Cultural Competency Needs Assessments: Tools for Improving Healthcare Design

In this episode, we explore the world of cultural competency needs assessments - essential tools for healthcare professionals designing community health programs. We dive into eight different assessment techniques, ranging from community surveys and focus groups to innovative approaches like photovoice. For each method, we discuss how it enhances cultural competency, its relative difficulty to implement, and provide a specific resource or tool to help listeners get started. Whether you're new to cultural competency or looking to refine your approach, this episode offers valuable insights into understanding and addressing the diverse needs of the communities you serve. Join us as we unpack these powerful tools for creating more inclusive, effective, and culturally responsive healthcare interventions.

Tami Moser [00:00:01]:
Welcome back to the community health management design podcast. I'm doctor Tammy Mosier. And in today's episode, we're gonna talk about cultural competency needs assessments, crucial tools for understanding and addressing the diverse needs of the communities we serve. Cultural competency needs assessments are systematic approaches to gathering information about the cultural backgrounds, preferences, and needs of a community. These assessments help healthcare designers and providers tailor their services to better meet the needs of diverse populations. So let's dive into some of the most common types of needs assessments and look at how they improve cultural competency and their relative difficulty level to implement. The first is community surveys. These are structured questionnaires distributed to community members.

Tami Moser [00:00:46]:
It provides quantitative data on community demographics, health beliefs, practices, and needs. The difficulty level is moderate here. It requires careful design of culturally appropriate questions, And this really means you would want to find a validated instrument, may need translation into multiple languages depending on the population you're trying to serve, and it can be time consuming to distribute and analyze. Although let me point out that the translation is not as difficult as it was at one time. There are multiple tools now that you can input in one language and have it exported in another. The biggest thing is gonna be checking those if you don't read in that language. So that can be an indicator that you need to have either people on your team that speak or you can find people that would be part of your normal, community service, and have them provide input as they read it to make sure that it's, valid. We have a resource to get you started here, and this is the Cultural Competence Health Practitioners Assessment, CCHPA, CCHPA, by the National Center For Cultural Competence.

Tami Moser [00:02:03]:
It's a comprehensive self assessment tool that can be adapted for community surveys, and you will find two links to the websites, up above that will take you to 2 different places where you have a good number of resources to work with here. Now, focus groups are the second and these are facilitated small group discussions with community members. It improves cultural competence because it offers rich qualitative insights into community perspectives, experiences, and needs. But the difficulty lever here ratchets up a little bit. It's moderate to high. 1st, you have to look and find skilled facilitators, ideally from the community. You need careful participant selection to ensure diversity, but also to ensure that you have the right people, meaning people that actually meet the population criteria that you have that are willing to share. And it's time intensive both for organizers and participants.

Tami Moser [00:03:01]:
But we have a resource to start. The toolkit for conducting focus groups by Omni Institute provides a step by step guide for planning and conducting those focus group sessions. And you'll find that in your additional resources list for this module. Number 3 is key informant interviews. These are in-depth interviews with community leaders, health care providers, or other knowledgeable individuals. It improves cultural competency because it provides expert insights into community dynamics, health issues, and cultural nuances. The difficulty level here is moderate. It requires identifying and recruiting appropriate informants.

Tami Moser [00:03:41]:
It's time consuming to conduct and analyze, and it may present biased views if it's not diverse enough. Let me take one step back. Time consuming to conduct and analyze. Analyzing qualitative data takes some training and skill. There are different programs you can use that can help in this area, and I'll mention a few up above in your website resources. But just keep in mind that that's a component of this. We do have some resources to start. The Key Informant Interviews Guide by UCLA Center For Health Policy Research offers detailed instructions on conducting these interviews and you'll find it up in your additional, resources.

Tami Moser [00:04:23]:
Observational assessments is your 4th option. This is systematic observations of community settings, interactions, and behaviors. It improves cultural competency because it offers direct insights into community life, health behaviors, and environmental factors. However, the difficulty for this one is high. It requires trained observers. It's time intensive and it can raise ethical concerns about privacy. One other issue associated with this is we know that watched behavior is changed behavior. In other words, if you're observing this over time, you need enough time for people you're observing to think of you like a fly on a wall.

