Department of Family Medicine, School of Medicine, University of California, 101 The City Drive S, Orange, CA 92868, USA.
J Gen Intern Med. 2011 Mar;26(3):317-25. doi: 10.1007/s11606-010-1529-0. Epub 2010 Oct 16.
Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities.
The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research.
The authors performed electronic searches in the MEDLINE/PubMed, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included.
Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted.
Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect.
There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities.
文化能力培训已被提议作为改善患者结局的一种方法。需要有证据表明这些干预措施可以减少健康差距。
本研究旨在进行系统评价，以确定文化能力培训对以患者为中心的结局的影响；评估研究质量和效应强度；并提出未来研究的框架。
作者在 MEDLINE/PubMed、ERIC、PsycINFO、CINAHL 和 Web of Science 数据库中进行了电子检索，检索了 1990 年至 2010 年间发表的英文原始文章，并进行了文献追溯。纳入的研究报告了针对卫生保健专业人员的文化能力教育培训干预措施，并将其对患者和/或卫生保健利用的影响作为主要或次要结局进行了测量。
四名作者独立使用验证标准对研究进行质量评估，并评估了培训对患者结局的影响。由于研究存在异质性，未对数据进行汇总；而是进行了定性综合和分析。
符合纳入标准的研究有 7 项。其中 3 项研究涉及医生，2 项研究涉及心理健康专业人员，2 项研究涉及多种卫生保健专业人员和学生。2 项研究为半随机，2 项研究为整群随机，3 项研究为前后对照现场研究。研究质量为低到中度，没有高质量的研究；大多数研究没有充分控制潜在的混杂变量。效应大小范围从无效应到适度有益（有 2 项研究无法评估）。有 3 项研究报告了积极（有益）的效果；没有研究显示出消极（有害）的效果。
有有限的研究表明文化能力培训与改善患者结局之间存在正相关关系，但高质量的研究仍然很少。未来的工作应该解决限制质量的挑战。我们提出了一个算法，以指导教育者设计和评估课程，严格证明对患者结局和健康差距的影响。
