Research Guides: Cultural Competency: Research

GW Resources

GW Anti-Racism Coalition (ARC)
Cultural Competence
Resources for professional development in the area of cultural competence, compiled by SMHS Office of Diversity and Inclusion
Race in America Lecture Series
GW Office for Diversity, Equity, and Community Engagement

Resources from Organizations

National Center for Cultural Competence
at Georgetown University
Think Cultural Health
a part of the DHHS Office of Minority Health
Cultural Competency in Nursing Education
American Association of Colleges of Nursing
2020 Institute for Nursing Leadership Critical Conversation on Health Equity and Racism
Video from the American Academy of Nursing Institute for Nursing Leadership. A summary report is also available.
Culturally Competent Nursing Care: A Cornerstone of Caring
Office of Minority Health
AAMC Publication "Assessing Change: Evaluating Cultural Competence Education and Training"
Tool for Assessing Cultural Competence Training (TACCT)
"67-item self-administered assessment tool that can be used by medical schools to examine all components of the entire medical school curriculum"
NIH Ending Structural Racism
Health Initiative of the Americas (UC-Berkeley)
Resources include:
- Research directory, reports, and policy briefs
- Spanish-English dictionary of health terms
Cochrane Equity Methods Group
- resources for planning, conducting, and reporting your equity-relevant systematic review
- additional training and support for conducting equity-related reviews

Training Opportunities

Implicit Bias: A Practical Guide for Healthcare Settings
40-minute training video for healthcare practitioners and trainees
Implicit Bias (DCRX: THE DC CENTER FOR RATIONAL PRESCRIBING)
"This module provides an overview of implicit bias, and how it is manifested in everyday clinical decision-making. Viewers will learn about the underlying psychology and neuroscience of implicit associations, and assess their own biases to increase self-awareness. This course also describes debiasing strategies and best practices to mitigate risks of the impact of bias on treatment and care."
Cultural Competence Courses
Courses availalble in various formats and for a variety of different audiences
"CDC TRAIN is a gateway into the TRAIN Learning Network, the most comprehensive catalog of public health training opportunities. TRAIN is a free service for learners from the Public Health Foundation."
Minority Health/Health Disparities Courses
Courses available in various formats and for a variety of different audiences
"CDC TRAIN is a gateway into the TRAIN Learning Network, the most comprehensive catalog of public health training opportunities. TRAIN is a free service for learners from the Public Health Foundation."
Learning Resources
Webinars, learning modules, webinars, and videos from the National LGBTQIA+ Health Education Center, a program of the Fenway Institute
more...less...
Topics include Introduction to LGBTQIA+ Health; Collecting Sexual Orientation and Gender Identity Data; Pre-Exposure Prophylaxis (PrEP); HIV/STI Treatment and Prevention; LGBTQIA+ Children and Youth; Behavioral Health; Transgender Health; and more.
Addressing the need for lgbtq-affirming cancer care: a focus on sexual and gender minority prostate cancer survivors
"This training aims to help social workers and other health care professionals better support sexual and gender minority cancer patients, with a specific focus on the needs of sexual and gender minority prostate cancer survivors."

Key Terms and Definitions

Culture

"Attitudes and behaviors, which are characteristic of a group or community." (HRSA, 2019)

Cultural Competence

"A set of similar behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations." (HRSA, 2019)

Another definition for cultural competence comes from the Center for Substance Abuse Treatment. Substance Abuse: Administrative Issues in Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 46.) Chapter 4. Preparing a Program To Treat Diverse Clients.

The capacity for people to increase their knowledge and understanding of cultural differences
The ability to acknowledge cultural assumptions and biases
The willingness to make changes in thought and behavior to address those biases

Cultural Humility

"It is a process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners. It is a process that requires humility in how physicians bring into check the power imbalances that exist in the dynamics of physician-patient communication by using patient-focused interviewing and care. And it is a process that requires humility to develop and maintain mutually respectful and dynamic partnerships with communities on behalf of individual patients and communities in the context of community-based clinical and advocacy training models." (Tervalon and Murray-Garcia,1998)

Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998 May;9(2):117-25. doi: 10.1353/hpu.2010.0233. PMID: 10073197. Access the PDF via Himmelfarb.

Also see:

Masters C, Robinson D, Faulkner S, Patterson E, McIlraith T, Ansari A. Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool. J Gen Intern Med. 2019 Apr;34(4):627-630. doi: 10.1007/s11606-018-4814-y. Epub 2019 Jan 8. PMID: 30623383; PMCID: PMC6445906.

Cultural Safety

See: Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition (Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P., 2019). The article presents a number of definitions for different terms, as collected from a literature review, and recommends a definition for cultural safety.

Culturally Adapted Health Care

See January 2020 article from County Health Rankings for background reading

Critical Consciousness

"critical consciousness... places medicine in a social, cultural, and historical context and ... is coupled with an active recognition of societal problems and a search for appropriate solutions" (Kumagai & Lypson, 2009)

Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education: Academic Medicine, 84(6), 782–787. https://doi.org/10.1097/ACM.0b013e3181a42398

Statistical Discrimination

"occurs when providers respond to the inherent uncertainty of the diagnostic and treatment processes by interpreting the data and information relevant to a minority patient differently from the way they do with white patients"... involves "misusing and misapplying factually accurate information to reach an inaccurate conclusion concerning the specific patient."

See pages 98-99 in Matthew (2015).

Matthew, D. (2015). Just medicine : a cure for racial inequality in American health care. New York University Press.

Available online through Himmelfarb.

