Effectiveness of Culturally Tailored Health Programs
Studies of culturally tailored health programs (CTHPs) report a positive effect or no effect on health outcomes. This is often measured by testing HbA1c levels, which measures control of blood glucose over the last three months. Even small decreases in HbA1c can be clinically significant if it can be sustained. A decrease in HbA1c by 1% reduces the risk of diabetes-related complications by 35% (cited in Toobert et al. 2010). These results, however, may be unreliable due to poor study design.
Problems with Current Studies
I found many problems with the studies I reviewed. At first, I was concerned that I had overlooked the well-planned studies, but in reading reviews on CTHPs and cultural competence training, I found that other reviewers found the same problems (Quiñones et al. 2011, Gonzalez et al. 2011, Lie et al. 2010). I discuss a few problems below:
1. Lack of a control group
Current studies lack a good control group. Some studies had no control group and thus no standard of comparison for the group participating in the CTHP. Other groups did have a control group, but the control group received normal care only, which consisted of routine check-ups. In order to know whether the culturally tailored aspects of CTHPs are reducing health disparities, there must be a control group in which patients participate in a health program that targets the general US population.
2. Variability between studies
The variability of the studies limits conclusions. Studies vary significantly in test subjects, settings, study designs and aspects of intervention. Test subjects can vary in level of acculturation, income, insurance, and country of origin. All these communities face different challenges in obtaining care, so comparisons between studies are limited. Study designs and aspects of intervention vary significantly as well. For this reason, it is difficult to compare studies to determine which aspects of intervention are most successful in improving patient outcomes.
3. Limited Sample Size
Many published studies have a limited sample size. A few that I reviewed include data from fewer than 20 patients (Mauldon et al. 2006, Valen et al. 2012). Small sample sizes limit the generalizability of results.
4. Undetailed report of methods
Many studies do not provide enough detail about the curricula of the CTHP to repeat the study. This makes it difficult to create a large body of research using similar methods to prove the results obtained in one study were not obtained by chance and can be repeated in other areas of the country.
1. Lack of a control group
Current studies lack a good control group. Some studies had no control group and thus no standard of comparison for the group participating in the CTHP. Other groups did have a control group, but the control group received normal care only, which consisted of routine check-ups. In order to know whether the culturally tailored aspects of CTHPs are reducing health disparities, there must be a control group in which patients participate in a health program that targets the general US population.
2. Variability between studies
The variability of the studies limits conclusions. Studies vary significantly in test subjects, settings, study designs and aspects of intervention. Test subjects can vary in level of acculturation, income, insurance, and country of origin. All these communities face different challenges in obtaining care, so comparisons between studies are limited. Study designs and aspects of intervention vary significantly as well. For this reason, it is difficult to compare studies to determine which aspects of intervention are most successful in improving patient outcomes.
3. Limited Sample Size
Many published studies have a limited sample size. A few that I reviewed include data from fewer than 20 patients (Mauldon et al. 2006, Valen et al. 2012). Small sample sizes limit the generalizability of results.
4. Undetailed report of methods
Many studies do not provide enough detail about the curricula of the CTHP to repeat the study. This makes it difficult to create a large body of research using similar methods to prove the results obtained in one study were not obtained by chance and can be repeated in other areas of the country.