Cultural Competence among Health Care Providers at a Teaching Hospital in Ethiopia

Cultural Competence among Health Care Providers at a Teaching Hospital in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cultural Competence among Health Care Providers at a Teaching Hospital in Ethiopia Wondimu Gudu, Malede Birara, Mekitie Wondafrash This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4228802/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. Most health care professionals are not culturally competent in health care provision which compromises quality of care. The aim of this study was to explore cultural competence among health care providers at Saint Paul’s hospital. Methods A cross sectional s study was conducted among 353 health care providers. Data was collected using the Campinha-Bacote’s Cultural awareness assessment tool. A five-point Likert scale was used to measure the respondents’ overall level of cultural competence which included 5 constructs: cultural awareness, cultural knowledge, cultural skills, cultural encounters and cultural desire. Data was analyzed using Stata Statistical Software Re. The score was classified as culturally incompetent (25–50 points), culturally aware (51–74 points), culturally competent (75–90 points) and culturally proficient (91–100 points). Ethical clearance was obtained from the IRB of the hospital and written consent was obtained from the study participants. Results The Campinha-Bacote’s cultural awareness assessment tool had an acceptable internal consistency with the calculated Chronbach’s α of 0.82. The overall cultural competence mean (SD) score was 67(9.3) among all health care professionals. Only 16% of the health care providers were culturally competent. Among the cultural competence constructs, the highest mean scores were obtained for cultural desire (15.7) followed by cultural encounter (13.2), cultural awareness (13.1). Male, those with higher incomes and midwives were found to have better cultural competence scores. Conclusion The Campinha-Bacote’s tool had a good internal consistency and can be utilized for assessment of cultural competence in a low income countries context. The overall cultural competence score among the health care professionals was low. Hence the hospital needs to devise strategies to improve cultural competence of its health care providers. culture competence sensitivity campinha-Bacote Ethiopia Background The provision of medical care taking in to consideration the socio cultural values of any community is gaining more attention recently. That is especially relevant in countries with wide differences in social, religious & cultural values owing to diverse ethnic groups. The focus of many health institutions/services is primarily on establishing health facility/infrastructure with expectations that services will be utilized. But for effective utilization of the facilities and better health outcomes, the health system management should ensure that service provision considers the socio cultural values of the society. ( 1 ). Culture is a critical element in most facets of life, especially in health care behaviors, decision making, and approaches to wellness and healing. Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability and occupation ( 1 ). Cultural competence in health care describes the ability of systems to provide care to clients with diverse values, beliefs and behaviors, including tailoring delivery to meet their social, cultural, and linguistic needs (1, 2,3 ). Patients want health care providers who value and respect their cultural views and beliefs, communicate effectively, and take an individualistic approach to their health ( 4 ). But often health care professionals do not consider it to be their responsibility to adapt to ethnic diversity, if health professionals do not feel a responsibility to adapt, they are less likely to be involved in culturally sensitive health care [5,6]. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care ( 5 , 6 , 7 ). Understanding clients’ beliefs can help providers align their services with their ideas or, when necessary, address local misconceptions. Providers can also bridge gaps by expressing respect for the clients’ beliefs and drawing connections between these beliefs and medical models of health ( 8 ) The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy ( 9 ). A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities ( 10 ) The Saint Paul Hospital is serving a large number of populations in the capital Addis & the surrounding towns. The population comprises wide range of ethnic groups with diverse social cultural and religious values. But adequate uptake of the services and subsequent consumer satisfaction will depend among other factors on provision of socio culturally sensitive health care. There are very few studies done in Ethiopia on cultural competence among health care provision but none at Saint Paul’s hospital ( 11 , 12 ). Little is known about the knowledge, attitude and practice of health professionals regarding cultural competence in medical care provision. Hence a cross sectional study was conducted at Saint Paul’s Hospital with the aim of exploring cultural competence among health care providers. Methods and subjects A hospital based cross sectional study was undertaken from Dec 2020 to Jan 2021 at Saint Paul's hospital which is one of the tertiary referral hospitals governed under the federal ministry of health. It is also a teaching hospital for the Millennium Medical College. The hospital gives services to an estimated 300,000 people annually who are referred from all corners of the country. It has a total bed capacity of 360 and on an average 650 patients visit the hospital as outpatient and emergency daily. The college trains Medical Doctors and has specialty and subspecialty trainings in various clinical disciplines. The study subjects were all health professionals who were employed and practicing at Saint Paul’s Hospital Millennium Medical College at the time of data collection. The sample size for study was calculated using single population proportion formula assuming 50% of health professionals (P = 0.5) are not know culturally competent in health care provision (as there is no previous data). The total sample size was 384 (adjusting for 10% non-response rate). This was thought to maximize the sample size for every component of culturally sensitive planned to be assessed in the study. Before the actual data collection census was conducted in each health care provision area to identify potential healthcare professionals that could be study subjects. The inclusion criteria were; Professionals who have worked in clinical and academic areas of service provision for at least 6months and who are willing to participate in the study. Data was