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Culturally responsive interventions: Innovative approaches to working with diverse populations. Citation. Ancis, J. R. (Ed.). (). Culturally responsive. Culturally Responsive Interventions: Innovative Approaches to Working with Diverse Populations. Front Cover. Julie R. Ancis. Psychology Press,
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Our platform features offers from merchants who have signed up with PriceCheck. You are welcome to search for the product on our website and make contact with any of the merchants featured on PriceCheck for more information regarding their offers. All merchants contact details can be found at pricecheck. From a healthcare systems perspective, Anderson et al. Pearson et al.
Forsetlund et al. However, the quality of evidence for these interventions was graded as low to very low. Bhui et al. They concluded that culturally competent care and services at the organizational level is addressed in different ways depending on the local context, for example managed care and insurance based service models in the United States may not to translatable in settings where services are dependent on government funds. The majority of reviews noted methodological limitations of studies.
This limited conclusive statements about the effectiveness of interventions to increase cultural competency. The main methodological criticisms of the studies by the reviews were: small samples [ 13 ], poor methodological rigor [ 7 , 13 , 15 ], no or few long-term studies [ 8 , 18 ], no economic analysis of interventions [ 6 , 8 ], reliance on self-report measures [ 19 ], lack of detail about interventions [ 7 , 19 ], lack of patient outcome measures [ 4 — 6 , 15 ] and lack of objective provider measures related to change in practice [ 14 , 17 ].
For example, Beach et al. In their review, evidence of impacts on provider knowledge were graded A compared with provider attitudes which were graded B.
Twelve of the nineteen reviews concluded that further research e. The reviews found that many of the studies were difficult to compare as different frameworks of cultural competency were used and studies often lacked a standardized and validated instrument to measure cultural competence [ 6 ]. Most reviews concluded that training had positive impacts on provider outcomes. However, it was difficult to determine exactly what types of training interventions were most effective in relation to particular outcomes [ 6 , 13 , 19 ]. A need for research into long-term outcomes [ 8 , 18 ] was identified along with the need to consider other factors that facilitate cultural competency, such as links with community organizations [ 3 , 15 ].
It was also recommended that cost-effectiveness be assessed [ 8 , 24 ]. Some of the reviews focused on one type of intervention such as diabetes education for patient outcomes [ 8 ] or health provider cultural competency training [ 14 ]; one type of study outcome such as patient outcomes [ 7 ]; one type of study design such as randomized controlled trials [ 25 ]; or a particular study population such as Hispanics [ 20 ], Asian women [ 24 ] or nurses [ 17 ].
Although it may be more feasible for a review to focus on a particular group of health providers or type of health care setting, it limits generalizability and applicability of the findings.
Many studies were heterogeneous in outcome and interventions, making statistical synthesis and analysis difficult [ 13 ]. According to Smith et al. Provider outcomes determined by self-report are subject to multiple threats to internal validity [ 36 ] and hence limit the conclusions made regarding impact on provider practice [ 19 ] and ultimately on patient outcomes.
The literature includes a diverse range of populations e. However, the majority of studies were based in the United States. Two reviews limited their included studies to only those conducted in the United States [ 15 , 21 ]. Meta-analysis was not conducted in this review of reviews due to the heterogeneity of the reviews and their included studies. Intervention effects were also difficult to determine as only some reviews described outcomes in terms of statistical significance and effect sizes [ 5 , 6 , 8 , 13 , 19 ].
Some reviews noted that studies rarely provided sufficient information on the curriculum or format, or details of the providers involved e. All reviews were critically appraised by two authors using the health-evidence. There were minor disagreements between authors and consensus was reached through discussion. All reviews had a clearly focused question in relation to the population, intervention and outcomes.
Appropriate inclusion criteria to select primary studies were used by the majority of reviews. The majority of reviews described comprehensive search strategies, although some were slightly limited in scope [ 4 , 14 , 15 , 20 ]. For example, Kehoe et al. The methodological rigor of studies was identified and described in thirteen reviews [ 3 , 5 , 7 , 8 , 13 , 15 , 16 , 18 , 19 , 22 — 25 ]. Nine reviews reported the use of two or more reviewers to assess each study for methodological quality [ 6 — 8 , 13 , 15 — 17 , 22 , 24 ].
Most reviews used appropriate methods for combining and comparing results across studies. However, Pearson et al. This systematic review of reviews has identified a number of key issues and limitations in what is currently known about interventions to improve cultural competency within healthcare. This reflects the complexity of the area and its translation to practice and research.
Overall, positive effects were reported by most reviews, particularly in relation to provider outcomes.