Using Service-Learning Experiences to Improve Cultural Competence in Pre-Professional Dietetic Students
Main Article Content
Abstract
Cultural encounters were used in a senior-level undergraduate nutrition capstone course to enhance students’ cultural competence attitudes and skills. The course included a service-learning component for which students met weekly with international students who were enrolled in an intensive English language program as conversation partners. The course content and structure focused on Campinha-Bacote’s cultural competence model. The model includes 5 constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. This capstone, writing-intensive course included creative writing activities, discussion, journaling, and reflection papers. The 20-item Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version© was used as the pre-post-test measure. Paired sample t-tests were used to calculate outcomes. A significant increase from pre-test to post-test in the total score was found (t(18) = -6.852, p < 0.001). Pre- and post-test scores indicated students were operating at a culturally competent level. There were significant increases in all constructs with notable increases in cultural knowledge and cultural skill constructs. A course dedicated to developing pre-professional healthcare students’ cultural competence levels may better prepare them for professional practice.
Keywords:
Service-Learning, Service-Learning Experiences, Competence in Pre-Professional Dietetic Students, Dietetic Students, Service-Learning Experiences to Improve Cultural Competence
Article Details
How to Cite
HUYE, Holly F..
Using Service-Learning Experiences to Improve Cultural Competence in Pre-Professional Dietetic Students.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4033>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.4033.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Vespa J, Medina L, Armstrong, DM. Demographic turning points for United States: population projections for 2020 to 2060. United States Census Bureau. February 2020. Accessed April 19, 2023.
https://www.census.gov/library/publications/2020/demo/p25-1144.html.
2. Centers for Disease Control and Prevention. What is heath equity? Reviewed July 1, 2022. Accessed May 3, 2023. https://www.cdc.gov/healthequity/whatis/index.html.
3. Kaiser Family Foundation. Disparities in health and health care. Questions and answers. April 21, 2023. Accessed April 26, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
4. Health Equity in Healthy People 2030. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed May 30, 2023. https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
5. Liaison Committee for Medical Education, Association of American Medical Colleges and American Medical Association. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. LCME; 2023. Accessed April 26, 2023. https://lcme.org/publications/
6. Academy of Nutrition and Dietetics. Practice paper of the Academy of Nutrition and dietetics: the role of nutrition in health promotion and chronic disease prevention. J Acad Nutr Diet, 2013;113:972-979.
7. Accreditation Council for Education in Nutrition and Dietetics. ACEND Accreditation Standards for Nutrition and Dietetics Didactic Programs (DPD). ACEND; 2021.
8. Cross TL, Bazron BJ, Dennis KW, Isaacs, MR. Towards a Culturally Competent System of Care. Georgetown University Development Center, CASSP Technical Assistance Center; 1989:iv.
9. Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: The Journey Continues. Transcultural C.A.R.E Associates; 2007.
10. Rosen D, McCall J, Goodkind S. Teaching critical self-reflection through the lens of cultural humility: an assignment in a social work diversity course. Soc Work Educ. 2017; 36(3):289-298. https://doi.org/10.1080/02615479.2017.1287260
11. Bringle RG, Hatcher JA. A service-learning curriculum for faculty. Mich J Community Serv Learn. 1995;2(1):112-122.
12. Eyler J, Giles DE, Schmiede A. A Practitioner’s Guide to Reflection in Service-Learning: Students Voices and Reflections. Vanderbilt University; 1996.
13. McCabe CF, O’Brien-Combs A, Anderson OS. Cultural competency training and evaluation methods across dietetics education: a narrative review. J Acad Nutri Diet. 2020;120(7):1198-1209. http://doi.org/10.1016/j.jand.2020.01.014
14. Jernigan VBB, Hearod JB, Tran K, Norris KC, Buchwald D. An examination of cultural competence training in US medical education guided by the Tool for Assessing Cultural Competence Training. J Health Dispar Res Pract. 2016;9(3):150-167.