collected using structured cultural diversity questionnaire (the Campinha-Bacote’s Cultural awareness assessment tool) which was adopted for the purpose of this study( 13 ). The instrument consists of two sections: demographic characteristics of the healthcare providers and five-point scale Likert type items intended to measure the respondents’ level of cultural competence [i.e., cultural awareness, cultural knowledge, cultural skills, cultural encounters and cultural desire ( 13 ). The questionnaire was prepared in English by the team of investigators based on previous studies. All the interviews were made by trained B.Sc. nurses using local language and supervised by general practitioners Data was exported to and analyzed using Stata Statistical Software Release 14 (College Station, TX: StataCorp LP). Cultural competence on each sub scale was calculated using IAPCC-R (Inventory for Assessing the Process of Cultural Competence among Health Care Professionals-Revised) (Campinha-Bacote 2002). The results range from 25 to 100 points, with a higher score correlating with a higher level of cultural competence. The score was classified as culturally incompetent (25–50 points), culturally aware (51–74 points), culturally competent (75–90 points) and culturally proficient (91–100 points). Ethical clearance was obtained from the IRB of Saint Paul’s Hospital Millennium Medical College. Permission was also obtained from the hospital medical service vice provost office. All the study participants were informed about the purpose of the study and their right to refuse. Written consent was obtained. Table 1 Operational definitions of components of culturally competent nursing care (Campinha-Bacote 2002) • Cultural desire : the nurse must be motivated to become involved in the process of becoming culturally competent. • Cultural awareness : the nurse becomes sensitive to the values, beliefs, lifestyles and practices of the patient and identifies his/her own values, biases and prejudices. • Cultural knowledge : the nurse seeks information about other cultures and different worldviews, and how these views impact a patient’s health. • Cultural skills : the nurse collects relevant cultural data regarding the patient’s presenting problem and accurately performs a culturally based physical assessment. • Cultural encounters : the nurse is involved in face-to-face encounters with patients from diverse cultures. Directly interacting with clients from diverse cultural groups will refine or modify one’s existing beliefs about a cultural group and will prevent possible stereotyping that may have occurred. Cultural competent- health workers were labeled culturally competent if they answered ≥ 75% of questions in favorable way (scoring 3 and above for an item). Culturally incompetent: health workers were labeled culturally incompetent if they answered < 75% of questions. Results Sociodemographic characteristics of study participants A total of 353 health professionals were included in this study. Almost equal number of male and female participants was included (48.7% and 51.3% respectively). Most (90%) of the health professionals were in the age group 21–30; single (66%); nurses (57%). Most of the study participants were Bachelor degree holders (68%) and 83% had less than 5yers of clinical experience (Table 2 ). Table 2 Sociodemographic characteristics of study participants Variables Number Percent Gender ( n = 353) Male 172 48.7 Female 181 51.3 Age in years ( n = 349) 21–30 years 314 90 31–45 years 31 8.9 >=46 4 1.1 Religion ( n = 353) Orthodox 234 66.3 Protestant 68 19.3 Muslim 43 12.2 Other 8 2.3 Marital status (n = 353) Single 233 66 Married 117 33.1 Living together 3 0.8 Profession ( n = 353) Medical Doctor 37 10.5 Nurse 200 56.7 Midwife 60 17 Public health officer 2 0.6 Resident 50 14.2 Others 4 1.1 Maximum educational level attended with your health profession ( n = 352) Diploma 16 4.5 B.Sc. 239 67.9 MSc 13 3.7 GP-MD 20 5.7 MD with specialty 64 18.2 Years of experience (n = 347) =11 years 10 2.9 Monthly salary (n = 346) =10000 73 21.1 Cultural competence of the health care professionals The overall Campinha-Bacote’s IAPCC-R tool had an acceptable internal consistency with the calculated Chronbach’s α (which is a function an average covariance or correlation among all possible combination of items) of 0.82; however, individual cultural competence constructs showed varied level of internal consistency which ranged from 0.39 (cultural awareness) to 0.73 (cultural desire) ( Table 3 ). Table 3 Cultural competence and reliability of constructs Constructs Mean Std. Dev. Chronbach’s α Cultural awareness 13.1 2.5 0.39 Cultural Knowledge 12.1 2.7 0.57 Cultural Skill 12.8 2.8 0.59 Cultural encounter 13.2 2.4 0.41 Cultural desire 15.7 2.7 0.73 Cultural competence 66.9 9.3 0.82 After the scores of the cultural competence items were added, the mean score was calculated. Hence, the overall cultural competence mean (SD) score was 67(9.3) among all health care professionals. Among the cultural competence constructs, the highest mean scores were obtained for cultural desire (15.7) followed by cultural encounter (13.2), cultural awareness (13.1), cultural skill (12.8) and cultural knowledge (12.1) after adding all the scores of the 25 items (Table 3 ). When the mean score of all the items were taken, the mean (SD) score was 2.7 (0.35). In the continuum of IAPCC-R, 4.3% of the various healthcare providers were culturally incompetent, 79% aware, 16.4% competent, and 0.3% proficient. Association of cultural competence items and sociodemographic characteristics Cultural competence constructs were analyzed against some sociodemographic characteristics. The median scores of cultural knowledge, skills and encounters and desire were compared between male and female health care professionals. There was statistical significant difference in the median cultural knowledge, skills and encounters between males in females in which males showed a higher score (Table 4 ). The same analysis was performed for age groups ( 30 years) and there was no statistically significant difference in the median scores of all the cultural competence constructs. When the median scores of the cultural constructs were compared with different categories of health care professions, there was a statistically significant difference in the median scores of cultural skills, encounter and desire. Midwives scored better in cultural skills (p = 0.003) and encounters (p = 0.003) while residents scored better in the scored better in the cultural awareness (p = 0.04) and skills (p = 0.01) construct of cultural competence (Table 5 ). Table 4 Cultural competence by gender of participants Factor Male (n = 172) Female ( n = 181) p-value* Cultural awareness, median (IQR**) 13.0 (12.0, 15.0) 13.0 (11.0, 