Section
I: Introduction
I.
Introduction
A. Project background and objectives
The
Health Resources and Services Administration
(HRSA) is sponsoring a project to develop a
cultural competence measurement profile comprising
a conceptual measurement framework and set of
measures for gauging cultural competence in
health care settings. HRSA has contracted The
Lewin Group to conduct this work. The goal of
this effort is to contribute to an understanding
of how the complex construct of cultural competence
can be measured and advance the capacity of
organizations to carry out such measurement.
As
the Nation’s “Access agency,” HRSA recognizes
that cultural competence is an essential component
of accessible, responsive, and high quality
health services. Ensuring cultural competence
is a key strategy in HRSA’s commitment to achieving
a goal of providing access to quality health
care for all. HRSA also recognizes that a key
mechanism for ensuring cultural competence is
the ability to measure it for purposes related
to developing, monitoring, and evaluating health
care services. While the field has made strides
in this area, much more needs to be known. Through
this project, HRSA hopes to make a contribution
to the field by providing a measurement profile
that can serve as a building block for future
work by HRSA and others interested in culturally
competent health service delivery, including
consumers, providers, policy makers, and researchers.
The objectives of this project are to: 1) develop
a conceptual framework for measuring cultural
competence in health care settings; 2) identify
specific indicators and measures that can be
used to assess cultural competence within health
care; and 3) assess the feasibility and practical
application of these measures. The following
report details a comprehensive review of the
cultural competence theoretical and methodological
literature. This report is one component of
the larger measurement profile project, which
involves further development and refinement
of the profile through site visits to best practice
health care organizations and clinics, as well
as discussions with experts in the field.
This
literature assessment serves two related purposes.
The first is to synthesize and examine the state-of-the-art
of measurement of cultural competence, particularly
as related to health care, in order to develop
a potentially useful resource for the field. In
addition, the literature assessment will provide
a basis for decisions about the scope, content,
and value of the measurement profile to be developed
in this project.
B. Organization
of the Report
This
report begins with a review of how cultural
competence has been conceptualized. The identification
and discussion of the areas in which cultural
competence must be evidenced are presented as
critical domains for measuring cultural competence.
The report then presents and applies a measurement
framework for the identification and review
of specific performance indicators and measures
of cultural competence that are garnered from
the literature. The report identifies key challenges
in measuring cultural competence and potential
areas for further analysis are discussed. The
conclusion section of this report highlights
key themes raised throughout the report and
presents considerations for next steps.
An
annotated bibliography of the works consulted,
which appears at the end of this report, is
categorized into the following areas: core models
and concepts of cultural competence, assessment
tools and evaluative models, performance measures
and/or indicators, and program-and condition-specific
studies.
Also
presented at the end of this report is a matrix
of measures and indicators of cultural competence
identified from the literature. (Attachment
3) These measures and potential indicators
of cultural competence are grouped by domain
areas and identified by type of measure.
C. Literature
review methodology
The
project team conducted a targeted literature
review of published and unpublished articles,
monographs, and reports identified through several
sources, including: a HRSA work-group, which
included individuals from a variety of bureaus
and offices comprising a subgroup of HRSA’s
Cultural Competence Committee; the project’s
Technical Expert Panel and interviews with other
experts in the field; and bibliographic search
engines, including (MEDLINE(R) 1993-2000/December,
Help News 154, HealthSTAR 1975-2000/Dec, TGG
Health&Wellness DB(SM) 1976-2000/Dec, and Allied
and Complementary Medicine 1984-2000/OCT).
HRSA and The Lewin Group jointly identified
several criteria to select the articles and
reports included in this review. The goal was
to target literature for theoretical and methodological
rigor, while maintaining enough flexibility
to capture the variety of perspectives on cultural
competence and its measurement. Attachment
2 of this report provides a summary
of these criteria.
Prepared
for:
The Health Resources and Services Administration
September 2001
Prepared
by:
The Lewin Group, Inc.
Acknowledgements:
Willine Carr, HRSA Project Officer
Jeanean Willis, HRSA Project Officer
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