Sweden develops tools to teach doctors cultural competence for migrant patients

<p><strong>Background</strong></p><p>Healthcare in Sweden must provide equitable and effective care to all residents by adapting to an aging and multicultural population with varied needs. To achieve this, increased cultural competence among healthcare professionals is required. To support healthcare professionals, in developing professional knowledge in encounters with migrant persons a self-rating instrument measuring cultural competence as well as education in cultural competence can equip professionals to meet this need. Improving cultural competence in healthcare can enhance communication and patient satisfaction, reduce misunderstandings and errors, and improve overall healthcare outcomes. However, there is a lack of relevant instruments and education to learn cultural competence across various healthcare areas in Sweden.</p><p><strong>Aim</strong></p><p>The general aim of this thesis was to develop and evaluate a self-assessment instrument in cultural competence for healthcare professionals. Further the aim was to design an educational program to enhance cultural competence among healthcare professionals working in interprofessional teams.</p><p><strong>Methods</strong></p><p>This thesis consists of four studies, with varied methodology and design. In study I, 19 occupational therapists participated, divided into four focus groups. Qualitative content analysis was used to examine the content validity and utility of the CCAI-S. In study II data was collected by a web-based questionnaire based on CCAI-S to 428 occupational therapists to investigate the construct validity, reliability and utility of the CCAI-S. Factor analysis was performed as well as descriptive statistics. In study III data was collected by a web-based questionnaire based on CCAI-S to measure cultural competence in 279 healthcare professionals in interprofessional teams. Data was analyzed with descriptive statistics, univariate analyses and linear regression. Study IV used a co-design methodology, in which healthcare professionals (n =11), patients (n =6) and researchers (n =5) collaborated to develop an educational programme in cultural competence. The analysis in the process was integrated with data collection through an iterative and agile approach.</p><p><strong>Results</strong></p><p>The CCAI-S showed high content validity for all 24 items, though six required reformulation. It demonstrated strong utility for increasing cultural awareness among healthcare professionals and highlighted the importance of organizational support in developing cultural competence. A three-factor model was identified: 'Openness and awareness,' 'Workplace support,' and 'Interaction skills,' with high factor loadings and strong Cronbach’s Alpha support. Even though all 24 items were deemed clinically relevant based on construct validity of CCAI-S led to 13 of 24 items deemed relevant. 58% of healthcare professionals reported high levels of Openness and awareness, 35% high interaction skills, and 6% high workplace support. Cultural competence was linked to a high percentage of migrant clients and prior cultural competence development through experience or education. Professionals felt open and aware but lacked workplace support and education. A prototype of an educational programme with four modules was co-designed: cultural knowledge, reasoning, interaction, and context, each with specific learning objectives and activities to enhance cultural competence in healthcare.</p><p><strong>Conclusion</strong></p><p>The CCAI-S demonstrated good measurement properties and high clinical relevance. Most healthcare professionals felt culturally open and aware but needed more workplace support and education to improve their interaction skills and develop cultural competence. The CCAI-S can guide organizations in enhancing staff cultural competence. The educational program's clinical relevance was ensured through co-design by professionals and patients. Fostering cultural competence in healthcare is essential for meeting diverse patient needs. Prioritizing self-assessment and education can lead to a more inclusive and effective healthcare system.</p>