14.0) 0.080 Cultural knowledge, median (IQR) 12.0 (11.0, 14.0) 12.0 (10.0, 13.0) 0.020 Cultural skills, median (IQR) 13.0 (11.0, 15.0) 12.0 (10.0, 14.0) 0.006 Cultural encounters, median (IQR) 14.0 (12.0, 15.0) 13.0 (12.0, 14.0) 0.008 Cultural desire, median (IQR) 16.0 (15.0, 18.0) 16.0 (14.0, 18.0) 0.080 *Comparing the medians of scores of the cultural competence constructs and p-values are calculated using Mann-Whitney test; **IQR: Interquartile range There was statistically significant difference in the median scores of all cultural competence constructs among the different income categories of the health professionals (Table 6 ). Table 5 Cultural competence constructs by profession of participants (n = 247) Factor Medical doctor (n = 37) Nurse (n = 200) Midwife (n = 60) Resident (n = 50) p-value* Cultural awareness, median (IQR) 12.0 (11.0, 14.0) 13.0 (12.0, 15.0) 13.0 (12.0, 15.0) 13.0 (11.0, 14.0) 0.083 Cultural knowledge, median (IQR) 12.0 (10.0, 13.0) 12.0 (10.5, 14.0) 12.0 (10.0, 14.0) 12.0 (10.0, 13.0) 0.28 Cultural skills, median (IQR) 11.0 (10.0, 14.0) 13.0 (11.0, 15.0) 13.0 (12.0, 15.0) 12.0 (10.0, 14.0) 0.003 Cultural encounters, median (IQR) 13.0 (12.0, 14.0) 13.0 (12.0, 15.0) 14.0 (13.0, 15.0) 13.0 (11.0, 14.0) 0.003 Cultural desire, median (IQR) 17.0 (15.0, 19.0) 15.0 (14.0, 17.0) 16.0 (15.0, 17.0) 17.0 (16.0, 19.0) < 0.001 *Comparing the medians of scores of the cultural competence constructs with professional categories and p-values are calculated using Kruskal-Wallis H Test; **IQR: Interquartile range Table 6 Cultural competence by monthly income of participants Factors =10000 ( n = 73) p-value Cultural awareness, median (IQR) 14.0 (12.0, 15.0) 13.0 (12.0, 14.0) 12.0 (11.0, 14.0) 0.03 Cultural knowledge, median (IQR) 12.0 (11.0, 14.0) 12.0 (10.0, 14.0) 11.0 (10.0, 13.0) 0.03 Cultural skills, median (IQR) 13.0 (11.0, 15.0) 13.0 (11.0, 15.0) 12.0 (10.0, 14.0) 0.003 Cultural encounters, median (IQR) 14.0 (12.0, 15.0) 13.0 (12.0, 15.0) 13.0 (11.0, 14.0) 0.01 Cultural desire, median (IQR) 15.0 (14.0, 17.0) 16.0 (14.0, 18.0) 17.0 (15.0, 19.0) < 0.001 *Comparing the medians of scores of the cultural competence constructs with the monthly salary categories and p-values are calculated using Kruskal-Wallis H Test; **IQR: Interquartile range Discussion This study showed that the overall cultural competence among health professionals working at Saint Paul’s Hospital was low. Although 79% were culturally aware, only 16.4% were culturally competent. The overall Campinha-Bacote’s IAPCC-R tool had an acceptable internal consistency. The Campinha-Bacote tool was used in this study as a review of 4 models of cultural competence revealed that it is sufficiently comprehensive to guide empirical research and the development of educational interventions as well as strengthening cultural competence of health professionals in countries across the world ( 14 ). Although there are concerns on the internal consistency of the Campinha-Bacote’s cultural competence tool; our study showed that it had an acceptable internal consistency with the calculated Chronbach’s α 0f 0.82 (which is a function an average covariance or correlation among all possible combination of items). This is consistent with a study done in South Africa which assessed cultural competence among critical care nurses using the same model ( 15 ). In our study only 16.0% of the health care professionals were culturally competent. This is consistent with 2 previous studies done in Ethiopia addressing cultural competence among health professionals both at the public and private facilities ( 11 , 12 ). The the study done at Bahir Dar City (2016) which assessed cultural competence among maternal health care providers showed that the overall competence level of health workers was low and concluded that the providers were aware of only their own culture but not the world view of their clients ( 11 ). In the other Qualitative study done at university specialized hospital at Jimma town of Ethiopia, it was explored that the cultural and linguistic diverse needs of patients were given inadequate attention during health care provision ( 12 ). The study done in South Africa which employed the Campinha Bacote’s tool, showed ( 15 ) a relatively higher score (25%) compared to ours (16%). This difference could be explained by differences in the clinical service provision area of the health care professionals included in the studies; health sciences education curriculum, institutional policies/protocols on cultural competence and the type health care professions included in the studies. The ultimate goal of cultural competence is to make healthcare more responsive to the needs of patients, and increase their satisfaction with healthcare provision, decrease inappropriate differences in the characteristics and quality of care provided, and close the gaps in health status in diverse populations ( 16 ). The low cultural competence score in a tertiary teaching center where socio-culturally diverse group of patients are served indicates the need for works to be done for improving provision of socio-culturally appropriate health care. These include the inclusion of cultural competence in institutional protocols, policies and curriculums at all levels of teaching as well as providing need based in-service trainings. In our study Cultural competence constructs were analyzed against some sociodemographic characteristics. Male health workers, those with higher incomes and midwives were found to have better cultural competence scores. Although it is difficult explain the association between being male and earning higher income with better cultural competence scores in this study, the higher score by midwives could be explained by the fact that mid wives in the study country are trained on respectful maternity care as part of in-service emergency obstetric care trainings. This is expected to improve their exposure to some of the concepts related to socio-cultural sensitivity in health care provision. Conclusions & Recommendations The Campinha-Bacote’s tool had a good internal consistency and can be utilized for assessment of cultural competence in a low income country context. The overall cultural competence score among the health care professionals in this study was low. Hence the hospital needs to devise strategies to improve socio-cultural competence of its professionals in health care provision. The strategies could include incorporation of cultural sensitivity in educational curriculums, institutional policies and documents; conducting in-service trainings Declarations Ethics approval and consent to participate Ethical clearance was obtained from the Institutional Review Board (IRB) of Saint Paul’s Hospital Millennium Medical College. Permission was also obtained from the hospital medical service vice provost office. All the study participants were informed about the purpose of the study and their right to refuse. Written consent was obtained. Availability of data and materials The data and materials are available on reasonable request to the primary or co-authors: email [email protected] or [email protected] Competing interests : The authors have no conflicts of interest Funding : None Authors' contributions : WG: inception, planning, conduct, data analysis, and manuscript writing; MB: inception, supervision, revision of manuscript; MW: data collection tools, analysis, write up Acknowledgement : We would like to extend our gratitude to Saint Paul’s Institute for Reproductive Health and Rights (SPIRHR) for facilitating acquisition of internationally accepted data collection tool (Campinha- Bacote’s cultural assessment tool). References Betancourt JR, Green AR, Carrillo JE. Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund; 2002. 13, Robins LS. Improving Cultural Awareness and Sensitivity Training in Medical School. 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Med Care. 2012;50:S48. Leclere B, Jensen L, Biddlecom E. Health care utilization, family 432 context, and adaptation among immigrants to the United States. J Health Soc Behav. 1994;35:370–84. 10.2307/2137215 . [PubMed]. Emily Ihara. Cultural competence in health care: is it important for people with chronic conditions? Issue Brief Number 5, February 2004. Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(Suppl 1):181–217. Aragaw, et al. Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional study. BMC Pregnancy Childbirth. 2015;15:227. Mesfin B. Cultural Sensitiveness in Health Care Delivery of Jimma University Specialized and Teaching Hospital, South West Ethiopia, 2016. Qual Prim Care. 2017;25(3):109–28. Campinha-Bacote J. Inventory for assessing the process of cultural competence among healthcare professionals- revised (IAPCC-R) 4. Cincinnati: Trans cultural Care Associates; 2003. [PubMed]. Albougami AS, Pounds KG, Alotaibi JS. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1–5. de Beer J, Chipps J. A survey of cultural competence of critical care nurses in KwaZulu-Natal. SAJCC November 2014, 30, No. 2. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems. A systematic review. Am J Prev Med. 2003;24(3 Suppl):69–79. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4228802","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288557894,"identity":"c958233d-0583-4dbc-88a0-ddaa0746d778","order_by":0,"name":"Wondimu Gudu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYJACCQYGGzBJkpY00rUcJkGLwfHegze/tp1P7J/dfPABQ41NNGEtZ84lW8u23U6ccedYsgHDsbTcBkJazG7kmElLArU0ABkSjA2HidZyLnE+SVokP7YdSNxAtBb7M2eMrRnOJRtvvJGWbJBAjF8k23sMb/4os5OddyP54IMPNTaEtYAAMw8DgyNYZQIxykGA8QfQgcQqHgWjYBSMghEIAJZiQx9n7FFpAAAAAElFTkSuQmCC","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wondimu","middleName":"","lastName":"Gudu","suffix":""},{"id":288557895,"identity":"4cb719bc-f85d-48da-a780-ac5a688f450a","order_by":1,"name":"Malede Birara","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Malede","middleName":"","lastName":"Birara","suffix":""},{"id":288557896,"identity":"ee927c01-2f37-41bd-a69d-9a7efac70367","order_by":2,"name":"Mekitie Wondafrash","email":"","orcid":"","institution":"St. Paul Institute for Reproductive Health and Rights","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mekitie","middleName":"","lastName":"Wondafrash","suffix":""}],"badges":[],"createdAt":"2024-04-06 22:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4228802/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4228802/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82787722,"identity":"f8d71f5d-3b2f-4d51-b8fe-cafb50edacc2","added_by":"auto","created_at":"2025-05-15 09:31:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":903744,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4228802/v1/be49d8d8-420d-466c-a4b0-afea19cb444b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cultural Competence among Health Care Providers at a Teaching Hospital in Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eThe provision of medical care taking in to consideration the socio cultural values of any community is gaining more attention recently. That is especially relevant in countries with wide differences in social, religious \u0026amp; cultural values owing to diverse ethnic groups. The focus of many health institutions/services is primarily on establishing health facility/infrastructure with expectations that services will be utilized. But for effective utilization of the facilities and better health outcomes, the health system management should ensure that service provision considers the socio cultural values of the society.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCulture is a critical element in most facets of life, especially in health care behaviors, decision making, and approaches to wellness and healing. Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability and occupation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Cultural competence in health care describes the ability of systems to provide care to clients with diverse values, beliefs and behaviors, including tailoring delivery to meet their social, cultural, and linguistic needs (1, 2,3 ).\u003c/p\u003e \u003cp\u003ePatients want health care providers who value and respect their cultural views and beliefs, communicate effectively, and take an individualistic approach to their health (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). But often health care professionals do not consider it to be their responsibility to adapt to ethnic diversity, if health professionals do not feel a responsibility to adapt, they are less likely to be involved in culturally sensitive health care [5,6]. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnderstanding clients\u0026rsquo; beliefs can help providers align their services with their ideas or, when necessary, address local misconceptions. Providers can also bridge gaps by expressing respect for the clients\u0026rsquo; beliefs and drawing connections between these beliefs and medical models of health (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe Saint Paul Hospital is serving a large number of populations in the capital Addis \u0026amp; the surrounding towns. The population comprises wide range of ethnic groups with diverse social cultural and religious values. But adequate uptake of the services and subsequent consumer satisfaction will depend among other factors on provision of socio culturally sensitive health care.