15. Arruzza E, Chau M. The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: a scoping review. J Educ Eval Health Prof. 2021;18:3. https://doi.org/10.3352/jeehp.2021.183
16. Wolff, M.; Santen, S. Re: Not another boring lecture: let’s be the guide on the side. J Emerg Med. 2015;49(5); 711–712. https://doi.org/10.1016/j.jemermed.2015.06.011
17. Bonwell, C, Eison JA. Active Learning: Creating Excitement in the Classroom. ASHE-Eric Higher Education Report No. 1. The George Washington University, School of Education and Human Development; 1991. Accessed on April 26, 2023. https://files.eric.ed.gov/fulltext/ED336049.pdf
18. Campinha-Bacote J. Many faces: addressing diversity in health care. Online J Issues Nurs. 2003;8(1):2. Accessed May 29, 2023. https://ojin.nursingworld.org/table-of-contents/volume-8-2003/number-1-january-2003/addressing-diversity-in-health-care/
19. Campinha-Bacote, J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs. 2011;16(2). https://doi.org/10.3912/OJIN.Vol16No02Man05
20. Transcultural C.A.R.E. About the IAPCC-SV. Accessed May 30, 2023.
http://transculturalcare.net/iapcc-sv/
21. Andrade JM. Determining the associations between dietetic-related activities and undergraduate dietetic students’ general cultural knowledge attitudes, and beliefs. Nutrients. 2019;11(6):1202. https://doi.org/10.3390/nu11061202
22. Betancourt JR, Green AR, Carrillo, JE, Ananeh-Firempong, O. Defining cultural competences: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports. 2003; 118:293-302.
23. Davis LM, Martin LT, Fremont A, Weech-Maldonado R, Williams MV, Kim, A. Development of a Long-Term Evaluation Framework for the National Standards For Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. U.S. Department of Health and Human Services, Office of Minority Health. 2018. PR-3598-DHHS/OMH. Accessed May 30, 2023. https://www.minorityhealth.hhs.gov/assets/PDF/Natn_CLAS_Standards_Evaluation_Framework_Report_PR-3598_final_508_Compliant.pdf
24. McArthur LH, Greathouse KR, Smith ER, Holbert D. A quantitative assessment of the cultural knowledge, attitudes, and experiences of junior and senior dietetics students. J Nutr Educ Behav. 2011;43:464-472. doi:10.1016/j.jneb.2010.11.005.
25. Eliot KA. Perceptions of the Effectiveness of Cultural Competence Training Among Nutrition and Dietetics Students [dissertation]. Saint Louis University; 2013.
26. Brottman MR, Char DM, Hattori, RA, Heeb R, Taff SD. Toward cultural competency in heath care: a scoping review of the diversity and inclusion education literature. Acad Med. 2020;95:803-813
27. Bauer K, Bai Y. Using a model to design activity-based educational experiences to improve cultural competency among graduate students. Pharm. 2018;6:48. doi:10.3390/pharmacy6020048
28. Khoury NM, Suser JL, Germain LJ, Myers K, Brown AEC, Lu FG. A study of a cultural competence and humility intervention for third-year medical students. Acad Psychiatry. 2022;46:451-454.
29. Arif S, Wang S, Lakada IY, Lee JY. An elective course to train student pharmacists to provide culturally sensitive health care. Am J Pharm Educ. 2019;83:7027. https://doi.org/10.5688/ajpe7027
30. Prescott GM, Nobel A. A multimodal approach to teaching cultural competency in the doctor of pharmacy curriculum. Am J Pharm Educ. 2019;83:6651. https://doi.org/10.5688/ajpe6651
31. Purnell L. The Purnell model for cultural competence. J Transcult Nurs. 2002;13:193-196.
32. Giger JN, Davidhizar R. The Giger and Davidhizar Transcultural Assessment Model. J Transcult Nurs. 2002;13:185-188.
33. Berlin EA, Fowkes WC Jr. A teaching framework for cross-cultural health care – application in family practice. West J Med. 1983;139:934-938.
