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Cultural Competence Training Program fFor African Immigrants

Chidinma Ogundu

School of Nursing, Touro University

DNP 761

Dr. Calaiselvy Elumalai

Dr. Jessica Grimm

May 19, 2021

Cultural Competence Training Program fFor African Immigrants

Introduction

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 of 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 in healthcare because cultural practices directly impact health care practices (Venters et al., 2019). African immigrants often find themselves in situations of cultural dilemmas due to the differences in culture between their original areas of residence and their new ones (Price et al., 2015).

The main problem witnessed in the project site is the lack of cultural competence among health care providers in regard toregarding African immigrants. This problem negatively affects the health care experience of African immigrants (Purnell & Fenkl, 2019). Due to 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 & Chae, 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).

The issue of 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, Jackson, & Knight, 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 they can use to effectively 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, Watson, & Hendrie, 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 for 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, Jackson, & Knight, 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, Watson, and Hendrie (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 (Okudo & Ross, 2016).

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 located 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 are not able to effectively 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. Additionally, there are several resources available that are not being utilized and this project is designed 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 evident 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 acquire the appropriate 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)?

Search Methods Comment by Elumalai, Calaiselvy - SRDH: Review begins here

The search for literature materials to support the topic ‘Cultural Competence Training Program For African Immigrants’ was conducted through online libraries and academic sites such as Google Scholar and Google Books. Due to information overload on the online academic sites, the search of literature is a quite cumbersome process. 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”. Search terms were also combined using Boolean operators to broaden or narrow the results and the specific Boolean operators used were “OR” and “AND”. A review of the studies’ citation lists was conducted for the identification of additional studies for potential inclusioninclusion, and this was aimed at minimizing the possible non-inclusion of relevant studies. Under the search strategy, the balancing of the breadth of the search (which is how many hypothetically relevant articles would be found) and the specificity (which is how many definitely-relevant articles will be found) was a priority. Comment by Elumalai, Calaiselvy - SRDH: Concise this entire section

Predetermined criteria for inclusion and exclusion had already been established and all the citations were reviewed against it. Various types of study designs were includedincluded, 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 were 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 with the aim of improving 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 due to the following. (a)The study population was not exclusively African immigrants or there was no separate reporting of the results of African immigrants. (b) The study discussed African-AmericansAfrican 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 on the basis ofbased on participant age or sex, or article language. Comment by Jessica Grimm: This section is well done. I offered a few minor edits for clarity and to improve concise writing.

Review Synthesis Comment by Jessica Grimm: I’m not sure that this is accurate. I would delete this paragraph. This is also not representative of a review synthesis.

The qualitative systematic review approach was used to organize all the reviewed literatures. The systematic review was listed at PROSPERO, which is a worldwide database of prospectively registered systematic reviews in healthcare and social care (Cornell University Library, 2021). This systematic review was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Review Synthesis Comment by Jessica Grimm: Please provide a summary of the major findings from your overall review of literature. Generally, you should present the themes identified here and the general idea of how the literature poses to solve the problem. See rubric outline for further details.

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 researchesresearch werewas conducted in hospital and clinical settings by assessing redacted medical records. The medical records gave more insights on the patient readmission rates, recovery rates, and patient satisfaction rates among the African immigrant populations. The facts gave insights on the issue of how cultural competence affected the quality of patient outcomes among the African immigrant population. The qualitative case study approach was also conducted on clinics and hospitals around the United States. The case study research was conducted to determine the number of hospitals around the United States that recognize the impact of cultural competence on the quality of patient outcomes. The case study aimed at identifying the percentages of hospitals and clinics that acknowledge cultural sensitivity and inclusion through cultural competence training. Comment by Elumalai, Calaiselvy - SRDH: Paragraph should be indented 0.5 inches Comment by Elumalai, Calaiselvy - SRDH: Not sure how medical records can provide the readmission and patient satisfaction rates. Comment by Elumalai, Calaiselvy - SRDH: Seems like the information is repetitive.

Literature Themes Comment by Jessica Grimm: You have improved on this submission, but you still need significant development to meet standards of this assignment. Literature review severely under-developed. I think we should meet. To review a theme, you should examine specific studies that explore the theme. Tell us what the studies were and what they teach us about the topic. Help us understand their relevance to the topic being explored. A minimum of 2-3 articles should be explored for major themes identified. By the end of reading your themes, I should have a really good idea of what needs to be done to practice culturally competent care.

Effects of Cultural Incompetence Comment by Jessica Grimm: To review this theme, please explore 2-3 studies that explore the effect of language barriers and how to address them from the literature. Avoid personal perspectives. Cite all resources you use here.