\u003c/p\u003e \u003cp\u003eThere are very few studies done in Ethiopia on cultural competence among health care provision but none at Saint Paul\u0026rsquo;s hospital (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Little is known about the knowledge, attitude and practice of health professionals regarding cultural competence in medical care provision. Hence a cross sectional study was conducted at Saint Paul\u0026rsquo;s Hospital with the aim of exploring cultural competence among health care providers.\u003c/p\u003e"},{"header":"Methods and subjects","content":"\u003cp\u003eA hospital based cross sectional study was undertaken from Dec 2020 to Jan 2021 at Saint Paul's hospital which is one of the tertiary referral hospitals governed under the federal ministry of health. It is also a teaching hospital for the Millennium Medical College. The hospital gives services to an estimated 300,000 people annually who are referred from all corners of the country. It has a total bed capacity of 360 and on an average 650 patients visit the hospital as outpatient and emergency daily. The college trains Medical Doctors and has specialty and subspecialty trainings in various clinical disciplines.\u003c/p\u003e \u003cp\u003eThe study subjects were all health professionals who were employed and practicing at Saint Paul\u0026rsquo;s Hospital Millennium Medical College at the time of data collection. The sample size for study was calculated using single population proportion formula assuming 50% of health professionals (P\u0026thinsp;=\u0026thinsp;0.5) are not know culturally competent in health care provision (as there is no previous data). The total sample size was 384 (adjusting for 10% non-response rate). This was thought to maximize the sample size for every component of culturally sensitive planned to be assessed in the study. Before the actual data collection census was conducted in each health care provision area to identify potential healthcare professionals that could be study subjects. The inclusion criteria were; Professionals who have worked in clinical and academic areas of service provision for at least 6months and who are willing to participate in the study.\u003c/p\u003e \u003cp\u003eData was collected using structured cultural diversity questionnaire (the Campinha-Bacote\u0026rsquo;s Cultural awareness assessment tool) which was adopted for the purpose of this study(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The instrument consists of two sections: demographic characteristics of the healthcare providers and five-point scale Likert type items intended to measure the respondents\u0026rsquo; level of cultural competence [i.e., cultural awareness, cultural knowledge, cultural skills, cultural encounters and cultural desire (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The questionnaire was prepared in English by the team of investigators based on previous studies. All the interviews were made by trained B.Sc. nurses using local language and supervised by general practitioners\u003c/p\u003e \u003cp\u003eData was exported to and analyzed using Stata Statistical Software Release 14 (College Station, TX: StataCorp LP). Cultural competence on each sub scale was calculated using IAPCC-R (Inventory for Assessing the Process of Cultural Competence among Health Care Professionals-Revised) (Campinha-Bacote 2002). The results range from 25 to 100 points, with a higher score correlating with a higher level of cultural competence. The score was classified as culturally incompetent (25\u0026ndash;50 points), culturally aware (51\u0026ndash;74 points), culturally competent (75\u0026ndash;90 points) and culturally proficient (91\u0026ndash;100 points).\u003c/p\u003e \u003cp\u003e Ethical clearance was obtained from the IRB of Saint Paul\u0026rsquo;s Hospital Millennium Medical College. Permission was also obtained from the hospital medical service vice provost office. All the study participants were informed about the purpose of the study and their right to refuse. Written consent was obtained.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eOperational definitions of components of culturally competent nursing care\u003c/b\u003e (Campinha-Bacote 2002)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eCultural desire\u003c/b\u003e: the nurse must be motivated to become involved in the process of becoming culturally competent.\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eCultural awareness\u003c/b\u003e: the nurse becomes sensitive to the values, beliefs, lifestyles and practices of the patient and identifies his/her own values, biases and prejudices.\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eCultural knowledge\u003c/b\u003e: the nurse seeks information about other cultures and different worldviews, and how these views impact a patient\u0026rsquo;s health.\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eCultural skills\u003c/b\u003e: the nurse collects relevant cultural data regarding the patient\u0026rsquo;s presenting problem and accurately performs a culturally based physical assessment.\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eCultural encounters\u003c/b\u003e: the nurse is involved in face-to-face encounters with patients from diverse cultures. Directly interacting with clients from diverse cultural groups will refine or modify one\u0026rsquo;s existing beliefs about a cultural group and will prevent possible stereotyping that may have occurred.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCultural competent- health workers were labeled culturally competent if they answered\u0026thinsp;\u0026ge;\u0026thinsp;75% of questions in favorable way (scoring 3 and above for an item). Culturally incompetent: health workers were labeled culturally incompetent if they answered\u0026thinsp;\u0026lt;\u0026thinsp;75% of questions.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eA total of 353 health professionals were included in this study. Almost equal number of male and female participants was included (48.7% and 51.3% respectively). Most (90%) of the health professionals were in the age group 21\u0026ndash;30; single (66%); nurses (57%). Most of the study participants were Bachelor degree holders (68%) and 83% had less than 5yers of clinical experience (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic characteristics of study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender ( n\u0026thinsp;=\u0026thinsp;353)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years ( n\u0026thinsp;=\u0026thinsp;349)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u0026ndash;30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u0026ndash;45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion ( n\u0026thinsp;=\u0026thinsp;353)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status (n\u0026thinsp;=\u0026thinsp;353)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession ( n\u0026thinsp;=\u0026thinsp;353)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic health officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum educational level attended with your health profession ( n\u0026thinsp;=\u0026thinsp;352)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB.Sc.