The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review

Abstract

BackgroundCultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes.MethodsThis scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature.ResultsThe review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts.DiscussionExamined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.

An international systematic review of dementia caregiving interventions for Chinese families

“…It is acknowledged that the researchers' backgrounds and predispositions might influence the analysis. Biases were minimized by using multiple coders and referring to empirical frameworks 71,72 for thematic synthesis.…”

The Global Spine Care Initiative: model of care and implementation

“…In this model, the system engages community representatives as stakeholders and part of the health care relationship in the health care system [49]. People-centered, culturally competent health care can be integrated throughout the system such as through educational interventions, clinical encounters, health promotion programs and services, and processes at the systems level [50]. Peoplecentered care contains a wide variety of community participants including the individual, care givers, families, and communities as participants in the health care process and includes not only the clinical encounter but also health policy and services [51].…”

An overview of reviews on strategies to reduce health inequalities

“…In addition, although there is a large variation in the types of strategies implemented, it is important to highlight the presence of interventions that recognize the intrinsic characteristics of the disadvantaged population. The implementation of these types of strategies encourages the acquisition of healthy styles and habits, which removes the focus of health from the disease and places it on the promotion and maintenance of health [ 12 ]. Additionally, some studies agree with the results on the integration of strategies based on the use of technologies and guided education, which showed positive results, particularly in clinical decision-making, consolidation and strengthening of health systems [ 70 , 72 ].…”

“…For this reason, actions such as the identification, synthesis and transfer of scientific knowledge are required, a process that requires transparent and reproducible research methods that allow evidence to be evaluated more efficiently [ 9 ]. Also, some authors have develop overview of reviews focused on strategies to implement evidence-based interventions in low-income countries [ 11 ] or to implement and evaluation of health promotion services and programs to improve cultural competency [ 12 ]. As a result, the objective of this overview of reviews was to identify and synthesize the strategies or interventions that facilitate the reduction of health inequalities.…”