CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
There is a corresponding neglect or under-emphasis of skills-focused training interventions (Curtis et al., 2007;
Engerbretso et al., 2008).
Curtis et al., moreover, cite research findings that suggest “even if measurable attitudinal change does occur as a
reported consequence of [such attitude-based] training, attitudinal change does not necessarily result in
changed behaviour” (see also Armour, Bain, & Rubio, 2004; Bieschke et al., 2003; Tomlinson-Clarke 2000).
(3) Stereotyping
Another limitation associated with knowledge-based approaches to cultural competence training concerns the
persistence of stereotyping teaching strategies that depict groups in static, homogeneous ways (Betancourt et al.,
2005; Engerbretso et al., 2008). The failure to recognize the complexity of individual cultural identity and
formation, can lead to misdiagnosis and culturally incompetent care. Frequently, such ‘categorical’ approaches to
training focusing on the particular cultural norms of particular ethnic groups, moreover, fail to address and account
for the cultural orientation of the dominant health care system and its providers (Engerbretson et al., 2008).
(4) Lack of standards and criteria for assessment
While cultural competence education for medical/healthcare professionals in training in universities and colleges has
grown in sophistication and consistency as a result of the introduction of accreditation standards, continuing cultural
competence education for practicing health care professionals has been described as “increasingly haphazard and
varying in quality” (California Endowment, 2003). One of the major reasons for this is the lack of agreed upon
standards and evaluative criteria by which to plan or assess cultural competence training for existing healthcare
professionals (ibid.).
(5) Training as substitute for organizational change
A last salient limitation or critique of cultural competence training in the literature is the false sense of
accomplishment this can bestow on organizations providing it. Cross et al.’s (1989) cultural competence continuum
for assessing organizations is telling in this respect as it situates organizations at the pre-competence phase as
frequently and inordinately focussing on training and diverse staff hiring, yet too often to the neglect of more
fundamental and systemic changes in the way business is conducted in the organization.
Cultural competence training – most of which tends to focus on improving individual staff attitudes, knowledge, and
behaviour - is a necessary but insufficient condition (and certainly no substitute) for improving the cultural and
linguistic appropriateness and accessibility of programs and services.
5.4. BEST PRACTICES & RECOMMENDATIONS
Among the salient recommendations and best practices identified in this review of the cultural competence training
literature are:
• Evaluating - and properly designing evaluations (e.g. experimental pre/post-test designs using validated
instruments) of - training programs for their impact on trainees behaviour as well as client health outcomes
(Gozu et al., 2007; Curtis et al., 2007).
• Developing greater (evidence-based) consensus on training standards and evaluative criteria for cultural
competency training and skills assessment. This is a particularly important priority in the field of continuous
education for existing health care professionals (OMH, 2001; Betancourt, 2005).
• Focusing on skills versus solely attitudes and knowledge in training modules by employing a practiceoriented,
skills-based approach to training that focuses on specific competencies and skills required to
function culturally competently in a particular organizational setting (Engerbretso et al., 2008).
Taking a systems approach to cultural competence training. A systems approach treats training as a “key
component of a health care organization’s strategic approach to organizational performance”, and links it to the
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