Two-Year Evaluation of the Office of Minority Health Cultural Competency Curriculum Modules Guadalupe Pacheco, MSW Project Officer, Office of Minority Health, HHS Ann S. Kenny, MPH, RN Project Director, SRA November 5, 2007

2 Why Develop a Cultural Competency Curriculum? u Increasing racial and ethnic diversity of U.S. population demands new skills from health care providers u Lack of cross-cultural training programs u Enhance providers’ communication skills – improving health care for all patients u Improve health of racial and ethnic minority populations u Close the gap between minority and non-minority populations

3 A Snapshot of the Nation’s Diversity u 33.4% of the U.S. population are minorities u 12% of people in U.S. are foreign-born u The U.S. accepted nearly 1,064,000 immigrants in the year 2002 alone u Approximately 11 million people in the U.S. self- report they do not speak English well or at all u 11% of population speaks Spanish u Nearly 1 in 5 Americans speaks a language other than English at home *Sources:

4 What is A Physician’s Practical Guide to Cultural Competent Care? u Continuing Medical Education (CME)/ Continuing Nursing Education (CNE)/ Continuing Education Unit (CEU) accredited training course comprised of nine modules u Designed to equip providers with cultural and linguistic competencies required to improve quality of care u Funded by the Office of Minority Health, Department of Health and Human Services u Offered online at no cost u Launched in December 2004

5 CCCM History u December 2000: OMH issues the CLAS standards u September 2001: OMH awards contract to develop cultural competency curriculum u December 2004: Program launched online at u January 2007: Qualitative and Quantitative Evaluation Report

6 Development Process of the Curriculum

7 Evaluation Methodology u Quantitative Pre- and Posttest Scores Course Evaluation Questionnaire “Take a Moment” Questions u Qualitative Focus Groups Web-captured Comments

8 Study Population u 2,213 participants in group u MDs and DOs included u Participant practice settings: Hospitals Clinics Private practice Community health centers Nursing homes Other u Common specialties: Family Practice Internal Medicine Pediatrics

9 Study Population Gender

10 Study Population Ethnicity

11 Evaluation Objectives u Explore the extent to which completion of the curriculum results in physician self-reported improvements in: 1) Knowledge of culturally competent care models, principles, and theories 2) Attitudes toward diverse patient types 3) Utilization of interpreter services and translated materials 4) Practice habits 5) Educational/communication practices in direct physician-patient interactions

12 Objective 1: Increased knowledge of culturally competent care models, principles, and theories u Physicians scored higher on posttests than on pretests Score increases ranged from 1.01 (approx. 1 point) to 2.01 (approx. 2 points) Pretest scores ranged from 73% to 75% Posttest scores ranged from 83% to 94% u No significant difference between White and minority physician test performances White and minority physicians scored approximately 73% on all pretests and scored similarly on posttests

13 Objective 2: Change in attitudes toward diverse patient types u 73.8% of participants sympathized with American Indian patient featured in case study one “I feel a lot of sympathy for Mrs. Williams. I believe Dr. Brown means well, but he comes across as arrogant and uncaring.” u 27.7% of participants directly expressed support for the patient in case study two and were concerned about the quality of care she received “The office staff are providing very substandard care by their underlying stereotyping.”

14 Objective 3: Change in use of interpreter services and translated materials u Increased awareness regarding current interpreter practices “One thing that impacted me was not using family members as interpreters. A lot of times I’m forced to do that or it seems like the best method at the time, but now I can understand how certain issues may be sensitive to people, even if I don’t think they are sensitive issues.” “I really started to realize that having an interpreter is a good practice builder. It has been a boon to my practice.” “I learned a lot about dealing with interpreters. Recently, I had an interpreter who just took off talking to the patient because I did not tell him I wanted to be in charge of the conversation. Now I am a lot more in-tune and aware.”

15 Objective 4: Improved practice habits *Data from focus groups (N=53)

16 Objective 5: Enhanced educational/communication practices in direct physician-patient interactions *Data from focus groups (N=52) “I have applied at least one of the communication techniques that I saw in the vignettes in my daily practice.”

17 Summary of Findings u Physicians enter CCCMs with a reasonable understanding of cultural competency, but still show increased posttest scores and knowledge gain u Curriculum participation renders a positive impact on practice behavior Increased sensitivity to cultural differences Took more time with patients Asked more patient-centered questions u Course resulted in improved perceptions of medical interpreters u Curriculum participation results in enhanced self- awareness of cultural competency concepts

18 Evaluation Limitations and Constraints u Reliance on participant self-report data Participants may overemphasize program impact u Posttests accurately capturing changes in clinical behavior Observation of physicians in practice or patient surveys could improve understanding of behavior change u No baseline established for assessing physician attitudes toward diverse patients Physicians were not exposed to case vignettes prior to viewing curriculum content

19 Recommendations for Further Research u Research link between curriculum participation to a reduction in health disparities u Explore why medical residents may be more likely to incorporate curriculum concepts into their daily practice u Determine if time lapse since completing curriculum influenced self-report of the impact of course participation u Widen study population to determine if curriculum impact is sensitive to provider type

20 For More Information, Contact: Guadalupe Pacheco, MSW Project Officer Office of Minority Health, HHS Ann Kenny, MPH, BSN, RN Project Director SRA International