Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program.
Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation.



Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation.



Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified.



Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.
Dr. Fox: Research Health Science Specialist, Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA. Dr. Hamilton: Research Health Scientist, HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA. Dr. Frayne: Professor of Medicine, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Palo Alto, CA, and Division of General Medical Disciplines and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA. Dr. Wiltsey-Stirman: Research Psychologist, Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, and Department of Psychiatry, Boston University School of Medicine, Boston, MA. Dr. Bean-Mayberry: VA HSR&D Investigator and Staff Physician, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, and Department of Medicine, University of California Los Angeles David Geffen School of Medicine, West Los Angeles, CA. Ms. Carney: Research Health Science Specialist, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA. Dr. Di Leone: Postdoctoral Researcher, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. Dr. Gierisch: Assistant Professor, Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, and Department of Medicine, Duke University School of Medicine, Durham, NC. Dr. Goldstein: Assistant Professor, Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, and Division of General Internal Medicine, Duke University School
Annie B
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Fox
Alison B
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Hamilton
Susan M
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Frayne
Shannon
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Wiltsey-Stirman
Bevanne
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Bean-Mayberry
Diane
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Carney
Brooke A L
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Di Leone
Jennifer M
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Gierisch
Karen M
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Goldstein
Yasmin
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Romodan
Anne G
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Sadler
Elizabeth M
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Ellen F
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Dawne
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D000328:Adult; D054521:Cultural Competency / Q000523:psychology*; D055317:Evidence-Based Practice / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards; D013663:Teaching / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans / Q000523:psychology*