Culturally Competent Health Care

Research Gaps

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field or can be a more extensive narrative that weaves mention of gaps into a discussion generated by findings from the review.

Identified Research Gaps

Results from the Community Guide review indicate that there were not enough qualifying studies to allow for conclusions about the effectiveness of interventions to improve the cultural competence of healthcare systems, highlighting the need for more, and better, research in this area.

Research is needed to assess intervention effectiveness in changing the structure and process of healthcare delivery. This research must examine meaningful health outcomes and focus on what works best, where, and for whom. Demonstrating differential effectiveness for specific subgroups of clients can help tailor interventions for maximum impact. The idea that “one size fits all” is contradictory to the very notion of cultural diversity.

Basic questions remain about the potential of the interventions reviewed here to improve satisfaction with care, reduce ethnic differentials in utilization and treatment, and improve health status. We noted an absence of comparative research, specifically studies in which interventions to improve cultural competence are compared with usual care alternatives. Evaluation studies must assess not only change in knowledge and attitudes but also use of services, receipt of treatments, and changes in health outcomes. Much remains to be learned about the effectiveness of, unintended consequences of, and potential barriers to the types of interventions reviewed here

Effectiveness

The ability to communicate in the clinical encounter is critical to good medical outcomes. Not all communications problems are attributable to language barriers. Effectiveness studies must take into account the additional effect of language on existing provider–client communication patterns.

In 1964, the Civil Rights Act, Title VI, mandated provisions for the language needs of clients. Healthcare organizations cite cost as an important factor that limits their ability to provide trained interpreters. Very little research has been done on the effectiveness and cost-effectiveness of providing linguistically competent healthcare services in the United States or on ways to reduce the costs of providing such services. Questions such as the following need to be answered.

• Do trained interpreters compare favorably with family or ad hoc staff interpreters in improving outcomes of satisfaction, appropriate utilization, and health status?
• What are the relative contributions of improvements in linguistic competence and cultural sensitivity skills to reducing miscommunication and the resulting medical errors? ?
• Are linguistically and culturally appropriate health education materials more effective than standard materials in improving health outcomes??

Healthcare providers and provider organizations are concerned about the burden placed on resources by implementing interventions to improve the cultural competence of healthcare systems, particularly in the absence of proven effectiveness. Answers to the following questions should be sought:

• What role should communities play in collaborating with area healthcare organizations to communicate the needs of ethnically diverse populations? At what levels (e.g., management, provider, staff) in a healthcare organization does investment in linguistic and cultural competencies create the greatest improvement in health or other outcomes?
• Which cultural competencies within a healthcare system increase client satisfaction and improve health outcomes?
• Does cultural competency training of healthcare providers have a lasting effect or should it be repeated periodically?

Other Positive or Negative Effects

• Do ethnic-specific health messages generate negative stereotypes?
• Do the client benefits of engaging in culturally competent healthcare systems carry over to other social institutions (e.g., education, employment)?

Cultural competence is increasingly important for healthcare quality. The burgeoning interest in culturally competent model programs is apparent in the healthcare literature, but a research base on program effectiveness to inform decision making is absent.