RESOURCE AND SELF-DIRECTED WORKBOOK TO ENHANCE CULTURAL COMPETENCE - - PowerPoint PPT Presentation

DEVELOPING A DIGITAL LEARNING RESOURCE AND SELF-DIRECTED WORKBOOK TO ENHANCE CULTURAL COMPETENCE IN PRIMARY HEALTHCARE

Sarah Salway, Sheffield Hallam University, UK Gina Higginbottom, University of Alberta, Canada Luke Miller, University of Salford, UK

Background

 Diverse definitions and models of 'cultural

competence' (CC) in the UK. A contentious term.

 Many criticisms of attempts to operationalise CC in

practice.

 Little improvement in service experiences among

minority ethnic groups over time.

 Lack of attention to developing and evaluating

pedagogical resources to enhance CC effectively and cost-efficiently.

 Challenges and opportunities at the present time.

Developing a digital learning resource, Salway, Higginbottom & Miller

 A diverse and contested term; criticisms include:

• confusing and misleading
• focuses attention on 'otherness' and pathologises
• obscures power, racism, socioeconomic factors
• focuses on specific knowledge rather than generic skills

and attributes

• other terms may be better e.g. 'cultural safety', 'difference

sensitivity' etc. Arguably, CC has yet to be defined precisely enough to inform effective workforce training and development.

Developing a digital learning resource, Salway, Higginbottom & Miller

 Past critiques of approaches to enhancing CC of

healthcare providers and organisations:

• Overly simplistic and stereotyping 'cook-book' solutions.
• Failure to engage with the emotional side of diversity work.
• Inadequate challenge to providers/services to recognise
• wn contribution to exclusionary processes and structures.
• Insufficiently grounded in the day-to-day realities of

providing healthcare in resource-poor, high-demand settings.

• Failure to engender responsibility for delivering sustainable

change in practices and structures.

Developing a digital learning resource, Salway, Higginbottom & Miller

 Lack of attention to developing and evaluating

pedagogical resources and approaches - key questions remain unanswered

• Does training in 'cultural competence' enhance quality and

experience of care for minority ethnic patients?

• What modes of training are effective and cost-efficient?
• Could a focus on cultural competence have unexpected

side-effects or adverse consequences?

Developing a digital learning resource, Salway, Higginbottom & Miller

 Challenges and opportunities:

• Sustained UK policy commitment to addressing

ethnic inequalities in healthcare experiences and

• utcomes.
• Evidence that those in training have an appetite/

interest for developing such competence.

• Complex interventions demand sophisticated

evaluation designs.

• Crowded policy arena and competition for

resources for interventions and research.

Developing a digital learning resource, Salway, Higginbottom & Miller

Key elements of our cultural competence learning resource

 Grounded in the experience of health professionals

working in multiethnic settings.

 Supported by published literature.  Web-based to allow flexible learning.  Accompanied by self-directed workbook to promote

reflexive thinking, problem identification and concrete planning towards improved practice.

 Attention to individual practitioner, organisation and

wider context.

Developing a digital learning resource, Salway, Higginbottom & Miller

The development process (1-6)

1.

8 in-depth interviews with general medical practitioners (GPs) who were first generation migrants from South Asia.

2.

Analysis and extraction of key themes.

3.

Background literature review.

4.

Story board / e-resource template development.

5.

Follow-up video-recorded interviews with 3 GPs.

6.

Supplementary video-recorded interviews with 7 health professionals working within the field of diversity.

Developing a digital learning resource, Salway, Higginbottom & Miller

The development process (7-14)

7.

Review and editing of filmed clips.

8.

Drafting of text and e-resource design.

9.

Piloting round 1.

• 10. Editing of e-resource.
• 11. Piloting round 2.
• 12. Finalisation of e-resource.
• 13. Workbook development and piloting.
• 14. Workbook finalisation.

Developing a digital learning resource, Salway, Higginbottom & Miller

Chapters of the resource

• 1. Introduction & Background
• 2. Minority ethnic patient experiences
• 3. Cultural competence
• 4. Barriers and facilitators
• 5. Rewards and benefits

Links ; Glossary; Acknowledgements

Throughout the resource the text is complemented by pictures and video clips in which professionals share their experiences and perspectives.

