REVISION 3-3
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REVISION3-3.docx2
Cultural Competence Training Program For African Immigrants
Chidinma Ogundu
Touro University Nevada
DNP 763: DNP Project III
In partial fulfillment of the requirements for the Doctor of Nursing Practice
Dr. Calaiselvy Elumalai
Dr. Jessica Grimm
Dr. Denise Zabriskie
Dr. Julie Astrella
December 15, 2021
Cultural Competence Training Program For African Immigrants
Cultural competence can be described as the ability of understanding, communicating, and interacting efficiently with people across cultures (Schouler-Ocak et al., 2015). Cultural competence comprises the process of one being aware of their own view of the world based on their cultural practices and traditions, as well as developing positive attitudes towards the difference in cultures of others (Allison et al., 2016). Cultural competence is an important aspect of healthcare because cultural practices directly impact health care practices (Venters et al., 2019). African immigrants often find themselves in situations of cultural dilemmas because of the differences in culture between their original areas of residence and their new ones (Price et al., 2015).
The main problem witnessed on the project site is the lack of cultural competence among health care providers regarding African immigrants. This problem negatively affects the health care experience of African immigrants (Purnell & Fenkl, 2019). Because of the gap in cultural incompetence, there is a huge disparity in the quality of health services received by the African immigrant population as compared to other population groups in United States (Clough et al., 2013). Evidence points to the fact that the African immigrant population has a lower health score and patient outcomes as compared to other groups with less than 18% of those admitted showing improved results over the course of their recovery (World Health Organization, 2020).
Knowledge gaps existing in practice causing cultural incompetence needs to be addressed because it violated the healthcare sector's goal of ensuring fairness and equality in the access to services regardless of ethnic or racial orientation (Allen et al., 2012). As the World Health Organization explains, the health care sector aims at ensuring that everyone can be as healthy as possible, including the African immigrants (World Health Organization, 2020). The lack of cultural competence among health care providers that leads to African immigrants having poor health experiences violates this goal. The solution put forth by this project is the development of a cultural training program for African immigrants. This program is aimed at equipping health care providers with the right knowledge and set of skills to address the health concerns of African immigrants. The development of a cultural competence program is important because it will help in the removal of sociocultural factors that negatively impact the health experiences of African immigrants (Omenka et al., 2020).
Background
The number of African immigrants entering and settling in the United States increases almost every year (Purnell & Fenkl, 2019). This is because African immigrants prefer moving to the United States in search of better living conditions, better employment opportunities, and better health care services (Seck, 2015). However, African immigrants have been brought up in entirely different societies with completely different cultural beliefs and practices (Allen et al., 2012).
The African immigrant group has unique health care needs and most of these needs are related to their cultural practices (Purnell & Fenkl, 2019). Purnell and Fenkl (2019), report that health care providers are not devoted to finding methods of addressing these unique health care needs of African immigrants. Omenka et al. (2020), explain that the lack of cultural competence among health care providers is a crucial contributing factor to the poor health of African immigrants. Without cultural competence training, health care providers cannot effectively tackle the health care concerns of African immigrants (Kamya, 2017).
Problem Statement
The main problem faced at the project site is the lack of cultural competence training among health care providers, specifically regarding African immigrants. The facility is a primary care clinic in Garland, Texas that attends to various groups of people and the African immigrants group is one of them. However, the African immigrant group is different in terms of their health care needs since most of their medical needs are related to their culture (Asare & Sharma, 2012). The staff have not received formal training on addressing the needs of this population, therefore they cannot deliver health services that address the cultural, social, and linguistic needs of the African immigrant group. This results in poor health conditions for African immigrants. There are several resources available that are not being used, and this project addresses to address these gaps.
The Center for Disease Control and Prevention (CDC) reports that the failure of health care providers to administer effective health care services to African immigrants puts the group at an increased risk of getting sick (CDC, 2021). The Center for Disease Control and Prevention (CDC) reports that this has been clear, especially during the COVID-19 period as many African immigrants have suffered from and died of COVID-19 (2021). The proposed solution is the development of a cultural competence training program for the health care providers. This program is aimed at enabling the health care providers to gain the knowledge and techniques they can employ to provide quality health care services to African immigrants.
PICOT Question
In healthcare workers caring for African Immigrant groups (P), how can how can an effective cultural competence training program (I) compared to no training program (C) be developed to improve the resource allocation and referrals for African Immigrants (O) in less than 4 weeks (T).
Literature Review
Search Methods
The search strategy for this project included the use of databases, search terms, and keywords. The databases included MEDLINE (PubMed), Web of Science, Google Scholar, and CINAHL Complete. The keywords used were based on the PICO framework. The participants were "African immigrants", "African incomers", and "African in-migrants". The intervention was "cultural competence", "competence in cultures", "cultural awareness", "intercultural competence", "culturally responsive", "cultural literacy", and "culturally informed". The outcomes were "improved health care", "better health care", "enhanced health", and "raised health care status". Boolean operators were also used to combine search terms. The search terms were combined to broaden or narrow the search results. "OR" and "AND" were the Boolean operators used. The citation list was reviewed to identify any additional studies that were eligible for inclusion. This was to ensure that no relevant studies were excluded. There was focus on the breadth and specificity of the search.
Predetermined criteria for inclusion and exclusion had already been established and all the citations were reviewed against it. Various types of study designs were included, and these include systematic reviews, cross-sectional studies, and case reports and series. All included studies specifically addressed how cultural competence in the healthcare profession would be useful in improving the health outcomes of African immigrants or how deficiency of cultural competence among health care providers contributed to the poor health of African immigrants. The definition of cultural competency along with all its elements was based on the United States National Library of Medicine-National Institutes of Health (National Library of Medicine, 2019). The library defines cultural competency among health care providers as the ability to collaborate effectually with individuals from different cultures to improve their health care experience and outcomes Health (National Library of Medicine, 2019).
The studies included also specifically compared the cultural competency of health care providers to the health outcomes and experiences of African immigrants. All potential settings, such as hospitals, clinics, community settings, and others that were related to the studies, were included. The studies included specifically had their participants as African immigrants and no other group was substituted for the participants. Studies were exempted because of the following. (a) The study population was not only African immigrants, or there was no separate reporting of the results of African immigrants. (b) The study discussed African Americans instead of African immigrants. (c) The study did not have its core focus as cultural competence among health care providers in relation to African immigrants. (d) The intervention targeted the health care system or the health care providers instead of the patients. However, no studies were excluded based on participant age or sex, or article language.
Review Synthesis
Developing the themes was founded on analysis and examination of previous studies that were related to cultural competence issues among African immigrants. The main themes that emerged include effects of cultural incompetence, how language barriers affect cultural competence, and the impact of cultural competence training on health care workers. These themes are the main points of emphasis when developing a cultural competence program for African immigrants. Focusing on these themes will guarantee the success of the cultural competence program for African immigrants.
Review of Study Methods
Most of the literatures reviewed the qualitative literature review methods to supplement the facts in their studies. The qualitative literature review research was conducted in hospital and clinical settings by assessing redacted medical records. The facts gave insights into how cultural competence affected the quality of patient outcomes among the African immigrant population. The case study aimed at identifying the percentages of hospitals and clinics that acknowledge cultural sensitivity and inclusion through cultural competence training.
