Mandating Cultural Competency
Training Through Legislation:
Impact on Attitudes?
Guadalupe Pacheco, MSW
Senior Health Advisor to the Director, Office of Minority Health, HHS
Project Officer, Think Cultural Health
March 19, 2011
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HHS Office of Minority Health
• Mission: To improve the health of racial and ethnic
minority populations through the development of
health policies and programs that will eliminate
health disparities
• National Standards for Culturally and Linguistically
Appropriate Services in Health Care (CLAS Standards)
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Think Cultural Health
from the HHS Office of Minority Health
• Continuing education programs that
equip health professionals with
awareness, knowledge, and skills to
treat diverse patients
• Up-to-date information on issues
related to cultural competency and
health inequities
• Tracking of cultural competency
legislation around the country
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What is Cultural and Linguistic Competency?
Cultural competency is
effectively providing
services to people of all
cultures, races, ethnic
backgrounds and religions
in a manner that respects
the worth of the
individual and preserves
their dignity.
Graves 2001
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Legislative Mandates on Cultural
Competency Training
Dark Blue denotes legislation
requiring (WA, CA, NJ, NM) or
strongly recommending (MD)
cultural competence training,
which was signed into law.
Purple denotes legislation
which has been referred to
committee and is currently
under consideration.
Royal Blue denotes legislation
which died in committee or was
vetoed.
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Legislative Mandates on Cultural
Competency Training
• Mandatory cultural competency education garners
some criticism; however, many feel that it will
improve patient-provider interactions, compliance,
and patient satisfaction.
• New Jersey: A case study on the implications of
legislation for cultural competency curricula
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A Physician’s Practical Guide to
Culturally Competent Care
• Free, online program
accredited for physicians,
physician assistants, and
nurse practitioners
• Designed to equip
physicians with the
awareness, knowledge and
skills to treat diverse
patients and improve
quality of care
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A Physician’s Practical Guide to
Culturally Competent Care
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A Physician’s Practical Guide to
Culturally Competent Care
• Two-year evaluation results: Curriculum participation
results in development of knowledge, awareness and
skills related to cultural competency.
• The curriculum shows the potential for improving
health outcomes and ultimately mitigating racial and
ethnic health disparities.
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Assessing the Impact of Cultural
Competency Mandates
• Mandatory training may be an ideal way to promote
cultural competency as an effective strategy to
eliminate health disparities:
– Higher exposure to cultural competency due to legislative
requirements
– Higher exposure to cultural competency creates a
workforce equipped to provide quality care to diverse
patients
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Assessing the Impact of Cultural
Competency Mandates
• New Jersey mandated 6 hours of cultural
competency continuing education for physician
relicensure.
• Examination of differences in attitudes about
cultural competency between individuals who selfselect to take the program and those who take it to
fulfill a mandate.
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Assessing the Impact of Cultural
Competency Mandates
• Self-reflection components of the curriculum were
compared among mandated and non-mandated
individuals.
• Physicians’ attitudes related to cultural
competency were similar for mandated and nonmandated participants.
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Assessing the Impact of Cultural
Competency Mandates
• Large increases in New Jersey physician
participation in the cultural competency curriculum
New Jersey physician participants:
1 year prior to the mandate
1 year following the mandate
156
9,078
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Cultural Competency Mandates
• Mandatory cultural competency education garners
some criticism, including the idea that forced
training will create negative reactions to cultural
differences or cross-cultural efficacy.
• However, these concerns seem to be unfounded
based on these results.
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Implications – Potential for
Cultural Competency Mandates
• Completion of the physicians’
curriculum, whether
mandated or not, increases
cultural competency
knowledge and may improve
practice behavior.
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Implications – Potential for
Cultural Competency Mandates
• This negates criticism that mandatory cultural
competency training is ineffective because
mandated providers will show reluctance in grasping
cultural competency concepts.
• Mandates may be an ideal way to help improve care
and ultimately help eliminate health disparities.
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Summary
• Cultural competency education has the potential to
improve patient-provider interactions, compliance,
and patient satisfaction.
• Through cultural competency education mandates,
policy can play a vital role in eliminating health
disparities.
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For information, contact:
Guadalupe Pacheco, MSW
Office of Minority Health, HHS
Guadalupe.Pacheco@hhs.gov
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