34. Kurtz DLM, Janke R, Vinek J, Wells T, Hutchinson P, Froste A. Health sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review. Int J Med Educ. 2018;9:271-285. https://doi.org/10.5116/ijme.5bc7.21e2
35. Hsiu-Chin, C, McAdams-Jones D, Tay DL, Packer JM. The impact of service-learning on students’ cultural competence. Teach Learn Nurs. 2012;7:67-73.
36. Young, S. An assessment of cultural diversity training: an experiment for Hawaii nursing students. [Doctoral Dissertation]. Charleston, SC: Medical University of South Carolina; 2009.
https://www.census.gov/library/publications/2020/demo/p25-1144.html.
2. Centers for Disease Control and Prevention. What is heath equity? Reviewed July 1, 2022. Accessed May 3, 2023. https://www.cdc.gov/healthequity/whatis/index.html.
3. Kaiser Family Foundation. Disparities in health and health care. Questions and answers. April 21, 2023. Accessed April 26, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
4. Health Equity in Healthy People 2030. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed May 30, 2023. https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
5. Liaison Committee for Medical Education, Association of American Medical Colleges and American Medical Association. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. LCME; 2023. Accessed April 26, 2023. https://lcme.org/publications/
6. Academy of Nutrition and Dietetics. Practice paper of the Academy of Nutrition and dietetics: the role of nutrition in health promotion and chronic disease prevention. J Acad Nutr Diet, 2013;113:972-979.
7. Accreditation Council for Education in Nutrition and Dietetics. ACEND Accreditation Standards for Nutrition and Dietetics Didactic Programs (DPD). ACEND; 2021.
8. Cross TL, Bazron BJ, Dennis KW, Isaacs, MR. Towards a Culturally Competent System of Care. Georgetown University Development Center, CASSP Technical Assistance Center; 1989:iv.
9. Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: The Journey Continues. Transcultural C.A.R.E Associates; 2007.
10. Rosen D, McCall J, Goodkind S. Teaching critical self-reflection through the lens of cultural humility: an assignment in a social work diversity course. Soc Work Educ. 2017; 36(3):289-298. https://doi.org/10.1080/02615479.2017.1287260
11. Bringle RG, Hatcher JA. A service-learning curriculum for faculty. Mich J Community Serv Learn. 1995;2(1):112-122.
12. Eyler J, Giles DE, Schmiede A. A Practitioner’s Guide to Reflection in Service-Learning: Students Voices and Reflections. Vanderbilt University; 1996.
13. McCabe CF, O’Brien-Combs A, Anderson OS. Cultural competency training and evaluation methods across dietetics education: a narrative review. J Acad Nutri Diet. 2020;120(7):1198-1209. http://doi.org/10.1016/j.jand.2020.01.014
14. Jernigan VBB, Hearod JB, Tran K, Norris KC, Buchwald D. An examination of cultural competence training in US medical education guided by the Tool for Assessing Cultural Competence Training. J Health Dispar Res Pract. 2016;9(3):150-167.
15. Arruzza E, Chau M. The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: a scoping review. J Educ Eval Health Prof. 2021;18:3. https://doi.org/10.3352/jeehp.2021.183
16. Wolff, M.; Santen, S. Re: Not another boring lecture: let’s be the guide on the side. J Emerg Med. 2015;49(5); 711–712. https://doi.org/10.1016/j.jemermed.2015.06.011
17. Bonwell, C, Eison JA. Active Learning: Creating Excitement in the Classroom. ASHE-Eric Higher Education Report No. 1. The George Washington University, School of Education and Human Development; 1991. Accessed on April 26, 2023. https://files.eric.ed.gov/fulltext/ED336049.pdf
18. Campinha-Bacote J. Many faces: addressing diversity in health care. Online J Issues Nurs. 2003;8(1):2. Accessed May 29, 2023. https://ojin.nursingworld.org/table-of-contents/volume-8-2003/number-1-january-2003/addressing-diversity-in-health-care/
19. Campinha-Bacote, J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs. 2011;16(2). https://doi.org/10.3912/OJIN.Vol16No02Man05