Structural Competency

"the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance,” trauma, psychosis) also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health" (Metzl & Hansen 2014)

See also: Spring 2014 article, With Understanding Comes Empowerment, from New Physician and Sep 2014 article, Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge, from AMA Journal of Medical Ethics.

Conducting Research

Considerations for employing intersectionality in qualitative health research.
Abrams JA, Tabaac A, Jung S, Else-Quest NM.
Soc Sci Med. 2020 Aug;258:113138. doi: 10.1016/j.socscimed.2020.113138. Epub 2020 Jun 16. PMID: 32574889; PMCID: PMC7363589.
Sexual & Gender Minority Research Office (SGMRO) (NIH)
"The Sexual & Gender Minority Research Office (SGMRO) coordinates sexual and gender minority (SGM)–related research and activities by working directly with the NIH Institutes, Centers, and Offices. The Office was officially established in September 2015 within the NIH Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI)."
Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use
Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016 May 3;1:2. doi: 10.1186/s41073-016-0007-6. PMID: 29451543; PMCID: PMC5793986.
Integrating Sex-Gender for Informative Clinical Trials: Points to Consider
" Integrating sex-gender considerations into clinical trials facilitates analysis of biological and social variables and gender-sensitive methodologies that support scientific rigor, lead to clinical relevance, and protect vulnerable participants. This overview of best practices includes links to tools and references to support sex-gender integration into clinical trials."
Equity and Inclusion Guiding Engagement Principles
"guiding engagement principles for placing diversity, equity, and inclusion at the center of health research partnerships. Developed by PCORI’s Advisory Panel on Patient Engagement, the four principles—Inclusion, Equitable Partnerships, Trust/Trustworthiness, and Accountability/Actionability—are offered to ensure that diversity, equity, and inclusion are an explicit goal of partnerships from the start."
Indigenous Research Toolkit (UBC)
"the resources on this page comprise a toolkit that will assist researchers already involved in Indigenous research with the various steps of their research collaborations"
Sex/Gender Methods Group (Cochrane)
Background and resources for addressing sex and gender in health research synthesis, including systematic reviews
PhenX SDOH Toolkit
Find standard data collection protocols for research
Minority Health and Health Disparities Research Framework [NIMHD]
"The framework serves as a vehicle for encouraging NIMHD- and NIH-supported research that addresses the complex and multi-faceted nature of minority health and health disparities, including research that spans different domains of influence (Biological, Behavioral, Physical/Built Environment, Sociocultural Environment, Healthcare System) as well as different levels of influence (Individual, Interpersonal, Community, Societal) within those domains. The framework also provides a classification structure that facilitates analysis of the NIMHD and NIH minority health and health disparities research portfolios to assess progress, gaps, and opportunities."

Database Search Tips

MeSH (Medical Subject Heading) terms for PubMed and MEDLINE searches:

Cultural Competency
Cultural Diversity
Culturally Competent Care
Prejudice
Clinical Competence
Professional Competence
Stereotyping
Unconscious, Psychology
Weight Prejudice

CINAHL Subject Heading terms for CINAHL searches:

Cultural Competence
Culture
Cultural Diversity
Transcultural Care
Transcultural Nursing
Professional Practice

Search Filters:

Health Equity Filters (ISSG Search Filters Resource)
Population Groups Filters (ISSG Search Filters Resource)
Health Disparities and Minority Health (Ovid Expert Searches, scroll down to find)

Additional Databases

Sage Research Methods Core
Research methods full-text collection provides access to 1,000+ books, reference works, and journal articles in research methods, statistics, and evaluation.

Health Equity: Public Health Genomics and Precision Health Knowledge Base (CDC)
"online, continuously updated, searchable database of genomics and precision health information and publications relevant to health equity. Health equity is when everyone has the opportunity to be as healthy as possible. Search terms are derived from a list provided by the Association for Territorial Health Officials which includes terms such as diversity, health disparities, and others. The search algorithm combines terms in health equity with those of genomics and precision health"
AHRQ Social Determinants of Health Database (Beta Version)
"These files contain the beta version of AHRQ’s database on Social Determinants of Health (SDOH), which was created under a project funded by the Patient Centered Outcomes Research (PCOR) Trust Fund. The purpose of this project is to create easy to use, easily linkable SDOH-focused data to use in PCOR research, inform approaches to address emerging health issues, and ultimately contribute to improved health outcomes."
more...less...
"Variables in the files correspond to five key SDOH domains: social context (e.g., age, race/ethnicity, veteran status), economic context (e.g., income, unemployment rate), education, physical infrastructure (e.g, housing, crime, transportation), and healthcare context (e.g., health insurance). The files can be linked to other data by geography (county and zip code). The database includes two documentation files and two types of publicly available data files."
Office of Minority Health Resource Center
"The Office of Minority Health Resource Center is a nationwide service of the Office of Minority Health that provides minority health literature, research and referrals for consumers, community organizations and health professionals. The Resource Center offers a variety of information resources, including access to online document collections, database and funding searches, and customized responses to requests for information."

Datasets and Data Sources

Minority Health Social Vulnerability Index (SVI)
uses data from the United States Census Bureau and other public sources to help identify communities that may need support before, during, and after disasters, with a focus on minority racial, ethnic, and language groups as well as medical vulnerability.
The dashboard has three sections: a sidebar menu, a bar chart, and a map

Government Reports and Publications

National Healthcare Quality and Disparities Reports (AHRQ)
"Tools for measuring healthcare quality, including the National Healthcare Quality and Disparities Reports, AHRQ Quality Indicators, and ambulatory clinical performance measures."