Literature Themes
Effects of Cultural Incompetence
The main issue observed in the research is the lack of cultural sensitivity and competence within the health care profession regarding African immigrants. This issue has a negative impact on the health care received by African immigrants. Because of the disparity in cultural competence, the health care providers cannot efficiently deliver health services that cater to the cultural, social, and linguistic needs of the African immigrant patients (Purnell & Fenkl, 2019). As a result, the African immigrant group is seen to have an overall health status score that is lower compared to other groups (Seck, 2015). As the World Health Organization defines, the health care sector has a goal of guaranteeing that everyone's wellbeing is catered for as effective as possible, including African immigrants (World Health Organization, 2020). Health is determined by various social factors outside of the traditional healthcare setting (Purnell & Fenkl, 2019).
Some of these social determinants of health are housing quality, access to healthy foods, and education. Seck (2015) explained that African immigrants have unfavorable social determinants of health which contribute to their lack of quality healthcare. This leads to their poor health experiences because of the lack of understanding by health care workers regarding these social determinants of health. Lack of representation of African immigrants both in leadership and training is also responsible for the lack of cultural competence programs for African immigrants (Clough et al., 2013). Another reason for the lack of cultural incompetence regarding African immigrants is the fact that even most health care workers are white and without cultural training, it is hard for them to understand the needs of African immigrants (Seck, 2015). Even though the medical field is showing increased diversity, most people working in healthcare are not familiar with the culture of African immigrants, so they do not know how to handle this group (Purnell & Fenkl, 2019).
Cultural incompetence has had negative outcomes for African immigrant patients, such as serious health complications and even death. Clough et al. (2013) explained that, due to cultural incompetence, African immigrants are two to three times more likely to suffer from various health-related issues compared to other groups, like white people. The cultural incompetence of health care workers makes African immigrants suffer severely and longer from easily preventable diseases. Seck (2015) reports that some of these negative outcomes are because of subconscious prejudices and implicit bias about the African immigrant group . Addressing cultural incompetence and its effects is the first step to the development of a successful cultural training program for African immigrants (Purnell & Fenkl, 2019).
Language Barriers and Cultural Competence
Language is an aspect of culture that affects the quality of treatment in African immigrant groups (Seck, 2015). Language barriers play an important role in miscommunication between patients and medical providers, which negatively affects the quality of healthcare services and patient satisfaction regarding the African immigrant group (Allison et al., 2016). Due to language barriers, health care professionals have an incomplete understanding of the situations of patients, poorly assess patients, prescribe treatment incompletely, or cause delayed treatment or misdiagnoses (Wamwayi & Murray, 2019). As a result of language barrier, African immigrants end up having decreased satisfaction with healthcare services, complications arising from medication, and a reduced level of understanding of their diagnosis even if they have access to health care (Venters et al., 2019).
All these elements lead to the reduction in the quality of healthcare experience of African immigrants. One way of overcoming the language barrier is through using technology to bridge the language gap between healthcare professionals and African immigrants (Venters et al., 2019). Health care professionals can make use of voice recognition technologies such as Google Assistant and Google Translate. These are technologies that allow for two-way interpretation and can help in transcribing and translating dictations such as a doctor's instructions (Wamwayi & Murray, 2019). Another effective way of overcoming the language barrier is the use of online applications, such as Duolingo, which offer new ways of learning different languages. Health care professionals can use these applications which keep things simple and make learning streamlined and easier, to understand elements of the African immigrants' language and enhance their communication (Wamwayi & Murray, 2019).
Another way of overcoming the language barrier is through the use of an interpreter. The medical facilities can have interpreters specifically for African immigrant groups to enhance communication (Venters et al., 2019). The interpreter can be available physically at the medical facility and if this is not possible, technology has made it easier for the use of an interpreter using virtual platforms such as zoom, Google meet, or Skype (Allison et al., 2016). All these techniques and technologies will help in breaking the language barrier and enhancing effective communication between African immigrants and healthcare professionals. In the long run, the quality of health care services in African immigrants will improve, hence enhancing their overall health care experience and satisfaction.
The Impact of Cultural Competence Training On Health Care Workers
Training programs and cultural competence among health care workers have social, health, and business benefits for healthcare organizations and African immigrants (Omenka et al., 2020). Cultural competence training programs would increase mutual respect and understanding between African immigrants and health care providers (Kamya, 2017). It would also ensure the inclusion of all community members and increased participation and involvement of African immigrants in health issues (Kamya, 2017). Being culturally competent would also enable health care workers to have improved patient data collection for African immigrants and reduce the health care disparities in the African immigrant population (Asare & Sharma, 2012).
Cultural competence training programs for health care workers would help in reducing medical errors, the number of treatments, and legal costs, which increase cost savings (Asare & Sharma, 2012). When healthcare workers undergo cultural competence training programs, they will incorporate diverse ideas, perspectives, and strategies when deciding about African immigrants. Barriers that slow the progress of the healthcare experience of African immigrants would also be decreased and the efficiency of these care services will be improved (Omenka et al., 2020). Cultural competence training would also help health care providers to reduce the literacy gap when handling African immigrants (Omenka et al., 2020).
Most African immigrants come from backgrounds of little or no education which makes it hard for them to gain literacy skills to overcome language barriers or to read and understand instructions and conversations with health care professionals (Omenka et al., 2020). Cultural competence training would provide health care professionals with techniques of dealing with African immigrants with low literacy and explain how to offer them the best care quality. Cultural competence training will also enable health care professionals to coordinate with traditional healers among African immigrants and incorporate culture-specific attitudes and values into health promotion activities for this group (Kamya, 2017).
National Guidelines
Various national guidelines provide standards for culturally and linguistically appropriate services in healthcare. These guidelines aim at making health care services more responsive to the individual needs of patients coming from various cultural backgrounds (U.S. Department of Health and Human Services, 2001). These guidelines include ensuring the provision of health care services in a manner that is compatible with patient cultural health beliefs, practices, and preferred language (U.S. Department of Health and Human Services, 2001). Health organizations are required to establish strategies of recruiting, keeping, and promoting organizational staff and leadership that represent demographic characteristics of the area of service (U.S. Department of Health and Human Services, 2001).
Health care organizations ensure that staff at all levels undergo education and training for culturally and linguistically appropriate delivery of service. Language help services inclusive of bilingual staff and interpreter services at no cost to the patients with limited English proficiency must be offered by health care organizations (U.S. Department of Health and Human Services, 2001). Patients should be informed of the right to receive language help services for their preferred languages. Easy-to-understand materials relating to patients should be made available by healthcare organizations and the development, implementation, and promotion of a written strategic plan outlining clear goals and policies for providing culturally and linguistically appropriate services must be in place (U.S. Department of Health and Human Services, 2001). Internal audits, patient satisfaction assessments, and outcome-based evaluations should be done on integrating culturally and linguistically related measures about the organizations' conduct. Health records should have slots for collecting the patient's race, ethnicity, and language, and this should be integrated into the management information system of the organization management (U.S. Department of Health and Human Services, 2002).
