CITI GUIDE: Cultural Competence in Research

What terms can you use to describe cultural competence?

Many terms are used to describe cultural competence: awareness, responsiveness, safety, and sensitivity. But, unlike cultural responsiveness, sensitivity, or appropriateness, cultural competency requires more than simply being sensitive to or aware of cultural differences. It necessitates taking action to improve one's competence. Becoming culturally competent is an on-going process of developing skills, values, and the capacity to function effectively in cross-cultural situations.

What is Cultural Competence?

-Cultural competence refers to understanding the importance of social and cultural influence on the beliefs and behaviors of the patient, student, colleague or client.

What is Culture?

-Culture is fundamental to everyone's perceived identity. It is a mix of... 1. one's values, beliefs 2. standards, norms 3. behaviors 4. language 5. communication styles 6. thinking patterns.

Learning Objectives

-Describe the concept of Cultural Competence in Research -Explain the importance of Cultural Competence in Research -Describe ways to enhance the engagement of diverse populations and communities in research -Identify cultural competence challenges faced by researchers when working with culturally diverse populations

Essentials of Cultural Competence in Research

-We define Cultural Competence in Research as the ability of researchers and research staff to provide high quality research that takes into account the diversity of a study population's values, beliefs and behaviors when developing research ideas, conducting research and exploring applicability of their findings. -Rapid changes in the US demographics and subsequently research study populations call for adjustments in research study design, analysis and interpretation processes.

Improving behavioral and health outcomes

Appreciating and integrating culturally diverse perspectives among providers (health workers, educators, researchers, and others) improves communication and builds confidence among minority populations, thus increasing access to resources among minority populations.

What is Diversity?

By definition, diversity can include differences in race, ethnicity, age, gender, size, religion, sexual orientation, and physical and mental ability.

What is CBPR?

CBPR, begins with a research topic of importance to a specific community, with the aim of combining knowledge and action for social change to improve community health and perhaps address health disparities.

CBPR

Community Based Participatory Research

What is cultural competency in research?

Cultural Competence in Research is the ability of researchers and research staff to provide high quality research that takes into account the culture and diversity of a population when developing research ideas, creating the theoretical and conceptual framework, designing the study, conducting research, interpreting and exploring the applicability of the research findings, and disseminating the results.

What Cultural Competency in Research does?

Cultural Competence in Research plays a critical role in study design and implementation processes, including the development of research questions and hypotheses, outreach and recruitment strategies, consent activities, data collection protocols, analyzing and interpreting research findings, drawing conclusions and presenting the results. Altogether, cultural congruence in these research processes helps to ensure the research is applicable to diverse populations and if necessary can be adapted to meet the target population's social, cultural, and linguistic needs. Cultural competence can be crucial to successfully recruiting and retaining diverse individuals as study subjects.

What is Cultural Competence in health care?

Cultural competence in health care describes the ability of systems and health care professionals to provide high quality care to patients with diverse backgrounds, values, beliefs, and behaviors, including communicating effectively and tailoring delivery to meet patients' social, cultural and linguistic needs and perspectives.

What can Institutional Review Boards (IRB's) and researchers do to support this work?

IRB's Should: -Review IRB membership to determine if there are large communities or cultures that participate in the research they approve and seek an IRB member that can help represent that community -Seek consultants as needed to help them understand the cultural issues as they pertain to a particular protocol -Consider educational initiatives on cultural competence -When appropriate, as part of a protocol application, ask questions regarding what efforts the researcher has made to work with and understand the communities being studied Researchers Should: -Look for members of specific communities to help identify areas of concern for research -Seek guidance from representatives of the community when developing and implementing protocols with communities -Consider adding members with expertise in the community under study as part of the research team

Conducting Research Ethically-The Belmont Report

In 1979, the National Commission for the Protection of Humans Subjects of Biomedical and Behavioral Research established ethical principles and guidelines for protecting human subjects in research. The three principles, 1.respect for persons 2. beneficence 3. justice their application, as outlined in the Belmont Report, requires culturally competent research-related interactions with study participants.

Federal Requirements for Minority Population Participation in Research

In 1994, the National Institutes of Health (NIH) established policy for the inclusion of women, children, and members of minority groups and their subpopulations in biomedical and behavioral clinical studies. Public Law 103-43 requires that women and minority subjects "be included in all clinical research studies, as appropriate for the scientific goals of the work proposed."

Importance of Cultural Competence in Research

It is important that research keeps pace with and is fully responsive to the challenges that arise as a result of the rapidly increasing diversity of U.S. demographics.

Beneficence

Second, beneficence requires favorably balancing physical, emotional, economic, stigmatization, and confidentiality risks and potential benefits of research participation. Risks and benefits differ according to multiple factors and circumstances that vary widely across diverse communities and minority populations are more vulnerable to risks. Researchers need to engage community leaders in the process of estimating risk/benefit ratios to gain a full appreciation for how participation might affect individuals participating in studies conducted with diverse populations.

Respect

Specifically, respect for persons requires researchers to assure autonomy and protect those with diminished autonomy. Researchers meet this obligation by allowing those who can to make informed choices about taking part in research and by instituting added protections for those who do not have the capacity to decide. In diverse communities, the former can only be accomplished when information is tailored to subjects' linguistic needs, comprehensible, and delivered in a culturally congruent manner.

Justice

Third, justice for the individual requires fair recruitment practices. Researchers should be impartial when it comes to the enrollment of study subjects. No single group or populations should be favored. No group or population should be exposed to riskier interventions due to their circumstances. Social justice requires decisions be made by researchers in light of the ability of certain ethnic and economic classes to bear added burdens of research. Disadvantaged groups should be protected from being asked to participate in research for convenience or socioeconomic status. In such cases, only less burdened groups should be asked to accept the risks of research except when the study relates directly to conditions specific to the disadvantaged group.

Trust, Transparency, and Impartiality

When conducting research with diverse communities, involving community members in decisions about key aspects of the research, promoting feelings of ownership within the community, maintaining public accountability and transparency, and assuring appropriate ethics oversight creates trust in study subjects.