Tami Moser [00:05:08]:
You're not thought of at all. In other words, they will react the way that they would if you weren't there. The beginning of your observation assessments often impacts that in that when you first start observing and they know you're observing, then they may shift their behavior to better fit what they think you want to see versus what they would actually normally do. And that's the barrier you have to break down, if you will, if you're gonna use observational assessments. Now you can do this through tapping into people that are always a part of the dynamic in those that particular a observation is happening. In other words, informed consent is impossible when you're kind of trying to, minimize someone's ability to sit to know that you're doing that. So there's a balancing act here, and that's why it's high level of difficulty and requires trained observers. So, one of the resources to start, if this is something you're interested in, is participant observation.

Tami Moser [00:06:23]:
It's a chapter in qualitative research methods, a data collector's field guide by Family Health International, and it provides a comprehensive overview of this particular method if it's something you wanna pursue. Your 5th option is a cultural competent self assessment. These are tools for health organizations or individuals to evaluate their own cultural competence. It improves cultural competency by helping to identify gaps in knowledge, skills, and practices within the healthcare system itself. The difficulty here is low to moderate. There's many standard tools available for this. It does require honest self reflection by those who are taking it. In other words, you want them to feel comfortable to answer the way that they would behave or actually answer to reflect their true attitudes versus trying to answer in a way that they think you want them to answer.

Tami Moser [00:07:17]:
So this can't have any kind of negative consequences associated with content, if you will. And it would also be a really good idea to make the questionnaire anonymous. In other words, they reply, you have 50 replies coming in. You have no idea who is who. So that's another option there to kind of help. It does or may need external facilitation for organizational assessments, depending on the assessment you choose. The resource to start here is the cultural competent self assessment checklist by the Central Vancouver Island Multicultural Society. It's a free easy to use tool for individual self assessment.

Tami Moser [00:07:58]:
So this might be a good time for you to either pause or know you're gonna come back to, self assessment from here and actually go through the checklist yourself and see where you fall. Number 6 is a community asset map. So this is a collaborative process to identify community resources, strengths, and potential partners. It improves cultural competency because you can recognize and leverage existing community strengths and networks. It's got a moderate difficulty level. It requires active community participation. It can be time intensive and it needs ongoing updates as the map shifts. The resource to start is an asset mapping toolkit by sustaining community.

Tami Moser [00:08:42]:
It offers a practical guide to get started with community asset mapping and you'll find a link to that up in your additional resources. Number 7 is health literacy assessments. These are tools to evaluate the community's ability to obtain, process, and understand basic health information. It's a great tool and provides a good amount of information to help you tailor health communication and education to community needs. In other words, you don't have to guess and just go with the 5th grade level, although you could. But this would give you more information about the actual health literacy of the community you're targeting. And as a moderate difficulty level, requires careful selection or development of culturally appropriate assessment tools and may need translation and validation in multiple languages. The resource to start here is the health literacy universal precautions toolkit by the agency for healthcare research and quality, and it includes tools for assessing health literacy in clinical settings.

Tami Moser [00:09:39]:
The agency for healthcare research and quality, you'll see a couple of different links for that in your materials. This is a great resource, has many different options available and many different toolkits. So I would highly recommend you become comfortable and familiar with that website and really look at what they've got available because you might be surprised at what could help you here. And then the last one we're gonna talk about is photo voice. And this is a participatory method where community members use photography to document their health experiences and concerns. It improves cultural competency by providing visual community driven insights into health issues and cultural context, but it's got a very high difficulty level. It requires significant time and resources, needs careful ethical considerations and intensive data analysis. But if this is something you're really interested in, there's a manual and resource kit by photovoice.org that provides comprehensive guidance on implementing photo voice, projects.

Tami Moser [00:10:39]:
And you'll see that you have a link to the photo voice website above in the website tools. Each of these assessment tools offers unique insights into the cultural competency needs of a community. The choice of tool depends on your specific goals, resources, and community context. Often a combination of methods yields the most comprehensive understanding. Remember, the assessment is just the beginning. The real work lies in using these insights to design and implement culturally competent healthcare programs. For our listeners interested in diving deeper into these assessment techniques, we've included links to these resources and the additional materials list. Remember, while these tools provide excellent starting points, they may need to be adapted to your specific community context.

Tami Moser [00:11:24]:
Until next time, I encourage you to explore these resources and consider which assessment methods might be most appropriate for your community health projects. Thank you for listening and remember effective cultural competency starts with understanding. Keep asking, keep listening and keep learning and until next time. This is Tammy Mosier.