An updated demographic cultural profile of the community should be maintained by the organization and collaborative, participatory partnerships with communities should be developed by the health care organizations regarding the designing and implementation of cultural and linguistic related activities (U.S. Department of Health and Human Services, 2002). Conflict and grievances resolution processes should be culturally and linguistically sensitive, also cross-cultural conflicts and complaints should be resolved appropriately by health care organizations (U.S. Department of Health and Human Services, 2002). Health organizations should make available to the public information about progress and successful innovations in implementing the culturally and linguistically appropriate services standards (U.S. Department of Health and Human Services, 2001).
Aims of the Quality Improvement Project
The quality improvement project is aimed at designing a cultural competence training program that will enable health care professionals to understand African immigrants' expression of health needs. The project is aimed at breaking down barriers that get in the way of African immigrant patients receiving the care they need. It is also aimed at ensuring improved understanding between African immigrant patients and their health care providers. The project is aimed at structuring a cultural competence training program that will accommodate the growing diversity of the United States population demands regarding the African immigrant group and expanding the ability of healthcare professionals to address the needs of this group. Generally, this quality improvement project is aimed at developing a cultural competence training program that will train health care providers on how to incorporate different ideas, perspectives and strategies as they make health decisions about African immigrants which would improve the overall health care experience of this group.
Objectives
The objectives of this project are:
1. To create a cultural competence training program that will help in promoting cross-cultural awareness and competence skills needed for health care professionals to be culturally competent regarding African immigrants.
2. To create an African Immigrant Cultural Competence Toolkit that will be used by care providers to assess and enhance cultural competence in the organization.
3. To create a Resources Toolkit that will be given to African immigrant patients visiting the primary care clinic.
Conceptual Model: Madeleine Leininger's Cultural Care Theory
The theoretical underpinning or conceptual framework for this project will be provided by Madeleine Leininger's Cultural Care Theory. Leininger's theory focuses on the definition of what pertains to transcultural nursing and how nurses comprehend the beliefs and practices of diverse cultural groups (Leininger, 1988). This theory is the most appropriate for this DNP project since it aims at explaining how nurses can provide culturally congruent care through taking actions that are mainly designed to suit the individual's, group's, or institution's cultural values, lifeways, and beliefs (Leininger, 1988). The goal of the Cultural Care Theory is to enable improved health outcomes for individuals of different cultural backgrounds (Leininger, 1988).
Historical Development of the Theory
In the late 1950s, Madeleine Leininger envisioned how the world was increasingly becoming integrated and human beings were interacting on a global scale (Leininger, 1988). Leininger decided that she would go beyond anthropology and emphasize groups of people from diverse parts of the world in expressing her thoughts from a nursing perspective (Leininger, 1988). Leininger had always believed that care is the most essential component of nursing, even before establishing the field of transcultural nursing (Leininger, 1988). Her study of the Gadsup people in Papua New Guinea in the early 1960s was the first transcultural nursing research, and she preceded to establish the initial formal doctoral programs and courses in transcultural nursing in 1965 at the University of the Colorado School of Nursing (Wehbe-Alamah, 2015). The first book to be published regarding Leininger's Cultural Care Theory was 'Nursing and Anthropology: Two Worlds to Blend', which was just published in 1970 (Wehbe-Alamah, 2015). A third and an updated edition of 'Transcultural Nursing: Concepts, Theories, and Research Practices' was authored by Leininger and McFarland in 2002 (Wehbe-Alamah, 2015).
Through her discussions of the theory, Leininger continued to elaborate on the significant features of culture care diversity within the context of transcultural nursing. Leininger established the Transcultural Nursing Society in 1974 aimed at serving nurses worldwide through teaching them how to reinforce the quality of culturally competent care aimed at improving the health and well-being of people worldwide (Wehbe-Alamah, 2015). Over the years, Leininger's theory has been used in training nurses how to provide culturally specific care, which is aimed at improving the health and well-being of people as well as helping them to face unfavorable human conditions, illnesses, or death, in culturally meaningful ways (Wehbe-Alamah, 2015).
The Major Tenets
In developing the major components of the theory, several factors were taken into account by Leininger. These factors were the elements that guided the development of the major tenets of the theory (Leininger, 1988). Leininger explained that wellness and illness are molded by various factors, inclusive of perception and coping skills (Leininger, 1988). Cultural competence is an essential component of nursing and culture affects diverse segments of human life including illness, health, and the search for relief from distress or diseases (Leininger, 1988). Cultural and religious knowledge is a significant aspect of healthcare and the health concepts that cultural groups hold may impact how they seek modern medical care (Leininger, 1988).
Before discussing the major tenets of the theory, it is important to understand the meaning of certain terms related to the theory as defined by Leininger. Care is assisting others in an effort of improving their human conditions of concern or facing death (Wehbe-Alamah, 2015). Caring is an act of providing care (Wehbe-Alamah, 2015). Culture is the learned, shared, and transmitted norms, beliefs, ways of life, and values of a specific group that guides their decision or lifestyle (Wehbe-Alamah, 2015). Cultural care refers to various elements of culture which are responsible for influencing and enabling people to enhance their human conditions or to face illnesses or death (Wehbe-Alamah, 2015). Cultural care diversity describes the differences in meanings, values, or accepted modes of care between or within diverse groups of people, while culture care universality describes the common and similar meanings of care in the cultures (Wehbe-Alamah, 2015).
Theory Application to the DNP Project
Generally, the major tenets of the theory will be used in guiding the research and documentation of how healthcare providers can develop an understanding, appreciation, and respect for the diversity and individuality of African immigrant patients’ values, beliefs, culture, and spirituality, in the context of illnesses, causes of illnesses, treatment, and outcomes (Wehbe-Alamah, 2015). They will be used in the project to research and document how nurses can develop care that fits the values, beliefs, and lifestyles of African immigrants, and which is based on the patients themselves rather than predetermined criteria (Wehbe-Alamah, 2015). The major tenets of the theory will also be used to identify how nurses can bridge the cultural gap to achieve meaningful and supportive care for African immigrant patients and their families (Wehbe-Alamah, 2015). Based on the concepts of the theory, the project will find out how nurses can self-examine their backgrounds, recognize biases and prejudices as well as assumptions about the African immigrant group.
Cultural care preservation or maintenance will be used to identify how the healthcare providers can develop assistive and facilitative professional actions and decisions that can aid the African immigrants to preserve or retain relevant care values that will help them in maintaining their well-being, recovering from illnesses, or facing handicaps or death (Wehbe-Alamah, 2015).
Cultural care accommodation or negotiation will be used in the project to guide the identification and documentation of the assistive, supportive, enabling, or facilitative professional decisions or actions that may help the healthcare providers in training African immigrants to adapt culturally, for improved and satisfactory health outcomes (Leininger, 1988).
Cultural care repositioning or restructuring will be used in the identification and documentation of techniques that the healthcare providers can use to help African immigrants in reordering, changing, or greatly modifying their lifestyles for newer, better, and different health care patterns while respecting the African immigrants’ cultural values and beliefs (Leininger, 1988).
