Cultural competence: a systematic review of health care provider educational interventions.
OBJECTIVE
We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals.


METHODS
This was a systematic literature review and analysis.


METHODS
We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria.


METHODS
We sought evidence of the effectiveness and costs of cultural competence training of health professionals.


RESULTS
Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs).


CONCLUSIONS
Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.
Beach
Mary Catherine
MC
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21287, USA. mcbeach@jhmi.edu
Price
Eboni G
EG
Gary
Tiffany L
TL
Robinson
Karen A
KA
Gozu
Aysegul
A
Palacio
Ana
A
Smarth
Carole
C
Jenckes
Mollie W
MW
Feuerstein
Carolyn
C
Bass
Eric B
EB
Powe
Neil R
NR
Cooper
Lisa A
LA
D001291:Attitude of Health Personnel / Q000208:ethnology; D003144:Communication Barriers; D018864:Cultural Diversity; D004496:Education, Continuing / Q000191:economics / Q000592:standards*; D006281:Health Occupations / Q000193:education*; D006801:Humans; D011361:Professional Competence; D011369:Professional-Patient Relations