The effectiveness of culturally-focused interventions in increasing satisfaction of hospitalized adult Asian patients: a systematic review protocol

Transcription

1 The effectiveness of culturally-focused interventions in increasing satisfaction of hospitalized adult Asian patients: a systematic review protocol Karolina Ubogaya, FNP-BC, RN 1 Millicent Alfred, FNP-BC, RN 1 Xing Chen FNP-BC, RN 1 Diana Wint, FNP-BC, RN 1 Priscilla Sandford Worral, PhD, RN 1,2 1. College of Health Professions, Pace University, New York 2. Northeast Institute for Evidence Synthesis and Translation (NEST): a Collaborating Centre of the Joanna Briggs Institute Corresponding author: Karolina Ubogaya ku75050n@pace.edu Review question/objective What culturally-focused interventions are most effective in increasing the satisfaction of adult Asian patients in the acute hospital setting? Background Cultural competence has gained global attention as a focus to improve quality and mitigate or eliminate racial and ethnic disparities in health care. 1 The globalization of migration flows over recent decades has increased the multicultural diversity of our societies. The total number of migrants worldwide for all ethnic groups has increased from 75 million in 1965 to 214 million in As a result of increasing migration, virtually all European countries are becoming ethnically and culturally more diverse. Canada, the United States (USA), Australia, and New Zealand display the greatest readiness to adapt their societies to diversity and have introduced multicultural policies to address the needs of migrants and their descendants. While these countries do focus on minorities needs in employment, housing, social integration, and law enforcement, they are not focused heavily on minorities needs in health care systems. 1 Over time, societies evolve in response to the needs of the majority population, but are not as readily culturally responsive to health care needs of newcomers and ethnic minorities. The medical work force is still relatively unprepared for giving care to the immigrant population world-wide. 2 Globally, healthcare organizations are challenged in providing culturally competent, evidence-based care to migrant and ethnic minorities. Those challenges are related, but not limited, to nutrition, pain, religion, ethics, and the multicultural health care workforce. 2 doi: /jbisrir Page 146

2 In the USA, the Asian population grew faster than did any other racial minority group between 2000 and 2010, and is expected to increase from 4.8% in 2010 to 9.2% in ,4 Given this trend, cultural competence in nursing care for individuals, families, groups, communities, and institutions has had an increased focus in recent years. The United States Department of Health and Human Services Office of Minority Health defines culture as integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 5(p.8) Cultural competence can be defined as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations." 6(p.11) In an effort to eliminate some of these challenges and to improve patients satisfaction, healthcare facilities are employing culturally diverse staff to bridge the cultural gaps and to improve the overall quality of care. Additionally, there is a need for cultural competence training for staff and providers, in order to identify cultural beliefs that positively impact the patient s experience. Some hospitals are providing interpreter services in an effort to communicate effectively and address patients needs and concerns while bridging the gaps in cultural diversity and improving patient satisfaction. 6 Patient satisfaction is multifaceted and a very challenging outcome to define. 7 Patient satisfaction can be viewed as an attitude, a person s general orientation towards a total experience of health. 7 Satisfaction is achieved when the patient s or client s perception of the quality of care and services that they receive in the healthcare setting is positive, satisfying, and meets or exceeds their expectations. Psychosocial factors, including pain and depression, are also known to contribute to patient satisfaction scores. 7 Level of satisfaction data can be collected in various ways, including telephone interviews, and computerized surveys, postal surveys, personal interviews, and focus groups. Standard questionnaires such as the Picker Patient Experience Questionnaire-15 (PPE-15), Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and Victorian Patient Satisfaction Monitor (VPSM) are in regular use in the United Kingdom (UK), USA, and Australia, respectively. 8 In Wong et al. 9 the PPE-15 was adopted for measuring patient satisfaction in Hong Kong hospitals. The PPE-15 includes 15 items with either three or four possible responses: yes, always; yes, sometimes; no; and not relevant. In the USA, HCAHPS is used as a survey instrument and data collection method for measuring patients perceptions of their hospital experience and overall patient satisfaction, with scores ranging zero (low) to ten. The VPSM has six survey questions addressing access and admission, general patient information, treatment and related information, physical environment, complaints management, and discharge follow-up. In the UK, the VPSM is used for a national patient survey, with scores ranging between three and four on a scale zero (low) to five. 10 A recent VPSM report found Asian patients are less satisfied with their hospital care. 10 National HCAPHS results in the USA found that ethnic minority patients tend to have scores between seven to eight, while the general USA patient population scores range between nine to ten. 11 Several HCAHPS surveys reviewed in New York and California recognized that Chinese patients satisfaction surveys had scores no higher than eight on the zero to ten scale. New York City has the largest growing Asian population of any city in the USA. 12 As a result, increased numbers of Asian patients with limited English proficiency (LEP) are at greater risk for ethnic and cultural disparities while seeking medical care. 13 Traditionally, healthcare satisfaction has been lower doi: /jbisrir Page 147

