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Cultural Competency Training and Evaluation Methods Across Dietetics Education: A Narrative Review

Published:March 19, 2020DOI:https://doi.org/10.1016/j.jand.2020.01.014

      Abstract

      Developing cultural competence among credentialed nutrition and dietetics practitioners is critical to move toward eliminating disparities in health care. Despite emphasis put forth on culturally competent care by credentialed nutrition and dietetics practitioners, the types, methods, and outcomes of cultural competency training are lacking or inconsistent. In this narrative review, we evaluated studies detailing cultural competency training for content, modes of delivery, and learner outcomes. Main inclusion criteria were students in dietetics or credentialed nutrition and dietetics practitioners engaging in an educational intervention. Exclusion criteria were studies published before 2000 and not published in the English language. Ten studies were reviewed from four health science databases. Our aims were to quantify the literature on cultural competence training in dietetics education and describe the interventions to identify gaps within the field; thus, a quality assessment tool was not utilized. Data were extracted on learner type, number of participants, curriculum content, intervention type, learning outcomes, and outcome evaluation tool. Most studies employed interprofessional education (n=7) and/or service learning (n=6) as interventions types. Quantitative evaluation of learners in the studies reviewed indicated increased knowledge and skill (statistically significant; n=2), whereas qualitative evaluation of learners indicated themes, including curriculum satisfaction, gains in competence, and comfort working with diverse people. Methods of evaluation and delivery were inconsistent, making it difficult to draw larger conclusions about cultural competency training in dietetics. Cultural competence creates opportunities for growth and development of health professionals to serve diverse communities and work environments; future work should include standardizing evaluations of training, specifically to include both qualitative and quantitative methods.

