title: Cultural competence and perceptions of community health workers' effectiveness for reducing health care disparities.
abstract: BACKGROUND
  Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown.
  
  
  METHODS
  A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice.
  
  
  RESULTS
  We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51).
  
  
  CONCLUSIONS
  Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA mmobula1@jhmi.edu.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mobula
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mekam T
authors.initials: MT
authors.lastname: Okoye
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003153:Community Health Services; D003150:Community Health Workers; D054521:Cultural Competency; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009042:Motivation; D009722:Nurse Practitioners; D009726:Nurses; D016017:Odds Ratio; D010465:Perception; D010820:Physicians; D011320:Primary Health Care; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: community health workers; cultural competence; health care delivery; health disparities; hypertension outcomes