3 among the Asian population as compared to other racial groups. This raises the question of whether satisfaction survey scores below the desired nine or ten are equally or more influenced by cultural perspective than by anything missing in the patient s care. An initial search of the literature identified six articles that evaluated the satisfaction of Asian patients experience during their hospital stay. There was an indication that patient satisfaction is negatively impacted by multiple factors, such as patients belief that less care is provided to them based on the number of patients their nurse is caring for, as well as the inability for patients family to stay with them at the bedside. 11,12 Patient satisfaction scores were low for patients who believed there was a lack of cultural communication and a lack of interpreters to communicate effectively. 13,14,15 A seminal study in Hong Kong, the first cross-sectional survey study for Asian patients, found the average global satisfaction scores for public and private hospital care were 7.3/10 and 7.8/10, respectively. 9 Liou et al. 13 found that a lack of communication, respect, and patient engagement in provider patient relationships negatively impact patient satisfaction. To better focus initiatives for hospitalized adult Asians, it is critical to understand the determinants of culturally and linguistically appropriate hospital services for this population. 8,11 A number of culturally-focused interventions have been assessed, including bilingual providers, interpreter services such as remote simultaneous medical interpreting (RSMI), providing hospital wide training in cultural competency for staff, and enhancing the nurses responsiveness to clinical needs. In addition, patient education, pain management and call bell response time have been studied in the USA. While many of these interventions have demonstrated some level of effectiveness, no one intervention or set of interventions has demonstrated transferrable or consistent effectiveness in increasing patient satisfaction among adult Asian patients admitted to acute care hospitals. No systematic reviews (SR) were found in CINAHL, PubMed, the Cochrane Library, or the Joanna Briggs Institute Library regarding interventions to improve patient satisfaction among hospitalized adult Asian patients. A systematic review on the effectiveness of culturally-relevant interventions in increasing satisfaction of hospitalized adult Asian patients satisfaction may add important evidence-based information for improving the hospital experience for this population. Keywords Patient/consumer satisfaction; culturally-focused; hospitals; Asian-American; adult; Asian ancestry; Acute care facility and culturally-focused Inclusion criteria Types of participants This review will consider studies that include Asian adults 18 years of age and older who were admitted to acute-care hospitals. In the case of studies with both Asian and non-asian subjects, studies where the effects of an intervention or set of interventions can be specifically identified in Asian subjects will be included. Types of intervention(s) This review will consider studies that include any intervention or set of interventions that are implemented by the hospital for the purpose of making the hospital experience consistent with cultural doi: /jbisrir Page 148

4 preferences of adult Asian patients. Examples might include, but not be limited to, communication, room cleanliness and quietness, ethnic diet, interpreter services, pain management, and staff responsiveness. Comparator intervention Commonly called "usual care, those hospital practices that are initiated for any adult admission and are not culturally specific. Types of outcomes Satisfaction of adult Asian hospital patients as measured by self-report satisfaction scales or tools considered by accrediting and/or governing bodies to be sources of evidence of hospital quality of care. Examples include, but are not limited to, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (USA), Victorian Patient Satisfaction Monitor (VPSM) (UK, Australia, USA), and the Picker Patient Experience Questionnaire-15, adapted (Hong Kong). Types of studies This review will first consider randomized controlled trials, non-randomized controlled trials, and quasi-experimental studies. If there is an insufficient number of randomized controlled trials, non-randomized controlled trials, and quasi-experimental studies then the review will consider before and after studies, prospective and retrospective cohort studies, and case control studies for inclusion. This review will also consider for inclusion descriptive study designs including case series, individual case reports and descriptive cross sectional studies related to the adult Asian population in acute-care hospital settings. Search strategy The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. The review will consider studies published nationally and internationally from in both English and Chinese languages, as these are the languages understood by the reviewers. The search will not be restricted by date. The databases to be searched include: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Global Health, Scopus Web of Science, Excerpta Medical Databases (Embase), The Cochrane Central Register of Controlled Trials, and Academic Search Premier. An additional grey literature search to identify unpublished studies, papers, and/or dissertations will include Mednar, Virginia Henderson Library of Sigma Theta Tau, Google Scholar, ProQuest Dissertations and Theses, Scirus, and hcahpsonline.org. National and international conference proceedings of professional organizations such as the American Public Health Association, International Council of Nurses, Institute of Medicine, International Society for Quality in Health Care, Institute for Health Care Improvement, Australasian Association for Quality in Health Care, and the World Health Organization will be searched for evidence of research currently underway or recently doi: /jbisrir Page 149

