Health Professional Students' Cultural Competence and Attitudes toward the Poor: The Influence of a Clinical Practicum Supported by the National Health Service Corps

Journal of Allied Health, Spring 2005 by Smith-Campbell, Betty

To provide quality health care today, practitioners must be culturally competent. Funding sources, such as the federal government, recognize the need to prepare culturally competent clinicians. The mission of the National Health Service Corps (NHSC), a federal program, is to increase access to primary care services and reduce health disparities by assisting in the preparation of community-responsive, culturally competent primary care clinicians. This study evaluated an NHSC program that funded, in part, health professional students' educational programs. Following their participation in an NHSC-supported clinical experience, students were assessed on their cultural competence, perceptions of the poor, and intention of serving in an underserved community. Health professional students completed a survey before and after the clinical practicum. Participants included students who were studying to be physicians, physician assistants, social workers, and nurse practitioners. Results of the study found no change in students' cultural competence after their clinical practicum. Although they remained in the "culturally aware" stage, they were not considered either "culturally proficient" or "culturally competent." However, their attitudes toward those in poverty were more positive than in previous studies of health professionals. The greatest impact from the students' clinical experience was their increased intention to practice in an underserved community following their practicum. They found their experience with the underserved to be rewarding, challenging, and humbling. Documenting the influence that government-funded programs have on health professional students is extremely important in studies such as this. J Allied Health 2005; 34:56-62.

ALL HEALTH PROFESSIONALS recognize the importance of cultural competence and cultural awareness.1-4 The National Center for Cultural Competence,5 a collaborative project with the federal government, has identified several important reasons why cultural competence is needed for current and future health care practitioners. First, demographics in the United States are changing. The number of people aged 65 years and older will increase from 12% of the population in 2000 to about 20% in 2010.^ Racial and ethnic diversity will continue to expand. The non-Hispanic white population is expected to decrease from 74% in 1995 to 53% in 2050. The black population is expected to double from 1995 to the middle of this century, but the largest growth will occur in the Hispanic population.6 The Hispanic population is expected to have annual growth rates of 2% until 2030 and will likely be the second largest race/ethnic group in the United States by 2010.6

A second reason for cultural competence, as identified by the National Center for Cultural Competence/is to eliminate current disparities** in the health status of people with diverse racial, ethnic, and cultural backgrounds. Such discrepancy in health status includes infant mortality rates that are 2.5 times higher for black people than for white people, higher tobacco use tor American Indian/Alaska Native people, and higher death rates for black peopled Persons of Hispanic origin, black people, and American Indian/Alaska natives all have substantially higher death rates related to diabetes than all other racial and ethnic groups.9

A third need for cultural competence is to improve the quality of services and health outcomes. There are noted differences in health outcomes between rural and urban cultures; adolescents and adults who live in rural counties have higher rates of smoking, rural communities have higher rates of obesity, and unintentional injuries increase markedly as counties become less urban.10

Although the relationship of culturally competent health services to patient satisfaction, clinical outcome, and health status is not fully understood, a lack of attention to cultural issues leads to less-than-optimal health care.11,12

A preponderance of government and professional organizations support the need for culturally competent practitioners for all of the aforementioned reasons. As well, many government organizations have set up guidelines and standards to assess cultural competence from a systems and organization perspective. However, these organizations "cannot ensure that those practicing within the agencies possess the attributes necessary to provide culturally competent care."13 Research is needed to validate the efficacy of culturally competent health care.12 Currently, the primary methods used to measure a clinician's cultural competence are self-evaluation tools.13,14 Before evaluating a clinician's cultural competence, the term should first be defined. "The precise meaning of the term, however, is often left open to each reader's interpretation."13In conducting a concept analysis of cultural competence, Burchum concluded that cultural competence was a nonlinear dynamic process possessing the key attributes of cultural awareness, cultural knowledge, cultural understanding, cultural sensitivity, and cultural skill. It is important to incorporate all or most of these key attributes when evaluating cultural competence. For the purposes of this study, cultural competence will be defined by Burchum's key attributes.