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      References

        • Saha S.
        • Beach M.C.
        • Cooper L.A.
        Patient centeredness, cultural competence and healthcare quality.
        J Natl Med Assoc. 2008; 100: 1275-1285
        • Chiu C.
        • Shi Y.
        Cross-cultural competence.
        in: Cross-Cultural Psychology. John Wiley & Sons, Ltd, 2019: 39-55
        • Abrishami D.
        The need for cultural competency in health care.
        Radiol Technol. 2018; 89: 441-448
        • Airhihenbuwa C.O.
        • Ford C.L.
        • Iwelunmor J.I.
        Why culture matters in health interventions: Lessons from HIV/AIDS stigma and NCDs.
        Health Educ Behav. 2014; 41: 78-84
        • Brach C.
        • Fraser I.
        Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model.
        Med Care Res Rev MCRR. 2000; 57: 181-217
        • Dovidio J.F.
        • Fiske S.T.
        Under the radar: How unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities.
        Am J Public Health. 2012; 102: 945-952
        • Roncoroni J.
        • Tucker C.M.
        • Wall W.
        • Nghiem K.
        • Wheatley R.S.
        • Wu W.
        Patient perceived cultural sensitivity of clinic environment and its association with patient satisfaction with care and treatment adherence.
        Am J Lifestyle Med. 2014; 8: 421-429
        • Beach M.C.
        • Price E.G.
        • Gary T.L.
        • et al.
        Cultural competence: A systematic review of health care provider educational interventions.
        Med Care. 2005; 43: 356-373
      1. Accreditation Council for Education in Nutrition and Dietetics of the Academy of Nutrition and Dietetics. ACEND Accreditation Standards For Nutrition and Dietetics Didactic Programs (DPD).
        • Knoblock-Hahn A.
        • Scharff D.
        • Elliot M.
        Cultural competence in dietetics education.
        J Am Diet Assoc. 2009; 109: A12
        • Mews C.
        • Schuster S.
        • Vajda C.
        • et al.
        Cultural competence and global health: Perspectives for medical education – Position paper of the GMA Committee on Cultural Competence and Global Health.
        GMS J Med Educ. 2018; 35: Doc28
        • Purnell L.
        The Purnell Model for cultural competence.
        J Transcult Nurs. 2002; 13: 193-196
        • Bennett M.
        Towards ethnorelativism: A developmental model of intercultural sensitivity.
        Educ Intercult Exp. 1993; : 1-20
        • Campinha-Bacote J.
        The process of cultural competence in the delivery of healthcare services: A model of care.
        J Transcult Nurs. 2002; 13: 181-184
        • Horvat L.
        • Horey D.
        • Romios P.
        • Kis-Rigo J.
        Cultural competence education for health professionals.
        Cochrane Database Syst Rev. 2014; : CD009405
        • Jongen C.
        • McCalman J.
        • Bainbridge R.
        Health workforce cultural competency interventions: A systematic scoping review.
        BMC Health Serv Res. 2018; 18: 232
        • Khalil H.
        • Peters M.
        • Godfrey C.M.
        • McInerney P.
        • Soares C.B.
        • Parker D.
        An evidence-based approach to scoping reviews.
        Worldviews Evid Based Nurs. 2016; 13: 118-123
        • Gallagher R.W.
        • Polanin J.R.
        A meta-analysis of educational interventions designed to enhance cultural competence in professional nurses and nursing students.
        Nurse Educ Today. 2015; 35: 333-340
        • Stein K.
        Cultural competency: Where it is and where it’s headed.
        J Acad Nutr Diet. 2009; 109: 388-391
        • Edelstein S.
        Measurement of diversity tolerance of nutrition professionals using the tolerance of ambiguity scale.
        Top Clin Nutr. 2007; 22: 130
        • Chang L.-C.
        • Guo J.L.
        • Lin H.-L.
        Cultural competence education for health professionals from pre-graduation to licensure delivered using facebook: Twelve-month follow-up on a randomized control trial.
        Nurse Educ Today. 2017; 59: 94-100
        • Horacek T.
        • Brann L.
        • Erdman M.
        • Middlemiss M.A.
        • Raj S.
        Interprofessional learning community: Educating dietetic and other health profession students through an interdisciplinary, service-learning experience.
        Top Clin Nutr. 2009; 24: 6
        • Palmer V.S.
        • Mazumder R.
        • Spencer P.S.
        Interprofessional global health education at Oregon Health and Science University: The Interprofessional Community Health and Education Exchange (iCHEE) experience.
        Acad Med J Assoc Am Med Coll. 2014; 89: 1149-1152
        • Christaldi J.
        • Bodzio J.R.
        Cultural competence and the global role of dietitians: A Haitian medical mission and inter-professional, service-learning nutrition course.
        Open Nutr J. 2015; 9: 35-41
        • Gilboy M.B.
        • Bill D.E.
        Cultural immersion experience: Promoting an understanding of Mexican American nutrition and food traditions.
        J Nutr Educ Behav. 2011; 43: 419-420
        • Rae K.
        • Bohringer E.
        • Ashman A.
