Dissertations & Theses (Open Access)

Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

Robert O. Morgan, Phd Academic Advisor/Committee Chair

Second Advisor

Maria E. Fernandez, Phd Committee Member

Third Advisor

Vanessa R. Schick, Phd Committee Member

Abstract

This study examined cultural humility of community health workers (CHWs) in ambulatory clinical settings. Cultural humility has been defined as an attitude, or process that incorporates openness, power-balance, and critical self-reflection when interacting with people of cultural differences. It differs from the more well-known concept of cultural competence in that cultural humility is not culture specific and reflects provider attitudes and an orientation towards recognizing differences rather than specific knowledge about another culture. As such, cultural humility may lend itself to improving the care process across diverse patient populations. The literature on cultural humility and its relationship with CHWs is relatively new. This study explores three key questions that are yet unaddressed regarding the study of cultural humility. First, it is assumed that client ratings of a provider’s cultural humility are more accurate than provider self-ratings. However, correspondence of client-ratings and provider self-ratings has not been explicitly examined. Second, no study has empirically explored the relationship of cultural humility of CHWs with linguistically discordant patients. Third, the level of client or self-rated cultural humility, has not been empirically linked to measures of client experience with care.

To measure the cultural humility of CHWs, 19 CHWs and 57 corresponding clients were surveyed from 12 ambulatory clinics. It was found that cultural humility scores reported through two modes of assessments differed significantly (Z=3.1/p=.0019). CHWs consistently under-rated their cultural humility. Furthermore, linguistically concordant clients did not significantly differ from linguistically discordant clients in the way they scored the cultural humility of their CHWs (p=0.525). Additionally, cultural humility was found to be a significant predictor of patient experience (aOR=1.18; [1.01-1.37]). Future studies can explore similar relationships of cultural humility with different cultural identities and health outcomes. Findings of this study support the foundational claim that humility measures should take an approach of multiple raters’ consensus for more accurate results. Findings also imply, cultural humility may potentially reduce interpersonal gaps created due to cultural differences. The last finding of this study was consistent with the hypothesis that higher ratings of cultural humility would be positively related to improved health outcomes. Overall, findings of this study are consistent with the growing knowledge that suggests cultural humility should be an integral part of any healthcare service training.

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