Mobula Linda M, Okoye Mekam T, Boulware L Ebony, Carson Kathryn A, Marsteller Jill A, Cooper Lisa A
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Prim Care Community Health. 2015 Jan;6(1):10-5. doi: 10.1177/2150131914540917. Epub 2014 Jul 1.
Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown.
A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice.
We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51).
Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities.
社区卫生工作者（CHW）干预措施可改善来自服务不足社区患者的健康状况，但卫生专业人员对其有效性的认知可能会阻碍CHW融入医疗服务提供系统。卫生专业人员的态度和技能，如与文化能力相关的态度和技能，是否会影响对CHW的认知尚不清楚。
2011年4月至12月，对马里兰州6家基层医疗诊所的提供者和临床工作人员进行了问卷调查。我们使用逻辑回归分析，对受访者的年龄、种族、性别、提供者/工作人员身份以及在该诊所的工作年限进行调整，量化了自我报告的文化能力和准备情况与对CHW有效性态度之间的关联。
我们联系了200名提供者和工作人员；119人（60%）参与了调查。那些报告有更强文化动机的人，认为CHW有助于减少医疗保健差距的几率更高（优势比[OR]=9.66，95%置信区间[CI]=3.48-28.80）。那些报告更频繁地表现出具有文化能力行为的人，也更有可能相信CHW有助于减少健康差距（OR=3.58，95%CI=1.61-7.92）。对权力和同化的态度与对CHW的认知无关。文化准备情况与CHW在减少医疗保健差距方面的感知效用相关（OR=2.33，95%CI=1.21-4.51）。
具有更强文化能力和准备情况的提供者和工作人员，对CHW干预措施减少医疗保健差距的期望更为积极。文化能力培训可能会补充CHW的使用，并支持他们有效融入寻求减少差距的基层医疗诊所。
