化能力培训作为提高少数族裔医疗保健质量策略的研究的方法严谨性。据作者所知，此前尚未进行过此类研究。
作为系统评价的一部分，作者评估了1980年至2003年以英文发表的评估文化能力培训的研究的方法严谨性，并确定所选研究特征是否与五个领域（代表性、干预描述、偏倚和混杂、结果评估以及分析方法）所定义的更好的研究质量相关。
在64篇符合条件的文章中，大多数研究（n = 59）最近（1990 - 2003年）发表在教育（n = 26）和护理（n = 14）期刊上。目标学习者大多是护士（n = 32）和医生（n = 19）。研究设计包括随机或同期对照试验（n = 10）、前测/后测（n = 22）、仅后测（n = 27）以及定性评估（n = 5）。课程内容、教学策略和评估方法各不相同。大多数研究报告了提供者的结果。21篇文章充分描述了提供者的代表性，21篇完整描述了课程干预，8篇有适当的对照组，27篇使用了客观评估，3篇对结果评估者进行了盲法处理，14篇报告了未纳入数据的数量或原因，15篇报告了差异幅度和变异性指数。针对医生的研究更常描述提供者和干预措施。大多数试验完整描述了目标提供者，有适当的对照组，并报告了客观评估。研究质量在时间、期刊类型或是否报告资金方面没有差异。
方法严谨性的缺乏限制了文化能力培训对少数族裔医疗保健质量影响的证据。应更加关注这些培训项目的合理设计、评估和报告。