Implementation Model: The Plan-Do-Study-Act Model
Many health care research and reports recommend the Plan-Do-Study-Act model as an implementation model for quality improvement projects (Donnelly & Kirk, 2015). The model is made up of four repeating phrases that are cyclical in nature. These are Plan, Do, Study, and Act (Donnelly & Kirk, 2015). Plan is about the effort and background work of proposing change (Donnelly & Kirk, 2015). Do is about implementing the proposed change (Donnelly & Kirk, 2015). Study is about conducting analysis and evaluation of the outcomes of the proposed change (Donnelly & Kirk, 2015). Act is about revisiting and redesigning the previously planned change to take into account the lessons which have been obtained at the Do and Study phases (Donnelly & Kirk, 2015). The PDSA model is selected because it will be effective in giving rise to changes in a short period and facilitating continuous quality improvement (Donnelly & Kirk, 2015). This model will be used to test the proposed change during the implementation process (Donnelly & Kirk, 2015). It will be used to the test the change through planning, trying, observing results, and taking action on the lessons learnt (Donnelly & Kirk, 2015). The model will be used during the course of the project to assess how the project implementation can be done in a manner that will lead to the desired improvement (Donnelly & Kirk, 2015). The model will also be used to evaluate how much improvement can be expected from the change and how best the proposed change can work in the real environment of interest (Donnelly & Kirk, 2015).
Setting
The setting of this project is a primary care clinic in Texas. It is an ideal place for conducting this project because it is home to a huge number of African immigrants (Chikanda & Morris, 2021). According to American Immigration Council, African immigrants are ever growing and constitute a diverse group in the United States (Chikanda & Morris, 2021). According to the American Immigration Council, Texas is one of the locations with the largest number of African immigrants with other areas being California, New York, Virginia, and Maryland (Chikanda & Morris, 2021). This means that because the project addresses cultural competence concerning African immigrants, it will be beneficial both currently and in the future. The practice location is made up of 10 healthcare providers, including a nurse, family nurse practitioner, office administrator, and medical assistants.
The system used as the solution for electronic health records is EPIC. EPIC provides the primary care clinic with a standard range of primary EHR functions and modules can be added depending on specialty (Milinovich & Kattan, 2018). The primary care clinic uses the EPIC system for appointment management, patient history, scheduling, e-prescription, and clinical workflow. The EPIC system will act as a significant source of data during data collection for the project because it contains all the necessary information about the patients who visit the clinic.
Population of Interest
The population of interest for this project will be in terms of direct and indirect population. The health care providers will form the direct population of interest. These health care providers will be the focus of this cultural competence program for African immigrants and they include nurse, family nurse practitioner, office administrator, and medical assistants. The inclusion criteria will focus on health care providers attending to the health concerns of the African immigrant patients. Anyone else who works at the clinic (either temporarily or permanently) but who is not involved in the provision of care for African immigrant patients will be excluded . This means that all other workers who are not involved in the treatment of African immigrants visiting the clinic for primary care services will be excluded from the project.
The African immigrant population visiting the clinic for primary care services will form the indirect population of interest. The inclusion criteria for this population will be any adults who identify as African immigrants and who visit the clinic for primary care services. The exclusion criteria will be any other patients besides African immigrants visiting the clinic for primary health services. This excludes patients from other ethnicities visiting the clinic for primary care services.
Stakeholders
The significant stakeholders in this project are the clinic owner, the medical director, and the health care providers. The owner of the clinic is a significant stakeholder since she is responsible for overseeing the daily operations of the facility (Kirchner et al., 2012). The owner of the clinic also provides administrative support and oversees the hiring, firing, and training of staff members (Kirchner et al., 2012). The owner of the clinic is also responsible for liaising with patients and health care providers, as well as coordinating plans for patient care (Kirchner et al., 2012). The site administrator is significant because he or she is responsible for ensuring that the running of the activities in the clinic is top notch and as expected. He or she also ensures that quality medical care is provided to the community being served by the clinic (Kirchner et al., 2012). The medical director is significant because they are in charge of the daily operations of the clinic and documentation of the patients seen (Kirchner et al., 2012).
Obtaining permission was vital for the sake of the project and it was granted by the owner of the clinic, the site administrator, and the medical director. Obtaining permission helps in ensuring that the activities of the project at the site will be conducted with adherence to both ethical and legal guidelines and considerations (Milinovich & Kattan, 2018). No affiliation agreements were necessary for this project.
Interventions
The activities of the project will be conducted during the regular working hours. The project lead will be available to assist the medical providers any questions about the AICCT tool Communication with the staff will be through physical means and phone calls or emails as needed. The following is a weekly timeline of the implantation.
Week 1
In the first week, a pretest located in Appendix E will be administered. This will be done a day before an educational training. The educational training will then be conducted the next day using the PowerPoint presentation material in Appendix D. The educational training session will be brief and to the point and will touch on all issues that concern cultural competence when handling the African immigrant group. One detailed session will be enough although the progress will be monitored to identify any need for an additional training session. The session will also include training the participants on how to use the African Immigrant Cultural Competence Toolkit (Appendix B). It will also include training the staff on how to use the African Immigrant Resources Toolkit (Appendix C). After the session, both toolkits will be handed to the participants. Additionally, a post-test will be administered after the educational training session. The post test will be done using the material in Appendix E, a pass grade of 80% is required. The goal is to determine how the participants perform in the test before the training and after the training has taken place. A remediation class will also be conducted for participants with a grade less than 80 on the posttest.
Week 2 to 4
The resources toolkit will be handed to the patients as they visit the clinic. There will be continued education and support to the participants to ensure efficiency of the progress. Participants will make use of the toolkit handed to them, data collection and assessment of compliance will be done at the end of each week to ensure that any loopholes are identified and any additional support is identified as well. Participants will be re-trained if needed.
Week 5
In week 5, data compilation will be done and its analysis will follow. The success of the project will be measured by the rate at which the resources toolkit were handed out to African immigrants and the rate at which the providers utilized the African Immigrant Cultural Competence Toolkit while interacting with African immigrant patients. The approach for measuring these rates is outlined in the Chart Audit Tool (Appendix F).
Tools
The tools that will be used during this DNP project include the AICCT, AIRT, educational presentation, pretest/posttest questionnaire and chart audit tool. The following is an explanation of each tool.
African Immigrant Cultural Competence Toolkit (AICCT) (Appendix B)
This is a one-page guideline that acts as a reference point for the African immigrants cultural competence issues. The guideline has cultural issues, their descriptions, and the solutions. It is to be handed to the healthcare providers. The toolkit is developed by the project lead and will utilize project team consultation for validation. The tool was developed based on evidence-based research about the main cultural competence issues and solutions involved when handling the African immigrant population and the sources are listed in the references.
African Immigrant Resources Toolkit (Appendix C)
This is a one-page toolkit with information about the food assistance, legal services, housing services, employment, financial, and health resources and where they can be found. It is to be handed to the patients during their visits to the clinic. It is developed by the project lead and will utilize project team consultation for validation. The tool was developed based on evidence-based literature identifying these resources as primary needs of African immigrants. These resources are important because they play a huge role in the social determinants of health of the African immigrant population. These resources impact the environment and manner in which the African immigrants live and work, which in turn impacts their health outcomes.