Developing a digital learning resource, Salway, Higginbottom & Miller

Chapter 2: Minority ethnic patient experiences

 Using direct quotations and vignettes from recent

research studies, we illustrated the following prevailing themes in minority ethnic patient experiences:

• communication problems
• being dismissed
• being excluded
• cultural misunderstandings
• lack of empathy
• fear and mistrust
• inappropriate service constellation & provision
• socioeconomic deprivation
• direct racial discrimination

Developing a digital learning resource, Salway, Higginbottom & Miller

Chapter 3: Cultural competence

 Using material from published literature and insights

from the interviews with healthcare providers this chapter combines text and video clips to cover:

• Definitions of CC
• Overview of terms and concepts
• Dimensions of CC
• CC in practice - GP experiences

Developing a digital learning resource, Salway, Higginbottom & Miller

Chapter 4: Barriers and facilitators

 Drawing on published literature and recorded

interviews, this chapter discusses the following barriers and facilitators to enhancing CC:

Barriers: apprehension & uncertainty; checklist/'cook book' approaches; failure to consider other axes of difference; over- reliance on 'BME experts'; competing priorities; limited evidence base; mixed messages in policy and wider society. Facilitators: leadership and strategic direction; monitoring and performance management; knowing communities and learning from patients; diversifying the workforce; training and support; innovation and flexibility.

Developing a digital learning resource, Salway, Higginbottom & Miller

Chapter 5: Rewards and benefits

 This chapter uses video clips to illustrate the rewards

and benefits of enhancing CC for:

• patients
• providers
• organisations

Developing a digital learning resource, Salway, Higginbottom & Miller

Design of workbook

 Self-directed with prompting questions and self-

completion boxes to encourage reflection and future planning.

 Sections of the workbook mirror the chapters of the

resource.

 Designed to be used flexibly alone or with support

• f a learning set.

 Certificate of completion included.

Developing a digital learning resource, Salway, Higginbottom & Miller

Insights from personal narratives

 The interviews with general medical practitioners

highlighted a number of issues that are not commonly emphasised in existing CC frameworks:

• Ambivalence and complexity in relation to ethnic and

religious identifications.

• The need to challenge structural factors that discriminate

against both providers and the populations they seek to serve in multiethnic settings.

• Centrality of personal skills and attributes.
• The complexity of insider-outsider identities.
• The need for innovation in managing needs and demands.
• Emotional aspects of working across difference.

Developing a digital learning resource, Salway, Higginbottom & Miller

Supplements to personal narratives

 Contrary to initial expectations from those who

commissioned the work, personal narratives were found to be insufficient to generate the material for a comprehensive learning resource. We therefore drew on published literature to provide:

• more comprehensive background material
• alternative perspectives and insights
• additional examples

Developing a digital learning resource, Salway, Higginbottom & Miller

Challenges

 Time-consuming to get consent to participation from

GPs - we had hoped for more narratives.

 Not all GPs displayed high levels of CC (according

to established frameworks); but personal journeys and empathy were important resource.

 Lack of funds for evaluation of (i) acceptability and

(ii) impact.

 Commissioners desire to sell the product rather than

make it freely available.

Developing a digital learning resource, Salway, Higginbottom & Miller

Follow on developments in Canada

 A team member (GH) subsequently obtained a

grant to develop the Canadian version of the digital resource

 The context of health care vastly different to the UK

as is the demographic profile of Canada

 Immigration used in Canada as a population

expansion couple with the very diverse Aboriginal groups in Canada means that the resource in a very different format is in development

Developing a digital learning resource, Salway, Higginbottom & Miller

Canadian Resource

 Target audience student nurses  Will include a chapter on Cultural Safety  A facilitators handbook will be developed  The resources will be implemented at different

points in the undergraduate curriculum

 The project will include a formal evaluation

component to include undergraduate students and facilitators

 A further research study will be developed

associated with the implementation.

Developing a digital learning resource, Salway, Higginbottom & Miller

Acknowledgments

 Bradford & Airedale Teaching PCT  Dr. Atif Imtiaz  Vicky Mathers  Jon Willis  Richard Badger

Developing a digital learning resource, Salway, Higginbottom & Miller

Further details

 Copies of the UK digital learning resource and

workbook are available from: Sarah Salway Centre for Health & Social Care Research 32 Collegiate Crescent SHEFFIELD S102BL UK s.salway@shu.ac.uk

Developing a digital learning resource, Salway, Higginbottom & Miller