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMSc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGP-MD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMD with specialty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience (n\u0026thinsp;=\u0026thinsp;347)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly salary (n\u0026thinsp;=\u0026thinsp;346)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eCultural competence of the health care professionals\u003c/h2\u003e\n \u003cp\u003eThe overall Campinha-Bacote\u0026rsquo;s IAPCC-R tool had an acceptable internal consistency with the calculated Chronbach\u0026rsquo;s \u0026alpha; (which is a function an average covariance or correlation among all possible combination of items) of 0.82; however, individual cultural competence constructs showed varied level of internal consistency which ranged from 0.39 (cultural awareness) to 0.73 (cultural desire) \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCultural competence and reliability of constructs\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConstructs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd. Dev.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChronbach\u0026rsquo;s \u0026alpha;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural Skill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural encounter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural desire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCultural competence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e66.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.82\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eAfter the scores of the cultural competence items were added, the mean score was calculated. Hence, the overall cultural competence mean (SD) score was 67(9.3) among all health care professionals. Among the cultural competence constructs, the highest mean scores were obtained for cultural desire (15.7) followed by cultural encounter (13.2), cultural awareness (13.1), cultural skill (12.8) and cultural knowledge (12.1) after adding all the scores of the 25 items (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). When the mean score of all the items were taken, the mean (SD) score was 2.7 (0.35). In the continuum of IAPCC-R, 4.3% of the various healthcare providers were culturally incompetent, 79% aware, 16.4% competent, and 0.3% proficient.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eAssociation of cultural competence items and sociodemographic characteristics\u003c/h2\u003e\n \u003cp\u003eCultural competence constructs were analyzed against some sociodemographic characteristics. The median scores of cultural knowledge, skills and encounters and desire were compared between male and female health care professionals. There was statistical significant difference in the median cultural knowledge, skills and encounters between males in females in which males showed a higher score (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The same analysis was performed for age groups (\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;30 vs\u0026thinsp;\u0026gt;\u0026thinsp;30 years) and there was no statistically significant difference in the median scores of all the cultural competence constructs. When the median scores of the cultural constructs were compared with different categories of health care professions, there was a statistically significant difference in the median scores of cultural skills, encounter and desire. Midwives scored better in cultural skills (p\u0026thinsp;=\u0026thinsp;0.003) and encounters (p\u0026thinsp;=\u0026thinsp;0.003) while residents scored better in the scored better in the cultural awareness (p\u0026thinsp;=\u0026thinsp;0.04) and skills (p\u0026thinsp;=\u0026thinsp;0.01) construct of cultural competence (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCultural competence by gender of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;172)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFemale ( n\u0026thinsp;=\u0026thinsp;181)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural awareness, median (IQR**)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural knowledge, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural skills, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural encounters, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural desire, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.0 (15.0, 18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.0 (14.0, 18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*Comparing the medians of scores of the cultural competence constructs and p-values are calculated using Mann-Whitney test;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e**IQR: Interquartile range\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eThere was statistically significant difference in the median scores of all cultural competence constructs among the different income categories of the health professionals (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCultural competence constructs by profession of participants (n\u0026thinsp;=\u0026thinsp;247)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedical doctor (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNurse (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMidwife (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResident (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural awareness, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural knowledge, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.5, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural skills, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e13.0 (12.0, 15.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural encounters, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e14.0 (13.0, 15.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural desire, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.0 (15.0, 19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.0 (14.0, 17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.0 (15.0, 17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e17.0 (16.0, 19.