20. Transcultural C.A.R.E. About the IAPCC-SV. Accessed May 30, 2023.
http://transculturalcare.net/iapcc-sv/
21. Andrade JM. Determining the associations between dietetic-related activities and undergraduate dietetic students’ general cultural knowledge attitudes, and beliefs. Nutrients. 2019;11(6):1202. https://doi.org/10.3390/nu11061202
22. Betancourt JR, Green AR, Carrillo, JE, Ananeh-Firempong, O. Defining cultural competences: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports. 2003; 118:293-302.
23. Davis LM, Martin LT, Fremont A, Weech-Maldonado R, Williams MV, Kim, A. Development of a Long-Term Evaluation Framework for the National Standards For Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. U.S. Department of Health and Human Services, Office of Minority Health. 2018. PR-3598-DHHS/OMH. Accessed May 30, 2023. https://www.minorityhealth.hhs.gov/assets/PDF/Natn_CLAS_Standards_Evaluation_Framework_Report_PR-3598_final_508_Compliant.pdf
24. McArthur LH, Greathouse KR, Smith ER, Holbert D. A quantitative assessment of the cultural knowledge, attitudes, and experiences of junior and senior dietetics students. J Nutr Educ Behav. 2011;43:464-472. doi:10.1016/j.jneb.2010.11.005.
25. Eliot KA. Perceptions of the Effectiveness of Cultural Competence Training Among Nutrition and Dietetics Students [dissertation]. Saint Louis University; 2013.
26. Brottman MR, Char DM, Hattori, RA, Heeb R, Taff SD. Toward cultural competency in heath care: a scoping review of the diversity and inclusion education literature. Acad Med. 2020;95:803-813
27. Bauer K, Bai Y. Using a model to design activity-based educational experiences to improve cultural competency among graduate students. Pharm. 2018;6:48. doi:10.3390/pharmacy6020048
28. Khoury NM, Suser JL, Germain LJ, Myers K, Brown AEC, Lu FG. A study of a cultural competence and humility intervention for third-year medical students. Acad Psychiatry. 2022;46:451-454.
29. Arif S, Wang S, Lakada IY, Lee JY. An elective course to train student pharmacists to provide culturally sensitive health care. Am J Pharm Educ. 2019;83:7027. https://doi.org/10.5688/ajpe7027
30. Prescott GM, Nobel A. A multimodal approach to teaching cultural competency in the doctor of pharmacy curriculum. Am J Pharm Educ. 2019;83:6651. https://doi.org/10.5688/ajpe6651
31. Purnell L. The Purnell model for cultural competence. J Transcult Nurs. 2002;13:193-196.
32. Giger JN, Davidhizar R. The Giger and Davidhizar Transcultural Assessment Model. J Transcult Nurs. 2002;13:185-188.
33. Berlin EA, Fowkes WC Jr. A teaching framework for cross-cultural health care – application in family practice. West J Med. 1983;139:934-938.
34. Kurtz DLM, Janke R, Vinek J, Wells T, Hutchinson P, Froste A. Health sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review. Int J Med Educ. 2018;9:271-285. https://doi.org/10.5116/ijme.5bc7.21e2
35. Hsiu-Chin, C, McAdams-Jones D, Tay DL, Packer JM. The impact of service-learning on students’ cultural competence. Teach Learn Nurs. 2012;7:67-73.
36. Young, S. An assessment of cultural diversity training: an experiment for Hawaii nursing students. [Doctoral Dissertation]. Charleston, SC: Medical University of South Carolina; 2009.