5 completed and not yet published. A hand search of references will be conducted from articles chosen for appraisal. Initial keywords to be used will be: Patient/consumer satisfaction, culturally-focused, hospitals, Asian-American, adult, Asian ancestry, Acute care facility and culturally-focused. Assessment of methodological quality Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Data collection Data will be extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods, and outcomes of significance to the review question and specific objectives. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. When articles are found to have missing or incomplete data directly relevant to the focused clinical question the authors will be contacted in an effort to obtain the necessary data. If missing or incomplete data cannot be collected, those articles will then be excluded from the review. Data synthesis Quantitative data will, be pooled in statistical meta-analysis using JBI-MAStARI, where possible. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Conflicts of interest None Acknowledgements This review will partially fulfill degree requirements for successful completion of the Doctor of Nursing Practice Program at Pace University, College of Health Professions, New York, NY for: Karolina Ubogaya, FNP-BC; Millicent Alfred, FNP-BC; Chen Xing, FNP-BC; and Diana Wint, FNP-BC. doi: /jbisrir Page 150

6 References 1. Betancourt JR, Green AR, Carrillo JE, Park ER. Cultural competence and health care disparities: key perspectives and trends. Health affairs. 2005; 24(2): Full proposal for a new cost action. Adapting European health systems to diversity [Internet]. [Cited 2014 Mar 20]. Available from 3. Centers for Disease Control and Prevention, Asian American Population, Minority health [Internet] [cited 2014 Mar 01]. Available from 4. U.S. Department of Commerce Economics and Statistics Administration U.S. Census Bureau. The Asian Population: 2010, 2010 census briefs [Internet] [Cited 2014 Mar 10]. Available from 5. Assuring Cultural Competence in Health Care: Recommendations for National Standards and Outcomes-Focused Research Agenda [Internet] [Cited 2014 Mar 01]. Available from 99.pdf. 6. Ngo-Metzger Q, Telfair J, Sorkin DH, Weidmer B, Weech-Maldonado R, Hurtado M, et al. Cultural competency and quality of care: obtaining the patient s perspective. The Commonwealth Fund Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) [Internet] [Cited 2014 Mar 01]. Available from 8. Weech-Maldonado R, Elliott MN, Pradhan R, Schiller C, Hall A, Hays DR. Can hospital cultural competency reduce disparities in patient experiences with care? A descriptive study. Medical Care. 2012, 50(11):S48-S Wong EL, Leung MC, Cheung AW, Yam CH, Yeoh EK, Griffiths S. A population-based survey using PPE-15: relationship of care aspects to patient satisfaction in Hong Kong. International Journal for Quality in Health Care, 2011 June 4, 23(4), State Government of Victorian, Department of Health, Victorian Patient Satisfaction Monitor Year 10 Annual Report [Internet]. [Cited 2014 Mar 20]. Available from nnual%20report%20year%2010%20final%28v2%29.pdf 11. Goldstein E, Elliott MN, Lehrman WG, Hambarsoomian K, Giordano LA. Racial/ethnic differences in patients perceptions of inpatient care using the HCAHPS survey. Medical Care Research and Review, 2010, 67(1), Zhu XW, You L, Zheng J, Lui K, Fang JB, Hou SA. Nurse Staffing Levels Make a Difference on Patient Outcomes: A multisite study in Chinese Hospitals. Journal of Nursing Scholarship June 25, 44(3): Liou C, Su W. A study of the needs and satisfaction of the in-patients families at a medical center. Journal of Nursing (China).1998, 45(2), doi: /jbisrir Page 151

7 14. Ng J, Popova S, Yau M, Sulman J. Do culturally sensitive services for Chinese in-patients make a difference?. Social Work in Health Care. 2007, 44(3): Gany F, Leng J, Shapiro E, Abramson D, Motola I, Shield DC, Changrani J. Patient satisfaction with different interpreting methods: A randomized controlled trial. Journal of General Internal Medicine. 2007[cited 2014.Mar 01], 22(2): Available from doi: /jbisrir Page 152

8 Appendix I: Appraisal instruments MAStARI appraisal instrument doi: /jbisrir Page 153

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11 Appendix II: Data extraction instruments MAStARI data extraction instrument doi: /jbisrir Page 156

12 Insert page bre doi: /jbisrir Page 157