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e*Comparing the medians of scores of the cultural competence constructs with professional categories and p-values are calculated using Kruskal-Wallis H Test; **IQR: Interquartile range\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCultural competence by monthly income of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5000 ( n\u0026thinsp;=\u0026thinsp;95)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;9999 ( n\u0026thinsp;=\u0026thinsp;178)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=10000 ( n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural awareness, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e14.0 (12.0, 15.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural knowledge, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e12.0 (11.0, 14.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.0 (10.0, 13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural skills, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.0 (10.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural encounters, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (12.0, 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0 (11.0, 14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCultural desire, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.0 (14.0, 17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.0 (14.0, 18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.0 (15.0, 19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e*Comparing the medians of scores of the cultural competence constructs with the monthly salary categories and p-values are calculated using Kruskal-Wallis H Test; **IQR: Interquartile range\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study showed that the overall cultural competence among health professionals working at Saint Paul\u0026rsquo;s Hospital was low. Although 79% were culturally aware, only 16.4% were culturally competent. The overall Campinha-Bacote\u0026rsquo;s IAPCC-R tool had an acceptable internal consistency.\u003c/p\u003e \u003cp\u003eThe Campinha-Bacote tool was used in this study as a review of 4 models of cultural competence revealed that it is sufficiently comprehensive to guide empirical research and the development of educational interventions as well as strengthening cultural competence of health professionals in countries across the world (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Although there are concerns on the internal consistency of the Campinha-Bacote\u0026rsquo;s cultural competence tool; our study showed that it had an acceptable internal consistency with the calculated Chronbach\u0026rsquo;s α 0f 0.82 (which is a function an average covariance or correlation among all possible combination of items). This is consistent with a study done in South Africa which assessed cultural competence among critical care nurses using the same model (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study only 16.0% of the health care professionals were culturally competent. This is consistent with 2 previous studies done in Ethiopia addressing cultural competence among health professionals both at the public and private facilities (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The the study done at Bahir Dar City (2016) which assessed cultural competence among maternal health care providers showed that the overall competence level of health workers was low and concluded that the providers were aware of only their own culture but not the world view of their clients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In the other Qualitative study done at university specialized hospital at Jimma town of Ethiopia, it was explored that the cultural and linguistic diverse needs of patients were given inadequate attention during health care provision (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The study done in South Africa which employed the Campinha Bacote\u0026rsquo;s tool, showed (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) a relatively higher score (25%) compared to ours (16%). This difference could be explained by differences in the clinical service provision area of the health care professionals included in the studies; health sciences education curriculum, institutional policies/protocols on cultural competence and the type health care professions included in the studies. The ultimate goal of cultural competence is to make healthcare more responsive to the needs of patients, and increase their satisfaction with healthcare provision, decrease inappropriate differences in the characteristics and quality of care provided, and close the gaps in health status in diverse populations (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The low cultural competence score in a tertiary teaching center where socio-culturally diverse group of patients are served indicates the need for works to be done for improving provision of socio-culturally appropriate health care. These include the inclusion of cultural competence in institutional protocols, policies and curriculums at all levels of teaching as well as providing need based in-service trainings.\u003c/p\u003e \u003cp\u003eIn our study Cultural competence constructs were analyzed against some sociodemographic characteristics. Male health workers, those with higher incomes and midwives were found to have better cultural competence scores. Although it is difficult explain the association between being male and earning higher income with better cultural competence scores in this study, the higher score by midwives could be explained by the fact that mid wives in the study country are trained on respectful maternity care as part of in-service emergency obstetric care trainings. This is expected to improve their exposure to some of the concepts related to socio-cultural sensitivity in health care provision.\u003c/p\u003e"},{"header":"Conclusions \u0026 Recommendations","content":"\u003cp\u003eThe Campinha-Bacote\u0026rsquo;s tool had a good internal consistency and can be utilized for assessment of cultural competence in a low income country context. The overall cultural competence score among the health care professionals in this study was low. Hence the hospital needs to devise strategies to improve socio-cultural competence of its professionals in health care provision. The strategies could include incorporation of cultural sensitivity in educational curriculums, institutional policies and documents; conducting in-service trainings\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Institutional Review Board (IRB) of Saint Paul\u0026rsquo;s Hospital Millennium Medical College. Permission was also obtained from the hospital medical service vice provost office. All the study participants were informed about the purpose of the study and their right to refuse. Written consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials are available on reasonable request to the primary or co-authors: email [email protected] or [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors have no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: WG: inception, planning, conduct, data analysis, and manuscript writing; MB: inception, supervision, revision of manuscript; MW: data collection tools, analysis, write up \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e: We would like to extend our gratitude to Saint Paul\u0026rsquo;s Institute for Reproductive Health and Rights (SPIRHR) for facilitating acquisition of internationally accepted data collection tool (Campinha- Bacote\u0026rsquo;s cultural assessment tool).