Attachment
2: Criteria for Literature Review
The set of
criteria that follows consists of factors
for consideration in judging the literature
both in its theoretical and methodological
rigor. The very nature of the field of
cultural competence requires a set of
criteria flexible enough to reflect the
multiplicity of perspectives within the
field, but also targeted enough to allow
for a meaningful review.
- Identification of definitions:
In developing a conceptual model of
cultural competence, consensus must
be achieved on the definition of cultural
competence and its associated domains.
Articles that present a cohesive and
rational definition of the key constructs
of cultural competence should be considered.
- Identification of measures:
Phase II of the literature review involves
identifying measures of cultural competence.
Priority should be given to those articles
that have developed a set of measures,
standards, and/or guidelines that reflect
a concrete manifestation of the abstract
and theoretical construct of cultural
competence.
- Application in direct service
settings: Since the scope of
this project is directed at developing
measures of cultural competence for
HRSA direct service delivery programs,
articles that focus on direct service
settings should be given priority. The
importance of this criterion is that
it suggests a real-world applicability
of cultural competence in service delivery
models.
- Identification of tools used
by direct service providers:
In addition to understanding the applicability
of cultural competence in direct service
settings, we must also identify the
applicability and the utility of tools
used in and outside of these settings.
This involves reviewing documents that
describe the use of outreach, provider
education and other enabling services
that are not necessarily provided within
the confines of a direct service delivery
setting.
- Applicability to a wide range
of populations: The very nature
of cultural competence requires an examination
of what cultural competence signifies
to a variety of different populations.
While our review should include those
articles that focus their attention
on particular populations, we should
also consider those articles that formulate
approaches and models that can be applied
to a wide range of populations.
- Cultural competence and managed
care: Managed care organizations
are increasingly becoming important
players in the delivery of care to underserved
and special populations. To ensure that
managed care organizations (MCOs) are
partners in the health care delivery
process attempts are being made to educate
MCOs on what is the necessary set of
services required and how to provide
those services to various populations.
Articles that reflect managed care’s
involvement in the arena of cultural
competence should be considered for
review.
- Cultural competence and quality:
Cultural competence is a key component
of a quality system of care. Therefore,
articles that focus on the role of cultural
competence as a part of delivering high
quality care should be considered for
review.
- Replicability of findings:
A key tenet of evidenced-based research
is whether other researchers under similar
conditions have replicated findings.
Replicability provides confidence that
the observed effect is a stable and
reliable effect that can been consistently
achieved across similar situations.
- Generalizability of findings: Related
to the notion of replicability is whether
findings possess generalizability. Generalizability
is central to establishing the external
validity of a study by demonstrating
that findings can be generalized and
applied beyond the confines of the study.
- Explanatory power of cultural
competence: Given the multiple
influences on health outcomes, it is
difficult to parse out the impact of
cultural competence compared to other
factors in achieving desired outcomes.
While there is not an expectation that
cultural competence alone can explain
the entirety of an observed result,
articles that are able to successfully
isolate the role that cultural competence
plays in explaining various outcomes
should be selected for review.
- Peer-reviewed articles:
The process of peer-review ensures that
an article is empirically and theoretically
sound and that a high level of rigor
has been applied. It is important to
note that this criterion should not
be applied without adequate consideration
given to value of unpublished literature
identified along the course of this
project.
- Empirical and consensus-based
articles: The field of cultural
competence contains much research that
focuses on obtaining input from critical
stakeholders from different racial and
ethnic groups in addition to empirically-driven
research on health outcomes and health
care processes. An assessment of
the field would naturally extend to
both empirical and consensus-based work.
- Multiple citations of authors/studies:
In reviewing articles, it is important
to identify those seminal studies and
authors that have been cited in multiple
publications. Multiple citations suggest
that those studies and work produced
by those authors have been accepted
in the field as influential and as reputable
bodies of work.
- Time period: In
order to gain a historical perspective
on the evolution of cultural competence
as a concept, we should review articles
published within a broad time period.
However, in identifying the state of
the art in study design and measurement,
we should select those articles that
have been published in the past 10 years.
This will ensure that we are constructing
a theoretical model built upon the seminal
thinking in the field as well as developing
measures and indicators that reflect
the most current and cutting-edge approaches
to measuring cultural competence.
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