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REFERENCE: Reimann, J.O.F., Talavera, G.A., Espinoza, M., Nuñez, J., & Velasquez, R.J. Cultural competence among physicians treating Mexican American diabetics: A structural model. Workshop presentation at the Second National Conference on Quality Health Care for Culturally Diverse Populations, Los Angeles, CA, Oct 11-14, 2000.

An increasingly varied population has heightened the complexities U.S. health care providers face when they attempt to deliver effective medical services. Latinos, who constitute the fastest growing sizable ethnic minority group in the U.S., account for a major portion of this diversity and pose special challenges. For example, the group is disproportionately afflicted with diseases such as diabetes and tuberculosis. Yet much-needed treatment is often hampered by linguistic barriers, conflicts between differing cultural expectations of patients and physicians, provider reactions based in stereotypes, and managed health care systems that fail to consider the needs of minority populations.

To overcome such barriers, we must first identify and understand specific factors that predict culturally competent actions among physicians. This includes learning specific connections between educational experiences, practice settings, ethnic background, acquired cultural knowledge, and an awareness that culture and personal biases play crucial roles in treatment. While several cultural competence models have been proposed in the literature, they are infrequently tested using comprehensive empirical methods.

Our project investigated cultural competence among physicians treating Mexican American diabetics in San Diego County. A sample of 134 practicing physicians provided demographic information and completed questions assessing their cultural knowledge, cultural awareness, and culturally competent behaviors specific to the treatment of Mexican Americans with diabetes.

Using structural equation techniques, a cultural competence model was then developed and empirically supported. Physicians' gender and the number of Mexican Americans seen in practice were not statistically relevant to the model. Experience in community clinics and participation in diverse educational settings predicted cultural knowledge. Participation in diverse educational settings, Latino ethnicity, bilingual skills, and cultural knowledge predicted cultural awareness. Finally, culturally competent behaviors were only predicted by cultural awareness.

The specified model supports a nmber of primary conclusions. First, knowledge of cultural factors per se and simple exposure to Mexican Americans in practice do not directly facilitate appropriate treatment. Rather such treatment is most strongly supported by a clear recognition that cultural factors are important and an awareness of potential personal biases. Consequently, results support educational approaches to cultural competence that emphasize the exploration of personal perceptions over superficial information about demographics and customs. Secondly, participation in diverse educational experiences impacts both cultural knowledge and awareness. It was thus identified as one of the key elements in the model. These results strongly support educational efforts such as training and residency programs that rotate participants through supervised experiences in a broad range of community and other sites. It is hoped that the present study will help facilitate such educational efforts.

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