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBetancourt JR, Green AR, Carrillo JE. Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund; 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e13, Robins LS. Improving Cultural Awareness and Sensitivity Training in Medical School. Acad Med. 1998;73(Supplement 10):S31\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00001888-199810000-00037\u003c/span\u003e\u003cspan address=\"10.1097/00001888-199810000-00037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [PubMed].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmedley BD, Stith AY, Colburn L, Evans CH. The right thing to do, the smart thing to do. Enhancing diversity in the health professions. Washington, DC: National Academies; 2001. pp. 1\u0026ndash;366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarrett PW, Dickson HG, Whelan AK, Roberto F. What do non-English-speaking patients value in acute care? Cultural competency from the patient\u0026rsquo;s perspective: a qualitative study. Ethn Health. 2008;13:479\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeaver SJ, Lubomksi LH, Wilson RF. Promoting a culture of safety as a patient safety strategy: A systematic review. Ann Intern Med. 2013;158:369\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeuter RF, Gallois C, Segalowitz NS. Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Serv Res. 2015;15:371.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeech-Maldonado R, Elliott MN, Pradhan R. Can hospital cultural competency reduce disparities in patient experiences with care? Med Care. 2012;50:S48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeclere B, Jensen L, Biddlecom E. Health care utilization, family 432 context, and adaptation among immigrants to the United States. J Health Soc Behav. 1994;35:370\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2307/2137215\u003c/span\u003e\u003cspan address=\"10.2307/2137215\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [PubMed].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmily Ihara. Cultural competence in health care: is it important for people with chronic conditions? Issue Brief Number 5, February 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(Suppl 1):181\u0026ndash;217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAragaw, et al. Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional study. BMC Pregnancy Childbirth. 2015;15:227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMesfin B. Cultural Sensitiveness in Health Care Delivery of Jimma University Specialized and Teaching Hospital, South West Ethiopia, 2016. Qual Prim Care. 2017;25(3):109\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampinha-Bacote J. Inventory for assessing the process of cultural competence among healthcare professionals- revised (IAPCC-R) 4. Cincinnati: Trans cultural Care Associates; 2003. [PubMed].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbougami AS, Pounds KG, Alotaibi JS. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Beer J, Chipps J. A survey of cultural competence of critical care nurses in KwaZulu-Natal. SAJCC November 2014, 30, No. 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems. A systematic review. Am J Prev Med. 2003;24(3 Suppl):69\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"culture, competence, sensitivity, campinha-Bacote, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4228802/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4228802/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. Most health care professionals are not culturally competent in health care provision which compromises quality of care. The aim of this study was to explore cultural competence among health care providers at Saint Paul\u0026rsquo;s hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A cross sectional s study was conducted among 353 health care providers. Data was collected using the Campinha-Bacote\u0026rsquo;s Cultural awareness assessment tool. A five-point Likert scale was used to measure the respondents\u0026rsquo; overall level of cultural competence which included 5 constructs: cultural awareness, cultural knowledge, cultural skills, cultural encounters and cultural desire. Data was analyzed using Stata Statistical Software Re. The score was classified as culturally incompetent (25\u0026ndash;50 points), culturally aware (51\u0026ndash;74 points), culturally competent (75\u0026ndash;90 points) and culturally proficient (91\u0026ndash;100 points). Ethical clearance was obtained from the IRB of the hospital and written consent was obtained from the study participants.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Campinha-Bacote\u0026rsquo;s cultural awareness assessment tool had an acceptable internal consistency with the calculated Chronbach\u0026rsquo;s α of 0.82. The overall cultural competence mean (SD) score was 67(9.3) among all health care professionals. Only 16% of the health care providers were culturally competent. Among the cultural competence constructs, the highest mean scores were obtained for cultural desire (15.7) followed by cultural encounter (13.2), cultural awareness (13.1). Male, those with higher incomes and midwives were found to have better cultural competence scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Campinha-Bacote\u0026rsquo;s tool had a good internal consistency and can be utilized for assessment of cultural competence in a low income countries context. The overall cultural competence score among the health care professionals was low. Hence the hospital needs to devise strategies to improve cultural competence of its health care providers.\u003c/p\u003e","manuscriptTitle":"Cultural Competence among Health Care Providers at a Teaching Hospital in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 15:25:58","doi":"10.21203/rs.3.rs-4228802/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2eb83c8d-2362-44a3-afb7-17e3454b9ec9","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-15T09:23:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 15:25:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4228802","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4228802","identity":"rs-4228802","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}