title: A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals.
abstract: OBJECTIVE
  To systematically examine the methodological rigor of studies using cultural competence training as a strategy to improve minority health care quality. To the authors' knowledge, no prior studies of this type have been conducted.
  
  
  METHODS
  As part of a systematic review, the authors appraised the methodological rigor of studies published in English from 1980 to 2003 that evaluate cultural competence training, and determined whether selected study characteristics were associated with better study quality as defined by five domains (representativeness, intervention description, bias and confounding, outcome assessment, and analytic approach).
  
  
  RESULTS
  Among 64 eligible articles, most studies (no. = 59) were published recently (1990-2003) in education (no. = 26) and nursing (no. = 14) journals. Targeted learners were mostly nurses (no. = 32) and physicians (no. = 19). Study designs included randomized or concurrent controlled trials (no. = 10), pretest/posttest (no. = 22), posttest only (no. = 27), and qualitative evaluation (no. = 5). Curricular content, teaching strategies, and evaluation methods varied. Most studies reported provider outcomes. Twenty-one articles adequately described provider representativeness, 21 completely described curricular interventions, eight had adequate comparison groups, 27 used objective evaluations, three blinded outcome assessors, 14 reported the number or reason for noninclusion of data, and 15 reported magnitude differences and variability indexes. Studies targeted at physicians more often described providers and interventions. Most trials completely described targeted providers, had adequate comparison groups, and reported objective evaluations. Study quality did not differ over time, by journal type, or by the presence or absence of reported funding.
  
  
  CONCLUSIONS
  Lack of methodological rigor limits the evidence for the impact of cultural competence training on minority health care quality. More attention should be paid to the proper design, evaluation, and reporting of these training programs.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Eboni G
authors.initials: EG
authors.lastname: Price
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Gary
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: Ana
authors.initials: A
authors.lastname: Palacio
authors.forename: Carole
authors.initials: C
authors.lastname: Smarth
authors.forename: Mollie
authors.initials: M
authors.lastname: Jenckes
authors.forename: Carolyn
authors.initials: C
authors.lastname: Feuerstein
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D018864:Cultural Diversity; D004501:Education, Medical; D004506:Education, Nursing; D006801:Humans; D008913:Minority Groups; D010506:Periodicals as Topic