Linking Cultural Competence to Functional Life Outcomes in Mental Health Care Settings.

Minorities in the United States have well-documented health disparities. Cultural barriers and biases by health care providers may contribute to lower quality of services which may contribute to these disparities. However, evidence linking cultural competency and health outcomes is lacking. This study, part of an ongoing quality improvement effort, tested the mediation hypothesis that patients' perception of provider cultural competency indirectly influences patients' health outcomes through process of care. Data were from patient satisfaction surveys collected in seven mental health clinics (n=94 minority patients). Consistent with our hypothesis, patients' perception of clinicians' cultural competency was indirectly associated with patients' self-reported improvements in social interactions, improvements in performance at work or school, and improvements in managing life problems through the patients' experience of respect, trust, and communication with the clinician. These findings indicate that process of care characteristics during the clinical encounter influence patients' perceptions of clinicians' cultural competency and affect functional outcomes.

Implementing Ask Me 3 to improve African American patient satisfaction and perceptions of physician cultural competency.

OBJECTIVE: Improve African American patient satisfaction and perceptions of physician cultural competency through the implementation of Ask Me 3 pamphlet which encourages patients to ask questions of physicians. METHODS: Intervention participants received the pamphlet prior to their visit with the physician. Analysis evaluated differences in patient satisfaction and perceptions of physician cultural competency between intervention participants and controls. RESULTS: Intervention participants who saw their regular physician reported higher satisfaction. All found the questions to be helpful and reported knowing more about their medical condition or illness after the visit. CONCLUSIONS: The Ask Me 3 pamphlet is a low cost and logistically feasible tool that could be readily implemented in medical settings to facilitate physician-patient interaction. Improved satisfaction with the visit was found when the pamphlet was implemented during visits with a regular physician. Thus, our research findings suggest implementation of the Ask Me 3 pamphlet has the potential to improve health care behaviors and health outcomes and may ultimately lead to a reduction in health care disparities.

Physicians' cultural competency as perceived by African American patients.

The purpose of the study was to determine the association between African American patients' perceptions of physician cultural competency and patient satisfaction with the visit, independent of other factors, including physician and patient race concordance. African American participants were surveyed at urban clinics. Cultural competency (Perceived Cultural Competency scale) was based on the 3-factor model that includes patients' perception of (1) physicians' cultural knowledge, (2) physicians' cultural awareness, and (3) physicians' cultural skill. The results confirmed that patients' perceptions of physician cultural competency are independently associated with satisfaction with the visit. These results further validate use of the Perceived Cultural Competency scale as a tool to measure patients' perceptions of physicians' cultural competency.

Healthcare provider cultural competency: development and initial validation of a patient report measure.

OBJECTIVE: Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. DESIGN: Samples of predominantly African American patients (N=310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. MAIN OUTCOME MEASURES: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. RESULTS: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. CONCLUSION: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.

Cisplatin-induced hyperactivity in the dorsal cochlear nucleus and its relation to outer hair cell loss: relevance to tinnitus.

Cisplatin causes both acute and chronic forms of tinnitus as well as increases in spontaneous neural activity (hyperactivity) in the dorsal cochlear nucleus (DCN) of hamsters. It has been hypothesized that the induction of hyperactivity in the DCN may be a consequence of cisplatin's effects on cochlear outer hair cells (OHCs); however, systematic studies testing this hypothesis have yet to appear in the literature. In the present investigation, the relationship between hyperactivity and OHC loss, induced by cisplatin, was examined in detail. Hamsters received five treatments of cisplatin at doses ranging from 1.5 to 3 mg. kg(-1). day(-1), every other day. Beginning 1 mo after initiation of treatment, electrophysiological recordings were carried out on the surface of the DCN to measure spontaneous multiunit activity along a set of coordinates spanning the medial-lateral (tonotopic) axis of the DCN. After recordings, cochleas were removed and studied histologically using a scanning electron microscope. The results revealed that cisplatin-treated animals with little or no loss of OHCs displayed levels of activity similar to those seen in saline-treated controls. In contrast, the majority (75%) of cisplatin-treated animals with severe OHC loss displayed well-developed hyperactivity in the DCN. The induced hyperactivity was seen mainly in the medial (high-frequency) half of the DCN of treated animals. This pattern was consistent with the observation that OHC loss was distributed mainly in the basal half of the cochlea. In several of the animals with severe OHC loss and hyperactivity, there was no significant damage to IHC stereocilia nor any observable irregularities of the reticular lamina that might have interfered with normal IHC function. Hyperactivity was also observed in the DCN of animals showing severe losses of OHCs accompanied by damage to IHCs, although the degree of hyperactivity in these animals was less than in animals with severe OHC loss but intact IHCs. These results support the view that loss of OHC function may be a trigger of tinnitus-related hyperactivity in the DCN and suggest that this hyperactivity may be somewhat offset by damage to IHCs.