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. Due to the disparity in cultural competence, the health care providers cannot efficiently deliver health services that cater for the cultural, social, and linguistic needs of the African immigrant patients. As a result, the African immigrant group is seen to have an overall health status score that is lower compared to other groups. As the World Health Organization defined, 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). The deficiency of cultural competence and sensitivity among health care professionals often leads to African immigrants having poor health outcomes, something which violates the goal of the healthcare sector. The resolution put forth by this project is the creation of a cultural training program for healthcare professionals, to sensitize them about cultural sensitivity and competence when caring for other cultural populations like African immigrants. Comment by Elumalai, Calaiselvy - SRDH: Paragraph should be indented 0.5 inches Comment by Elumalai, Calaiselvy - SRDH: Purnell and Fenkl (2019) explain that the need for cultural competence for African immigrants is increasing day by day among health care providers and health related organizations in the United states, since African immigrants deserve respect both as individuals and within their cultural framework. Seck (2015) explained that health care providers have to give undivided attention to cultural diversity and inclusion as well as cultural competency every time they are dealing with African immigrants. Clough et al. (2013) explained that cultural competence will be essential in attaining high quality services for this group, achieving health equity, and eliminating disparities as well as improving the health of the group. The creation of a social and physical environment that promotes good health for African immigrants is hugely reliant on the health care providers’ cultural competence (Allison et al., 2016). Cultural competence will not only enable health care providers to promote the quality of lives of African immigrants but develop healthy behaviors that cuts across all other groups as well (Wamwayi & Murray, 2019).Venters et al. (2019) explain that African immigrant group is underrepresented in the research in healthcare and this is the reason why health care providers are not cultural competent in regard to the group. After moving into the United states, health care providers group African immigrants either as Black or African American without paying attention to any cultural practices that are unique to the group (Omenka, Watson, & Hendrie, 2020). This hinders the delivery of health care services to the African immigrant group (Omenka, Watson, & Hendrie, 2020). Encouraging cultural competence among health care providers for African immigrants will help in highlighting the group’s complex cultural identities and help them in responding to the unique issues that are represented by African immigrants (Asare & Sharma, 2012). African immigrants poses distinct African values, ideologies and knowledge, all which impact their views on healthcare experience. Practitioners and researchers should both aim at being culturally competent in regard to the group if the success of health of the group is to be achieved (Kirmayer, 2012). Some of the most important areas where health care providers have to invest a lot of time and effort in include issues of language barrier, religious practices, and the difference in meanings of concepts (Okudo & Ross, 2016). Training of health care providers in relation to cultural competence for African immigrants should be aimed at exposing health care providers to information about this specific cultural group, assess the professionals’ current perceived competence, and develop ways of improving their cultural competence (Betancourt & Green, 2010). However, even though the studies discuss the importance of cultural competence for African immigrants, they do not provide information about how a cultural competence program for African immigrants can be developed. The studies discuss the impacts of lack of cultural competence and its benefits but no specific focus is directed towards how the program can be developed. This is the gap that the present study will be aimed at. The present study will aim at the development of a cultural competence program for African immigrants aimed at improving their health care experiences and outcomes. Comment by Jessica Grimm: Please cite all of this. Comment by Elumalai, Calaiselvy - SRDH: You already have mentioned the same deficiency early in this paragraph Comment by Jessica Grimm: This is not the section to discuss the purpose of the project- right now- you should discuss the studies that support the project and then cite them. Avoid repetition through only covering what you are exploring in the section heading. Recommend deleting this sentence.

Language Barriers and Cultural Competence Comment by Jessica Grimm: To review this theme, please explore 2-3 studies that explore the effect of language barriers and how to address them from the literature. Avoid personal perspectives. Cite all resources you use here.

Cultural competence is a vital factor in healthcare because cultural beliefs and practices has a direct impact on healthcare practices (Venters et al., 2019). Language is one aspect of culture and due to language barriers most African American immigrants end up not getting quality treatment for their conditions. Ensuring that there is diversity in the workforce ensures that the issue of language barriers is effectively dealt with. Comment by Elumalai, Calaiselvy - SRDH: Nowadays, there are many technologies and strategies available to overcome language barriers in healthcare.

The Impact of Cultural Competence Training on Health Care Workers Comment by Jessica Grimm: To review this theme, please explore 2-3 studies that explore the effect of language barriers and how to address them from the literature. Avoid personal perspectives. Cite all resources you use here.

Training programs on cultural competence among healthcare workers would to enable them to gain the proper knowledge and methods they can implement to provide quality health care services to African immigrants. Cultural competence training programs would also improve the quality of healthcare outcomes of the African immigrants since healthcare workers would have knowledge on how to cater for the said population. Comment by Elumalai, Calaiselvy - SRDH: Paragraph should be indented 0.5 inches

National Guidelines Comment by Jessica Grimm: Are there any national guidelines that guide this topic? Please explore them here. These standards should provide the foundation of your project. There were a few global standard documents I found that you can discuss https://tcns.org/wp-content/uploads/2018/03/Standards_of_Practice_for_Culturally_Compt_Nsg_Care-Revised_.pdf https://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved from http://www. healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39 https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf

Comment by Jessica Grimm: Hi! I appreciate your efforts on this section. You are truly at risk of failing. I love your project topic and I want to help you develop this out so you can pass. Please let us know when you would like to meet.

References

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).

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

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.

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.

Seck, M. M. (2015). West African immigrants in the United States: Challenges and empowering strategies. Social Development Issues, 37(2), 68-79.

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.

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.

World Health Organization. (2020, March). Health Equity.

https://www.who.int/health-equity