The Impact of a Cross-Cultural Care Education Program on Cultural Competence of Aged Care Staff

Sunday, 22 July 2018: 2:45 PM

Lily Xiao, PhD1
Eileen Willis, PhD, MEd2
Ann Harrington, PhD3
David Gillham, PhD4
Anita De Bellis, PhD4
Wendy Morey, MN5
Lesley Jeffers, MN6
(1)College of Nursing and Health Sciences, Flinders University of Australia, Adelaide, Australia
(2)College of Nursing and Health Sciences, Flinders University, Adelaide South Australia 5001, Australia
(3)College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
(4)Flinders University, Adelaide, Australia
(5)6 Bartley Crescent, Wayville, Resthaven Inc. Australia, Adelaide, Australia
(6)Aged Care Research and Development National Office, Adelaide, Australia

Purpose:

Cultural and linguistic diversity between residents and staff is significant in aged care homes in Australia. Residents are from over 170 countries with 31% born overseas and 20% born in a non–English speaking country (Australian Institute of Health and Welfare 2016). Staff who care for residents are also from culturally and linguistically (CALD) diverse backgrounds. It is estimated that 32% of staff were born overseas and 26% were born in a non–English speaking country (Mavromaras et al. 2017). The diversity generates demands for education interventions to improve cultural competence for staff in cross-cultural interactions with older people and team members. However, research evidence on the impact of a cross-cultural care education program on staff cultural competence is scarce.

The aim of the study was to test the hypothesis that an evidence-based cross-cultural care education program would improve cultural competence for staff in skill-mixed and resource poor care settings in aged care homes. This study was part of a 3-year project conducted between 2015 and 2017 undertaken by a university partnering with two aged care organisations.

Methods:

A pre-test- post-test design was applied to address the aim of the study. Staff who participated in the study were from four large size aged care homes in a state of Australia. The University concerned formed a consortium with these aged care organisations to co-design and implement the education program. The program included five modules: An introduction to cross-cultural care for new staff; Cross-cultural Communication; Cross-cultural leadership; Cross-cultural dementia care and Cross-cultural end of life care. The intervention lasted 12 months and was led by site champions who were Registered Nurses.

Data were collected at three time points prior to the intervention, at 6 months and 12 months after the commencement of the intervention. The study adapted the Clinical Cultural Competency Questionnaire (CCCQ) to measure staff cultural competence. The CCCQ was developed by Like (2004) and revised by Mareno and Hart (Mareno and Hart 2014). The CCCQ shows acceptable internal consistency (Cronbach’s alpha 0.8). Participants’ socio-cultural demographics were also collected. Data were entered into SPSS Statistics Version 22 for descriptive and inferential statistical analysis. A Mann–Whitney Test for two independent samples was used to test the differences between Australian-born groups and Overseas-born groups. One-way ANOVA was used to test the differences of (i) ‘Cultural competencies’ and (ii) ‘Aged care facilities’ capacity to create and sustain improvement’ across the three-time points of the intervention evaluation.

Results:

The number of staff who participated in the program evaluation prior to the intervention, at 6 months and at 12 months were 113, 104 and 97 respectively. The baseline data revealed that overseas-born staff made up 45% of the participants and were from 18 countries that were mainly low- and middle-income countries where aged care homes were underdeveloped. The vast majority of participants were female (98%) with a median age of 50 years. Unlicensed staff made up 51% of the participants while Registered Nurses and Enrolled Nurses made up 28% of the participants.

Changes of the CCCQ scores among the whole group:

  1. Staff self-perceived knowledge, skills, comfort level, self-awareness and education and training showed a statistically significant increase. The increase of the scores in these areas between time 1 and time 3, provide an indication that a sufficient time period was needed for the intervention to be effective.
  2. The factor of ‘Importance of awareness’ showed no statistically significant changes over time. The mean score for this factor was relatively higher across the 3 time points. This might be an indicator that staff were cognisant that cultural awareness was an important aspect of their care activities prior to the intervention.

Changes of the CCCQ scores between Australian-born and overseas-born groups:

  1. Knowledge: Prior to the intervention, there was no statistically significant difference between Australian-born and overseas-born groups in cultural knowledge. Across the 3-time points, both Australian-born and overseas-born groups showed a statistically significant increase in ‘knowledge’ scores.
  2. Skills: Prior to the intervention, overseas-born groups showed a statistically significant higher score in ‘skills’ compared to Australian-born group. Across the 3-time points, Australian-born groups showed a statistically significant increase in skill scores while overseas-born groups showed no statistically significant change.
  3. Comfort level: Prior to the intervention, overseas-born groups showed a statistically significant higher score on ‘Comfort level’ compared to Australian-born groups. Across the 3-time points, Australian-born groups showed a statistically significant increase on ‘Comfort level’ scores while overseas-born groups showed no statistically significant change.
  4. Importance of Awareness: Prior to the intervention, overseas-born groups showed a statistically significant higher score on ‘Importance of Awareness’ compared to Australian-born groups. Across the 3-time points, Australian-born groups showed a statistically significant increase on ‘Importance of Awareness’ score while overseas-born group showed no statistically significant change.
  5. Self-awareness: Prior to the intervention, there was no statistically significant difference between the two groups. Across the 3-time points, both Australian-born and overseas-born groups showed statistically significant increase of ‘Self-awareness’ scores.
  6. Education and training: Prior to the intervention, overseas-born groups showed a statistically significant higher score on ‘Education and training’ compared to Australian-born group. Across the 3-time points, both Australian-born and overseas-born groups showed statistically significant increase on ‘Education and training’.

Conclusion:

Previous studies report that education interventions demonstrate improved cultural competence for health professionals and health professional students (Gallagher and Polanin 2015, Bezrukova et al. 2016). Findings from our study support these studies, but add new evidence that a cross-cultural care education program can improve cultural competence in a skill-mixed and resource poor care setting in aged care homes. Co-designing and implementing education program between universities and aged care industry, orgniasations’ support and registered nurses’ leadership are crucial factors to ensure the successful implementation of the education program in aged care homes (Garneau and Pepin 2015, Pepin et al. 2017).

An evidence-based cross-cultural care program co-designed and implemented by aged care homes and a university can improve staff cultural competence. Findings have implications for investing in cultural competence development for staff in aged care in order to improve quality of care for older people and workforce cohesion.

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