Educational Presentation (Appendix D)
This is a power point presentation educational material that will be used for the training session. It is developed by the project lead and will utilize the project site and team for consultation and validation before seeking approval. The material is based on evidence-based literature regarding the cultural competence of African immigrants in healthcare. The material addresses the meaning of cultural competence for African immigrants, its importance, and expected impacts. The material also addresses the main challenges faced by African immigrants in healthcare and their solutions. It addresses the objectives of this project and the interventions for achieving these objectives.
Pre and Post Test Questionnaire (Appendix E)
This is a tool used to assess the healthcare professionals’ level of cultural competence regarding the African immigrant group (see Appendix E). It is developed by the project lead and will require expert and project team consultation for validation. The tool is developed based on the objectives of the project and the educational material used in the educational training session. The tool contains 10 questions and each of the question addresses specific content while testing a specific level of cognitive skill. The test is in a multiple-choice question format. Three experts will rate the relevance of each item on the test using the Expert Rating Form (see Appendix F). This data will then be used to calculate the validity of the tool.
Chart Audit Tool (Appendix F)
This is a tool for auditing the rate that the handout of resources was provided to African immigrant patients and the rate at which the providers utilized the African immigrant toolkit when interacting with the patient. Guidelines on how these rates will be calculated are provided in the tool (see Appendix F). The tool is developed by the project lead and will require experts and project team consultation for validation.
Patient Data Collection Form (Appendix G)
This is a tool used to collect data about the patient to determine whether the patient is part of the African immigrant population and whether they need assistance with community resources. The tool is developed by the project lead and it will utilize project and site team consultation for validation.
Provider Data Collection Form (Appendix H)
This is a tool that will be used to collect data about the providers such as the number of African immigrants attended to in a week, the number of resources toolkits a provider had in the beginning of the week, the number of resources toolkit the provider has at the end of the week, and the number of times the provider utilized the African immigrant cultural competence toolkit when interacting with the patients. The tool will be used to collect the about whether the providers are utilizing the African immigrant cultural competence toolkit and whether they are handing out resource toolkit to African immigrant patients. The tool is developed by the project lead and will require project and site team consultation for validation.
Two separate forms will be utilized for the project to facilitate data collection. One form will be used for the providers and another for the patients. The patient form has sections for a patient to fill their name, race, ethnicity, immigration status, and country of origin. This will be given to all patients at the intake level. This is what the provider will use to screen the patient. The providers' form contains the initials of the participant, the number of the week, the number of African immigrant patients attended to, the number of resources toolkit at the beginning of the week and at the end, and the number of instances the provider referred to the African immigrant cultural competence toolkit when attending to the patient. This form will be filled at end of the week and it will be collected weekly. It will provide the project lead with all the information needed to calculate the outcomes.
Data collection segment will involve the pre-survey about the cultural competence of the participants. This will be administered on the same day as the educational presentation and will be stored in digital form to prevent manipulation of data. The educational training on cultural competence via a PowerPoint presentation will then be conducted by the project lead. This educational training will include information regarding the purpose, goals, expected outcomes, and the flow of activities of the project. A post -survey will be administered after the session and the data will be collected. The surveys will have a label with the names of each participant, but they will be recorded using unidentified initials for privacy and confidentiality (Martinez et al., 2018). This will help to mark the end of the objective regarding the creation and delivery of a cultural competence training session for African immigrant patients.
At the end of the educational training session, the participants will receive both the resources toolkits that they will hand to patients visiting the clinic and the developed cultural competence toolkit that will act as a guideline as they attend to the patients. The intervention will then begin and there will be data collection at the end of every week. The data collected will include information regarding whether the African immigrant patients visiting the clinic have been given the resource toolkit and whether the participants are using the cultural competence guideline tool handed to them. The site administrator will be consulted to validate the providers' utilization of the toolkits. The procedure for collecting data about whether a patient is an African immigrant will be done using the Patient Data Collection Tool. All patients will fill out the form at the intake level with information about their race, ethnicity, whether they identify as immigrants, their initial country of origin, and whether they need assistance with community resources.
Assessing whether the providers are handing out resources toolkit to patients and whether they are utilizing the African immigrant cultural competence toolkit will be done using data collected from the Provider Data Collection form. Each participant will be given a specific number of copies of the resources toolkit. At the end of each week, the Project Lead will collect information about how many African immigrant patients the participant attended to in that week, how many toolkits the participant had in the beginning of the week, and how many toolkits the participant has at the end of the week. This way, the project lead will calculate the difference in the number of toolkits. Additionally, every participant will record how many African immigrant patients they attended to during the week and the number of instances they utilized the African immigrant toolkit. For example, a healthcare provider may have attended to 4 African immigrant patients during the week and utilized the African immigrant toolkit on 2 of those occasions. This data will be collected weekly. I plan to consult a statistician to ensure that appropriate statistical testing is utilized to analyze this collected data.
Ethics/Human Subjects Protection
After reviewing Touro University DNP Project Determination document, it was determined that the project is a Quality Improvement project and not a research project. Therefore, this means that there is no need for an Institutional Review Board committee, as it meets the minimum requirements for a quality improvement project. However, the DNP project will uphold the highest standards of ethical practice, inclusive of issues regarding confidentiality and privacy as required by the code of ethics. The Health Insurance Portability and Accountability Act (HIPAA) rules will be maintained during the extraction of information because of the sensitivity of data in health care. These data collection procedures will also aim to ensure that only data required for this project is collected and no unauthorized parties have access to this information. Anonymity of the data will also be upheld for preserving identities, locations, and addresses as private (Martinez et al., 2018). Some techniques that will be used include the removal and destruction of data identifiers to ensure that the information is anonymous (Kamya, 2017).
All participants will be educated on the benefits and risks of taking part in the project. Benefits of their participation in the project include boosting their skills in handling this population, reducing inefficiencies when attending to this population, and improving African immigrants’ overall health care experience. The risks involve loss of confidentiality and privacy of the data that the participants provide. However, the issues are addressed in the project document and various approaches of mitigating them shall be implemented as described earlier on. The recruitment will be mandatory for all the health care professionals attending to the health care needs of African immigrants and will be done by email. The recruitment will be fair and just, and no participant will be excluded from the research based on gender, age, race, religion, or socioeconomic status. All the benefits and burdens of the project will be shared equally by the participants. The project lead will request information from the organization about the email contacts of the providers attending to African immigrants. The project lead will then determine how many of the providers will be emailed. The project lead will design an email containing information about the overview of the project, the goal, the requirements of participation in the project, the willingness of the provider to participate, the reasons why the provider should participate, and all the information about the potential benefits and risks of participating. The email will request the recipient to reply confirming their interest in participation. The emails will be sent a week before the start of the project to ensure enough time for replies. Once the project lead receives responses confirming the provider's interest to participate, an email will be sent to the participants to ask them about their preferred dates and times. After deciding on the best dates and times for all the participants, the project lead will send an email containing the information about the first scheduled meeting. The first meeting will confirm successful recruitment for the participants, and project activities will begin. The participants will not be compensated and they will be informed at the beginning of the project implementation.
