Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature
| Autor: | Janya McCalman, Crystal Jongen, Roxanne Bainbridge |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Canada
Cultural competency Psychological intervention 03 medical and health sciences 0302 clinical medicine Health systems Nursing Health care Medicine Humans 030212 general & internal medicine Health policy Medical education business.industry 030503 health policy & services Health Policy lcsh:Public aspects of medicine Ethnic minorities Public Health Environmental and Occupational Health Health services research Australia lcsh:RA1-1270 Health equity United States Indigenous Health services Health promotion Cultural competence in healthcare Systematic Review Health disparities 0305 other medical science business Cultural competence Delivery of Health Care New Zealand |
| Zdroj: | International Journal for Equity in Health, Vol 16, Iss 1, Pp 1-19 (2017) International Journal for Equity in Health |
| ISSN: | 1475-9276 |
| DOI: | 10.1186/s12939-017-0571-5 |
| Popis: | Introduction Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods A literature search was completed as part of a larger systematic search of evaluations and measures 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 from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. |
| Databáze: | OpenAIRE |
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