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.