Measurable Plan for Analysis
The data collected before and after the interventions will use the SPSS statistics software for analyzing and running statistical tests. The statistical analysis of the data collected by the pre-post tests will be done using the special processes for this project described below. To begin with, identification of the patients as part of African immigrant population will be done as they fill the Patient Data Collection Form.
Measuring if Resources Handout Was Provided To African Immigrant Patients
To measure if the handout of resources was provided to African immigrant patients, the project lead will calculate the difference in the number of toolkits the provider had at the beginning and at the end of the week. The assumption here is that the toolkit was not misplaced or used for any other purpose. The project lead will rely on the honesty of the participants. The rate at which the toolkit was handed out will be calculated by taking the number of toolkits handed out divided by the number of African immigrant patients that the participant attended to that week. For example, if 3 toolkits were given, and the participant attended to 3 African immigrant patients, the rate will be [(3/3) *100%] which will be 100%.
Measuring The Rate At Which The Providers Utilized The African Immigrant Toolkit
To measure the rate at which the providers utilized the African immigrant toolkit when interacting with the patient, every participant will record how many African immigrant patients they attended to during the week and the number of instances they utilized the African immigrant toolkit. For instance, if a provider attended to 4 African immigrant patients during the week and utilized the African immigrant toolkit on 2 of those occasions, the provider will have utilized the African immigrant toolkit 50% of the time. This data will be calculated weekly for each of the participants and represented.
Measuring the Improvement in Cultural Competence
The improvement in cultural competence will be measured using pre and post test scores, participants will be expected to score 80% and above on the posttest, and a paired t-test will be used to analyze results since it compares the mean of two measurements taken from the same individual, object or related units (Yaeger, 2021). Paired t-test is used to test if the mean of two paired measurements, such as pretest/posttest scores, are incomparably different. These “paired” measurements can represent things like: A measurement taken at two different times e.g., pre-test and post-test score with an intervention administered between the two time points (Yaeger, 2021). The assumptions of the paired t-test are that the subjects are independent and the measure for one subject do not impact the measure of other subjects (Yaeger, 2021). Another assumptions is that each of the paired measurements are collected from the same subject (Yaeger, 2021). The final assumption is that the differences will be normally distributed (Yaeger, 2021). Even though no statistician will be hired to help in the analysis process, the statistician will be consulted to ensure that the analysis processes are effective and consistent. After the analysis, a presentation of the results and discussion of findings will follow.
Analysis of Results Comment by Denise Zabriskie: My review begins here
The timeline for the intervention was 5 five weeks. However, the implementation began in the second week since the first week involved educational training and testing of the participants. The data collected was from week 2 to week 5. The data collected during project implementation was analyzed utilizing a paired t-test to measure cultural competence by completing a pre and posttest. Comment by Denise Zabriskie: Please remove this an add an introduction related to your analysis. Comment by Julie Astrella: I asked her to add a brief timeline to this section, to give a summary of what the interventions were and when they were completed (that part is still lacking). I agree that a more robust introduction is needed. Comment by Denise Zabriskie: Educating the participants is considered part of implementation. There should be a total of 5 weeks for implementation. Week 1 of project implementation (education) took place in week 2 of the DNP Project III course. However, none of this pertains to analysis of results except you should have collected data beginning in week 2.
Measuring the Improvement in Cultural Competence
The cultural competence improvement was measured using pre-test and post-test scores of the participants. The participants needed to score 80% and above in the post-test for their data to be included in the results. The cutoff mark was met by all the three providers. Comment by Julie Astrella: Pre and post test scores of what? What is your tool for this data point? Comment by Julie Astrella: Revise—data shouldn’t be excluded if it was not 80%. It would categorized differently, but you can’t delete data that was gathered.
Table 1
Descriptive Statistics and Paired T-Test results for Assessing the Cultural Competence Improvement Among Healthcare Providers Attending to African Immigrant Patients
|
Variable |
Pretest |
Posttest |
p |
||
|
|
M |
SD |
M |
SD |
|
|
Test Scores |
60.00 |
10.00 |
96.67 |
5.77 |
0.01 |
|
N=3 |
|
|
|
|
|
Note. M= Mean; SD= Standard Deviation; p= Paired t-test value Comment by Denise Zabriskie: So what does all this mean? Is there a statistical significant change in these results? Comment by Julie Astrella: Typically you would make a notation (like a star) in your table that denotes a statistically significant result.
The paired t test calculations produced a p-value of 0.01 (< 0.05). This implies strong evidence that the cultural competence skills of the healthcare providers attending to African immigrant patients was improved after the cultural training conducted during the project. One of the assumptions is that the measurements of one subject did not affect the measurements of the other. The subjects were independent and each of the paired measurements was obtained from the same subject.
Measuring The Rate At Which The Resources Handout RateWas Provided To African Immigrant Patients
To measure compliance in providing the African immigrant population with current community resources, Eeach provider participant was required to offer provide a Resources toolkit during the visit. to a eapatient that they attended to. A patient was not supposed to be given more than one toolkit even if they made such a request because this would interfere with data collection. Similarly, a provider was supposed to provide a toolkit to a patient only once even if they attended to that same patient more than once.If the patient received the toolkit and followed up in the clinic, they would not receive another toolkit during the follow up visit. A provider recorded only recorded one instance of an interaction with a patient for each week in the “Number of patients seen” section of the data collection form. This means that if a provider attended to a patient, recorded the interaction, and gave the patient a resources toolkit, the provider would not record the interaction if it happened again with the same patient. To measure if the resources toolkit was provided to African immigrant patients, the project lead calculated the difference in the number of toolkits the provider had at the beginning and at the end of the week. Comment by Denise Zabriskie: Not necessary Comment by Julie Astrella: Per APA 7th, you can use they as a single pronoun Comment by Denise Zabriskie: This is 3 different ways of saying the same thing. Comment by Denise Zabriskie: There should be a statistical test used here to measure compliance. Perhaps consider using a simple percentage with a 95% confidence interval. Please seek assistance from a statistician.
Also, this does not let you know if they handed the resource out to each patient that fell into the criteria.
Table 2
Statistics Showing the Rate at Which the Providers Provided tThe Resources Toolkit rate to African Immigrant Patients between Week 2 and Week 5
|
No. of patients seen |
No. of resources toolkits handed out |
|
|
Week 2 |
42 |
42 |
|
Week 3 |
33 |
33 |
|
Week 4 |
58 |
58 |
|
Week 5 |
54 |
54 |
|
Total |
187 |
187 |
|
Average Rate (in %) |
100% |
The rate which the providers handed out the resources toolkit to African immigrant patients was calculated as specified in the “Measurable Plan for Analysis” section. The total number of toolkits handed out during the 4 four weeks of protocol implementation were divided by the total number of patients that the providers attended to during that period. Based on the results, the providers handed out a Resource Toolkit to each patient that they attended to during the implementation period. Comment by Denise Zabriskie: I don’t think you have to repeat this again
Measuring The Rate At Which The Providers UtilizeUtilization ofd The African Immigrant Toolkit
Table 3
Statistics Showing the Rate at Which the Providers Utilized the African Immigrant Toolkit while Attending to African Immigrant Patients between Week 2 and Week 5
|
Variable |
No. of patients seen |
No. of times providers utilized the toolkit |
|
Week 2 |
42 |
21 |
|
Week 3 |
33 |
16 |
|
Week 4 |
58 |
35 |
|
Week 5 |
54 |
23 |
|
Total |
187 |
95 |
|
Average Rate (in %) |
50.8% |
The rate at which the providers utilized the African Immigrant Cultural Competence Toolkit was calculated as specified in the Measurable Plan for Analysis section. The providers attended to 187 patients during the implementation period and utilized the toolkit 95 times. Therefore, the toolkit was utilized at an average rate of 50.8%. This means that the providers utilized the toolkit half the total time they attended to the African Immigrant patients during the project implementation period. Comment by Denise Zabriskie: Again, statistical testing should be performed. You can use a simple percentage again with a 95% confidence interval or a Fisher’s test. Please follow the recommendations from Dr. Vanier in Project II. Also please utilize your learning from biostats. Please consult a statistician
References Comment by Denise Zabriskie: References should be on the next page.