        • Brown L.
        • Collins C.
        Cultural experiences of student and new-graduate dietitians in the Gomeroi gaaynggal ArtsHealth program: A quality assurance project.
        Health Promot J Austr. 2016; 27: 162-166
        • Wilson A.M.
        • Delbridge R.
        • Palermo C.
        Supporting dietitians to work in Aboriginal health: Qualitative evaluation of a community of practice mentoring circle.
        Nutr Diet. 2017; 74: 488-494
        • Wright L.
        • Lundy M.
        Blogging as a tool to promote reflection among dietetic and physical therapy students during a multidisciplinary international service-learning experience.
        J Allied Health. 2012; 41: 73E-78E
        • Wright L.
        • Lundy M.
        Perspectives of cultural competency from an international service learning project.
        J Acad Nutr Diet. 2014; 114: 996-997
        • Hark L.A.
        • Deen D.
        Position of the Academy of Nutrition and Dietetics: Interprofessional education in nutrition as an essential component of medical education.
        J Acad Nutr Diet. 2017; 117: 1104-1113
        • Bridges D.R.
        • Davidson R.A.
        • Odegard P.S.
        • Maki I.V.
        • Tomkowiak J.
        Interprofessional collaboration: Three best practice models of interprofessional education.
        Med Educ Online. 2011; 16
        • Reeves S.
        • Pelone F.
        • Harrison R.
        • Goldman J.
        • Zwarenstein M.
        Interprofessional collaboration to improve professional practice and healthcare outcomes.
        Cochrane Database Syst Rev. 2017; 6: CD000072
        • The Interprofessional Education Collaborative
        Core competencies for interprofessional collaborative practice.
        • Health Professions Accreditors Collaborative
        Members.
        • Earland J.
        • Gilchrist M.
        • McFarland L.
        • Harrison K.
        Dietetics students’ perceptions and experiences of interprofessional education.
        J Hum Nutr Diet. 2011; 24: 135-143
        • Bringle R.G.
        • Hatcher J.A.
        Implementing service learning in higher education.
        J High Educ. 1996; 67: 221-239
        • Heiss C.J.
        • Goldberg L.R.
        • Weddig J.
        • Brady H.
        Service-learning in dietetics courses: A benefit to the community and an opportunity for students to gain dietetics-related experience.
        J Acad Nutr Diet. 2012; 112: 1524
        • Chupp M.G.
        • Joseph M.L.
        Getting the most out of service learning: Maximizing student, university and community impact.
        J Community Pract. 2010; 18: 190-212
        • Dooley K.
        • Dooley L.M.
        • Carranza G.
        Beliefs, barriers, and benefits of a faculty abroad experience in Mexico.
        J Int Agric Ext Educ. 2008; 15: 29-38
        • Sevin A.M.
        • Hale K.M.
        • Brown N.V.
        • McAuley J.W.
        Assessing Interprofessional Education Collaborative Competencies in service-learning course.
        Am J Pharm Educ. 2016; 80: 32
        • Santos M.D.L.
        • McFarlin C.D.
        • Martin L.
        Interprofessional education and service learning: A model for the future of health professions education.
        J Interprof Care. 2014; 28: 374-375
        • Shorten A.
        • Smith J.
        Mixed methods research: Expanding the evidence base.
        Evid Based Nurs. 2017; 20: 74-75
        • Halcomb E.
        • Hickman L.
        Mixed methods research.
        Nurs Stand. 2015; 29: 41-47
        • Hammarberg K.
        • Kirkman M.
        • de Lacey S.
        Qualitative research methods: When to use them and how to judge them.
        Hum Reprod. 2016; 31: 498-501
        • Betancourt J.R.
        • Green A.R.
        Commentary: Linking cultural competence training to improved health outcomes: Perspectives from the field.
        Acad Med J Assoc Am Med Coll. 2010; 85: 583-585
        • Fergusson P.
        • Greenspan N.
        • Maitland L.
        • Huberdeau R.
        Towards providing culturally aware nutritional care for transgender people: Key issues and considerations.
        Can J Diet Pract Res. 2018; 79: 74-79
        • Butler M.
        • McCreedy E.
        • Schwer N.
        • et al.
        Disability Populations.
        Agency for Healthcare Research and Quality, Washington, DC2016
        • Flavell J.H.
        Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry.
        Am Psychol. 1979; 34: 906-911
        • Pintrich P.R.
        Chapter 14: The role of goal orientation in self-regulated learning.
        in: Boekaerts M. Pintrich P.R. Zeidner M. Handbook of Self-Regulation. Academic Press, San Diego, CA2000: 451-502

      Biography

      C. F. McCabe is a doctoral degree candidate, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.

      Biography

      A. O’Brien-Combs is a dietetic intern; at the time the study was completed, she was a master of public health nutrition candidate, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.

      Biography

      O. S. Anderson is a clinical assistant professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.