Cross-cultural training program on mental health care for refugees - a mixed method evaluation

Abstract

Background Refugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden. Intercultural interactions between refugees and mental health professionals have been described as challenging. Cross-cultural training is proposed as one way to improve care for refugees. Evaluations of such training outcomes are sparse. The overall aim of this study was to evaluate Comprehensive Cross-Cultural Training for mental health care professionals in Stockholm, and to assess training outcomes for participants’ perceived knowledge regarding mental health and care for newly arrived refugee patients, asylum seekers and undocumented refugees. In addition, we analysed the dimensionality of the pre- and post-training questionnaires used. Methods An embedded mixed-method design was applied. We used pre-and post-training questionnaires (n = 248) and conducted six focus group discussions (FGDs) with mental health professionals after training. Quantitative data was analysed by t-tests and factor analysis, qualitative data was analysed using thematic content analysis. Results Participants experienced gained knowledge and new perspectives in all aspects covered in the training. Training led to participants restructuring their existing knowledge. Those who had reported experience of refugee patients and working with interpreters pre-training in the past month, had higher ratings of perceived knowledge. Post-training, there were no significant changes in perceived knowledge between those with, and those without, experience of refugee patients and working with interpreters. Factor analysis resulted in 3 factors for the pre-training questionnaire, explaining 71% of the covariance, and 4 factors for the post-training questionnaire, explaining 78% of the covariance. Findings from the post-training FGDs, revealed that refugee patients were described as challenging. Also, that training promoted empathy towards refugees and strengthened participants’ professional role. Conclusions This cross-cultural training contributed to knowledge development and attitude changes. It was valuable regarding care providers’ professional role. Additional outcomes of the training were that participants not only gained knowledge about refugee mental health care but also restructured their existing knowledge.

Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011–2021

“… Perry et al (2015) used only post-testing. The post-test used by McDonald et al (2021) statistically confirmed that participants who had experience with patients from different cultural backgrounds had higher cultural assessments than participants who did not. A similar relationship was seen regarding the use of interpreting services.…”

“…The articles included in the analysis were published from 2011 to 2021. The articles came from 6 countries: South Korea ( Ahn, 2017 ), Israel ( Slobodin et al, 2021 ), Sweden ( McDonald et al, 2021 ), Australia ( Perry et al, 2015 ), the Netherlands ( Celik et al, 2012 ), and Finland ( Kaihlanen et al, 2019 ). Three articles used a mixed-method method ( Celik et al, 2012 ; Perry et al, 2015 ; McDonald et al, 2021 ).…”

“…The articles came from 6 countries: South Korea ( Ahn, 2017 ), Israel ( Slobodin et al, 2021 ), Sweden ( McDonald et al, 2021 ), Australia ( Perry et al, 2015 ), the Netherlands ( Celik et al, 2012 ), and Finland ( Kaihlanen et al, 2019 ). Three articles used a mixed-method method ( Celik et al, 2012 ; Perry et al, 2015 ; McDonald et al, 2021 ). One article was based on a cross-sectional study ( Ahn, 2017 ), and one article used an online education intervention study ( Slobodin et al, 2021 ).…”

“… McDonald et al (2021) used Comprehensive Cross-Cultural Training (CCCT), developed in 2016, in response to a health crisis. The authors carried out 12 all-day training and two half-day interventions in this study.…”

“… Celik et al (2012) , McDonald et al (2021) , and Slobodin et al (2021) used pre and post-tests to determine the effect of individual training on cultural competence. Perry et al (2015) used only post-testing.…”