Adekeye, O. A., Adesuyi, B. F., & Takon, J. G. (2018). Barriers to healthcare among African immigrants in Georgia, USA. Journal of immigrant and minority health, 20(1), 188-193.
Allen, K. M., Jackson, I., & Knight, M. G. (2012). Complicating culturally relevant pedagogy: Unpacking African immigrants' cultural identities. International Journal of Multicultural Education, 14(2).
Allison, K. W., Echemendia, R. J., Crawford, I., & Robinson, W. L. (2016). Predicting cultural competence: Implications for practice and training. Professional Psychology: Research and Practice, 27(4), 386.
Asare, M., & Sharma, M. (2012). ROLE OF HEALTH BELIEF MODEL ON SEXUAL COMMUNICATION AMONG AFRICAN IMMIGRANTS. American Journal of Health Studies, 27(2).
Betancourt, J. R., & Green, A. R. (2010). Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Academic Medicine, 85(4), 583- 585.
Centers for Disease and Prevention. (2021, February). Health Equity Considerations & Racial & Ethnic Minority Groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
Chikanda, A., & Morris, J. S. (2021). Assessing the integration outcomes of African immigrants in the United States. African Geographical Review, 40(1), 1-18.
Clough, J., Lee, S., & Chae, D. H. (2013). Barriers to health care among African immigrants in
Davidhizar, R., Giger, J. N., & Hannenpluf, L. W. (2016). Your continuing education topic 3 2005: using the giger-davidhizar transcultural assessment model (GDTAM) in providing patient care. Journal of Practical Nursing, 56(1), 20.
Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Education for Primary Care, 26(4), 279-281.
Giger, J. N., & Davidhizar, R. (2012). The Giger and Davidhizar transcultural assessment model. Journal of Transcultural Nursing, 13(3), 185-188.
Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590-603.
https://www.who.int/health-equity
Ibn El Haj, H., Lamrini, M., & Rais, N. (2013). Quality of care between Donabedian model and ISO9001V2008. International Journal for Quality Research, 7(1).
Kamya, H. A. (2017). African immigrants in the United States: The challenge for research and
Kirchner, J. E., Parker, L. E., Bonner, L. M., Fickel, J. J., Yano, E. M., & Ritchie, M. J. (2012). Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders' perspectives. Journal of Evaluation in Clinical Practice, 18(1), 63-69.
Leininger, M. M. (1988). Leininger's theory of nursing: Cultural care diversity and universality. Nursing science quarterly, 1(4), 152-160.
nursing, 28(5), 1113-1121.
Martinez, D. A., Kane, E. M., Jalalpour, M., Scheulen, J., Rupani, H., Toteja, R., ... & Levin, S. R. (2018). An electronic Dashboard to monitor patient flow at the Johns Hopkins Hospital: communication of key performance indicators using the Donabedian model. Journal of medical systems, 42(8), 1-8.
McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature. International journal for equity in health, 16(1), 1-19.
Milinovich, A., & Kattan, M. W. (2018). Extracting and utilizing electronic health data from Epic for research. Annals of translational medicine, 6(3).
National Library of Medicine. (2019). Improving Cultural Competence to Reduce Health Disparities https://www.ncbi.nlm.nih.gov/books/NBK361121/
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC public health, 20(1), 1-13.
practice. Social Work, 42(2), 154-165.
Price, E. G., Beach, M. C., Gary, T. L., Robinson, K. A., Gozu, A., Palacio, A., ... & Cooper, L. A. (2015). A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals. Academic Medicine, 80(6), 578-586.
Purnell, L. D., & Fenkl, E. A. (2019). Transcultural diversity and health care. In Handbook for culturally competent care (pp. 1-6). Springer, Cham.
Schouler-Ocak, M., Graef-Calliess, I. T., Tarricone, I., Qureshi, A., Kastrup, M. C., & Bhugra, D. (2015). EPA guidance on cultural competence training. European Psychiatry, 30(3), 431-440.
Seck, M. M. (2015). West African immigrants in the United States: Challenges and empowering strategies. Social Development Issues, 37(2), 68-79.
the United States: a traditional review. Journal of health care for the poor and underserved, 24(1), 384-403.
U.S. Department of Health and Human Services. (2001, March). National Standards for Culturally and Linguistically Appropriate Services in Health Care. https://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf
U.S. Department of Health and Human Services. (2002). National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf
Venters, H., Adekugbe, O., Massaquoi, J., Nadeau, C., Saul, J., & Gany, F. (2019). Health concerns among African immigrants. Journal of Immigrant and Minority Health, 13(4), 795-797.
Wamwayi, M. O., Cope, V., & Murray, M. (2019). Service gaps related to culturally appropriate mental health care for African immigrants. International journal of mental health
Wehbe-Alamah, H. I. B. A. (2015). Madeleine Leininger´s s theory of culture care diversity and universality. Nursing theories and nursing practice, 37-54.
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Appendices
(Appendix A)
Permission to complete project at the site
(Appendix B )African Immigrant Cultural Competence Toolkit (AICCT).
(Appendix C)
African Immigrants Resources Toolkit (AIRT).
AFRICAN IMMIGRANT RESOURCES TOOLKIT (AIRT)
(This toolkit contains the various resources available for African immigrants in Texas)
|
Resource |
Information |
|
|
Food Assistance |
|
|
|
Legal Services |
Legal Aid of Northwest Texas 1515 Main St, Dallas, Texas 75201 (214) 748-1 234
RAICES (Refugee and Immigrant Center for Education and Legal Services) 1910 Pacific Ave, Dallas, Texas 75201 (214) 295-9554 |
|
|
Housing Services |
Interfaith Housing 5600 Ross Ave, Dallas, Texas 75206 (214) 827-7 220 https://interfaithdallas. Org / DHA Housing Solutions for North Texas 2575 Lonestar Drive, Dallas, Texas 75212 |
|
|
Employment Services |
Dallas Employment Services 3626 N Hall St Suite 610, Dallas, TX 75219 https://des-inc. com/ Immigration Services Catholic Charities 249 Thornhill Dr, Fort Worth, Texas 76115 (817) 289-4399 https://ccfwimmigration. com Immigration & Refugee Resources Dallas County 411 Elm Street, Dallas, Texas 75202 |
|
|
Financial Assistance |
North Dallas Shared Ministries 7211 Regency Square Drive. Houston, Texas 75229 (214) 358-8700 https://www.ndsm.org/about-us/ Dallas Tanf Office 1010 Cadiz Bldg B, Suite 110, Dallas, Texas 75215 (214) 421-7722 |
|
|
Health Services |
Hope Clinic of Garland 800 S 6th St Suite 100, Garland, Texas 75040 https://hopeclinic-garland.org/ Dallas County Health and Human Services 2377 N. Stemmons Freeway, Dallas, Texas 75207 (214) 819-2000 |
Appendix D (Educational Presentation)
(Appendix E)
Pre/Post Survey Questions
(Please answer all the questions to the best of your ability. Please circle the most appropriate answer. Kindly note that your responses are strictly confidential and will only be seen by the appropriate leader(s) of the project. Your participation is highly valued. Thank you!)
