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UBC Theses and Dissertations

Cultural competence of healthcare professionals : a critical analysis of the construct and its correlates Capell, Jennifer

Abstract

Background: Globalization has implications for healthcare worldwide including healthcare disparities and outcomes. Cultural competence of healthcare professionals has emerged as a field to address such issues. Purpose: This thesis proposed to (a) critically appraise the construct of cultural competence and its assessment in healthcare professionals, and (b) identify relationships between cultural competence and selected attributes including ethnocentrism and international experience. Design: The construct of cultural competence and tools to assess it were critiqued. This was followed by a cross-sectional questionnaire study associating the cultural competence of physiotherapists, occupational therapists, and nurses with the attributes of ethnocentrism, international experience, and additional variables. Subjects and Methods: Participants (n=71) were recruited from hospitals in Greater Vancouver, Canada. The questionnaire included demographic and cultural information, the Inventory to Assess the Process of Cultural Competence-revised (IAPCC-R), the Generalized Ethnocentrism Scale (GENE), and exploratory questions regarding international experience and clinical practice. Results: Cultural competence scores did not differ by profession. Cultural competence scores were negatively associated with ethnocentrism, and positively associated with general (but not healthcare specific) international experience and desire to gain international experience. Number of languages spoken and proportion of people from other cultures in a practitioner’s caseload were also positively associated with cultural competence. Discussion and Conclusions: Campinhe-Bacote’s model and assessment tool (IAPCC-R) for cultural competence are primary contributions to the field of cultural competence in healthcare. The well established IAPCC-R focuses on practitioner’s attributes but does not link these attributes to improved clinical outcomes. Therefore, the IAPCC-R may reflect cultural sensitivity rather than competence. We argue that enhanced patient outcomes may be the more valid indicators of cultural competence in healthcare. Ethnocentrism and international experience were related to cultural competence, however causality within these relationships warrant further study. Studies need to establish the uniqueness of the construct versus general interpersonal effectiveness. If it exists, the construct of cultural competence warrants refinement to reflect its distinctiveness. In this way, its elements perhaps could be taught to healthcare professionals to enhance their clinical effectiveness and outcomes, and new directions for research established.

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