Assessing Cultural Humility in an Interprofessional Behavioral Health Training Program

Background and Purpose: Social work science plays an important role in increasing cultural humility (CH) in healthcare. Social workers have long recognized the importance of CH in healthcare as a way to promote equity, and other health disciplines are gaining awareness of the need to practice CH. If healthcare providers can learn to demonstrate more CH, marginalized patients may have more positive healthcare outcomes. Few studies highlight interdisciplinary higher-education programs to increase CH, and health systems lack data about effective CH techniques and their implementation. This study addressed these gaps by examining: 1) the effects of an interdisciplinary university program on a 28-item CH pre/post measure and 2) group differences at posttest on the 28-items.

Methods: The sample was comprised of social work, psychiatric nurse practitioner, psychiatry, and psychology students (n=60) participating in the university-based Integrated Behavioral Health Scholars program. In addition to their disciplinary requirements, students participated in 15 interdisciplinary CH seminars, completed six-month field practicums serving diverse patients, and reported how they were meeting CH competencies. All pre and posttests were completed in 2018 and 2019. The 28 pre/posttest items were divided into four subscales: Knowledge of Self, Knowledge of Community, Knowledge of Risk Factors, and Cultural Sensitivity/Skills. Repeated Measures ANOVA was used to assess both overall pre/post change and pre/post-change by student discipline, race/ethnicity, SES, and other control variables. Post hoc independent samples t-tests using Bonferroni adjustment were conducted to elucidate differences between groups. Analyses were conducted with SPSS 24 and Stata 14.

Results: Cronbach’s alpha for the 28-item scale was .90. The total sample improved significantly on more than 80% of scale items. Improvements were greatest for the six-item Knowledge of Community subscale (p<.001) and the seven-item Knowledge of Health Disparity/Risk subscale (p<.001). The greatest increase was on Knowledge of Infant Mortality (F_1,58 = 183.63, p<.001), a Health Disparity/Risk item. There were group differences by discipline, SES, age, and bilingual ability on five items at pre-test. However, at posttest, differences on only two items remained with psychology students improving more on Knowledge of Social Services Availability (F_2,57 =3.20, p<.05) and Unemployment Rates (F_2,57 = 4.55, p<.05) than social work students.

Conclusion and Implications: Results show positive impacts on CH with the greatest gains in items that required students to acquire factual knowledge. The more modest gains in Knowledge of Self and Cultural Sensitivity/Skills suggest that these areas may take more time to develop. With regard to group differences, by the training’s end, most pretest differences had disappeared, demonstrating that the training increased CH for students with different background characteristics. The two differences that remained at posttest may suggest that disciplines traditionally focused on more individualistic theories benefit from CH training, which places more emphasis on systems of oppression. Findings suggest that policies that promote student education on CH are a vital social justice initiative. Social work science should continue to highlight programs that increase CH as a way to improve healthcare and reduce health disparities.