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How to measure cultural competence when evaluating patient-centred care: a scoping review
  1. Sadia Ahmed1,
  2. Fartoon M Siad2,
  3. Kimberly Manalili2,
  4. Diane L Lorenzetti2,
  5. Tiffany Barbosa3,
  6. Vic Lantion3,
  7. Mingshan Lu4,
  8. Hude Quan2,
  9. Maria-Jose Santana1,2
  1. 1 Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  3. 3 Ethno-Cultural Council of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Economics, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Sadia Ahmed; sadahmed{at}


Objectives The purpose of this study was to identify patient-centred quality indicators (PC-QI) and measures for measuring cultural competence in healthcare.

Design Scoping review.

Setting All care settings.

Search strategy A search of CINAHL, EMBASE, MEDLINE, PsycINFO, Social Work Abstracts and SocINDEX, and the grey literature was conducted to identify relevant studies. Studies were included if they reported indicators or measures for cultural competence. We differentiated PC-QIs from measures: PC-QIs were identified as a unit of measurement of the performance of the healthcare system, which reflects what matters to patients and families, and to any individual that is in contact with healthcare services. In contrast, measures evaluate delivery of patient-centred care, in the form of a survey and/or checklist. Data collected included publication year and type, country, ethnocultural groups and mention of quality indicator and/or measures for cultural competence.

Results The search yielded a total of 786 abstracts and sources, of which 16 were included in the review. Twelve out of 16 sources reported measures for cultural competence, for a total of 10 measures. Identified domains from the measures included: physical environment, staff awareness of attitudes and values, diversity training and communication. Two out of 16 sources reported PC-QIs for cultural competence (92 structure and process indicators, and 48 outcome indicators). There was greater representation of structure and process indicators and measures for cultural competence, compared with outcome indicators.

Conclusion Monitoring and evaluating patient-centred care for ethnocultural communities allows for improvements to be made in the delivery of culturally competent healthcare. Future research should include development of PC-QIs for measuring cultural competence that also reflect cultural humility, and the involvement of ethnocultural communities in the development and implementation of these indicators.

  • cultural competence
  • health quality
  • patient-centred care
  • quality indicators
  • measures
  • culturally competent care
  • cultural humility

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  • Contributors MJS conceived the study, and SA, FMS, KM, ML, MJS, DLL, TB and VL identified key literature to be included in the review. MJS and ML independently screened each identified title and abstract for eligibility. The updated peer-reviewed search was conducted by FMS and KM, and the grey literature search was conducted by SA and TB. DLL provided guidance on the search strategy. SA led the drafting of the manuscript, design of the tables (with feedback from all authors) and management of references. MJS, FMS, KM, ML, DLL, TB and VL provided input on various drafts of the manuscript. All authors provided important intellectual contribution and guidance throughout the development of the manuscript. HQ, KM, DLL and ML provided guidance on the presentation of the findings and guidance on final revisions. All of the authors (SA, FMS, KM, DLL, TB, VL, ML, HQ, MJS) contributed to critical review and revisions to the manuscript, agreeing on the final version.

  • Funding MJS received funding from the MSI Foundation (Grant No 886) based in Alberta, Canada. ML acknowledges support from the Alberta’s Strategy for Patient Oriented Research (SPOR). KM acknowledges support from the Ward of the 21st Century, University of Calgary.

  • Disclaimer All authors had access to the data (literature identified and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Patient consent None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.