1. What is cultural competence in healthcare?
A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage.
B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact.
C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.
D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.
2. A healthcare professional will know that he/she is culturally competent when
A. He/ she has successfully completed a cultural competence program.
B. He/she is able to obtain knowledge of a patient's individualized culturally-influenced worldview and how their culture affects their physical and mental health.
C. He/she is able to answer key cultural competence questions regarding a particular cultural group.
D. He/she is able to treat a patient belonging to a different culture.
3. Which of the following would not be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient?
A. Difficulty understanding medical instructions.
B. Problem with the reliability of information.
C. Possible medical errors.
D. Increased readmission for the patient.
4. Which of the following is not a basic resource needed by African immigrants as they seek healthcare services?
A. Legal Resources
B. Housing Resources
C. Food Assistance Resources
D. Finance Aid Resources
5. The main reason for cultural competence in healthcare is
A. Delivering quality care.
B. Improving cultural awareness.
C. Demographic change
D. Changing policies.
6. What is the relationship between poverty and quality care among African immigrants?
A. African immigrants are barred from accessing healthcare when needed.
B. African immigrants are not able to purchase those things that are needed for good health.
C. B only.
D. A and B.
7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ?
A. Failing to understand the social determinants of the health of the patient.
B. Failing to communicate in the patient’s language.
C. Involving a third party (e.g. translator) to help in the communication process.
D. All of the above.
8. African immigrants may fear seeking health care services due to the following reasons except :
A. Fear of racial discrimination.
B. Difference in culture and beliefs.
C. Fear of new environments.
D. Inability to pay for the services.
9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would not provide solutions to the communication barrier you are experiencing?
A. Finding an effective translating software.
B. Asking a (present) member of the family to provide interpretation in the communication process.
C. Seeking the services of a professional interpreter.
D. All of the above.
10. Which of the following is an example of an immediate remedy for a cultural challenge when attending to African immigrants?
A. Learning about different cultures.
B. Employing diversity training.
C. Ensuring effective communication.
D. Working towards cultural humility.
Content Validity Index Table
|
Item |
Expert 1 |
Expert 2 |
Expert 3 |
Mean |
CVR |
|
1 |
4 |
4 |
4 |
4.0 |
1 |
|
2 |
4 |
4 |
4 |
4.0 |
1 |
|
3 |
4 |
3 |
3 |
3.33 |
1 |
|
4 |
4 |
4 |
4 |
4.0 |
1 |
|
5 |
3 |
3 |
3 |
3.0 |
1 |
|
6 |
4 |
4 |
4 |
4.0 |
1 |
|
7 |
3 |
4 |
3 |
3.33 |
1 |
|
8 |
4 |
4 |
4 |
4.0 |
1 |
|
9 |
3 |
3 |
4 |
3.33 |
1 |
|
10 |
4 |
4 |
4 |
4.0 |
1 |
|
Mean Total |
3.7 |
1 |
(The procedure consists of having experts rate items on a four-point scale of relevance. Then, for each item, the item (CVI) (I-CVI) is computed as the number of experts giving a rating of 3 or 4, divided by the number of experts-the proportion in agreement about relevance)
The mean total of all the means is 3.7. This means that the questions/items in the questionnaire are moderately/highly relevant.
Content Validity is then calculated as :
CVR= [(X-(N/2))/(N/2)] where X is the number of experts who rated the item as moderately/highly relevant and N is the total number of experts.
For example:
Item 1:
CVR= [(3-(3/2))/(3/2)]
CVR= [(3-(1.5))/(1.5)]
CVR=1.5/1.5
CVR = 1
Reliable
Based on Research Guidelines, the following is the reliability score of the item depending on the result of the calculation (Allison et al., 2016). The maximum score is 1.
>0.79 the item is highly reliable
0.70<X>0.79 the item needs revision
<0.70 the item should be eliminated
Conclusion
Chat Audit Tool.
|
Chart Review Tool |
Rate in Percentage (%) |
|
The rate that the handout of resources was provided to African immigrant patients. |
|
|
The rate at which the providers utilized the African immigrant toolkit when interacting with the patient. |
|
Guidelines for the Chart Audit Toolkit
How to measure if the handout of resources was provided to African immigrant patients.
· The rate at which the toolkit was handed out will be calculated by taking the number of toolkits handed out divided by the number of African immigrant patients that the participant attended to that week. For example, if 3 toolkits were given and the participant attended to 3 African immigrant patients, the rate will be [(3/3)*100%] which will be 100%.
How to measure the rate at which the providers utilized the African immigrant toolkit when interacting with the patient.
· Every participant will record how many African immigrant patients they attended to during the week and the number of instances they utilized the African immigrant toolkit. For example, a healthcare provider may have attended to 4 African immigrant patients during the week and utilized the African immigrant toolkit in 2 of those occasions.
· This data will be collected weekly and a percentage will be calculated. For instance in the example above, the provider will have utilized the African immigrant toolkit 50% of the time.
· Calculation= (X/N)* 100% where N= total number of African immigrant patients attended to
· X= number of times the African immigrant toolkit was utilized.
· The cumulative percentage results will be added together and then divided by the total number of healthcare providers.
Example: Let’s say healthcare provider A has used the African immigrant toolkit 50% of the time, provider B 100% of the time, and provider C 30 % of the time.
Rate = (A+B+C)
3
In this case, (50+100+30) = 60%
3
Therefore, the rate at which the providers utilized the African immigrant toolkit when interacting with the patient in this case is 60%.
Project Patient Data Collection Form (Appendix G)
|
Name |
Race |
Ethnicity |
Immigration status (Do you identify as an immigrant?) Please answer with Yes or No. |
If Yes, what is your initial country of origin? |
Do you need assistance with community resources? (Yes/No) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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Provider Data Collection Form (Appendix H)
(Kindly fill the following form as honestly as possible. Thank you.)
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Week Number |
Participant Initials |
No. of African immigrant patients attended to |
No. of copies of resources toolkit at the beginning of the week |
No. of copies of resources toolkit at the end of the week |
No. of instances the cultural competence toolkit was utilized |
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Week 1 |
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Week 2 |
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Week 3 |
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Week 4 |
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