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cultural competence, disparities, home health, hospice, training



  1. AbuDagga, Azza
  2. Weech-Maldonado, Robert
  3. Tian, Fang


Background: Despite the increasing interest in community-based health care, little information exists on cultural competency training (CCT) and its predictors in this setting.


Purpose: We examined the associations between six organizational characteristics and the provision of CCT in home health care and hospice agencies.


Methodology: We used cross-sectional data from the agency component of the 2007 National Home and Hospice Care Survey. The CCT provision composite was composed of three items: whether the agency provides mandatory cultural training to understand cultural differences/beliefs that may affect delivery of services to (a) all administrators, clerical, and management staff; (b) all direct service providers; and (c) all volunteers. Organizational characteristics were volume, ownership status, chain membership, teaching status, Joint Commission accreditation status, and formal contracts.


Principal Findings: The weighted sample (n = 14,469) had a mean CCT provision score of 1.75 (range = 0-3). Our ordinal logistic regression model showed that Joint Commission accreditation increased CCT provision odds in the home health (odds ratio [OR] = 2.07, 95% confidence interval [CI] [1.01, 4.24]) and hospice (OR = 4.40, 95% CI [2.07, 9.38]) settings. Teaching status increased CCT provision odds (OR = 2.71, 95% CI [1.19, 6.17]) in the home health setting. Formal contracts increased CCT provision odds (OR = 4.03, 95% CI [1.80, 9.00]), whereas not-for-profit ownership decreased CCT provision odds (OR = 0.19; 95% CI [0.07, 0.50]) in the hospice setting.


Practice Implications: Home health care and hospice agencies need to increase their CCT practices to overcome health disparities in an increasingly diverse and aging population.