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Health services, migration and diversity. Perspectives on the implementation of cultural competence
Author/s: Giuseppina Dell’Aversana, Andreina Bruno 
Year:  2020 Issue: Language: Italian 
Pages:  25 Pg. 275-299 FullText PDF:  263 KB
DOI:  10.3280/RIP2020-001013
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Evidence of inequities in migrants’ health has demanded for the reorientation of health policies to provide diversity responsive, cultural competent and equitable health services. Cultural competence, defined as a strategy to promote equity for “diverse” populations, requires interventions at individual, organizational and system levels. Organizational practices of cultural competence remain heterogeneously implemented in Italian health services. This study aims to explore managers’ perspectives on cultural competence in the healthcare system, considering how cultural competence is integrated in managerial practices and in service provision, and examining facilitators and barriers in the implementation of culturally competent interventions. We conducted a qualitative study based on the case study methodology. Data were collected in three health organizations of three Italian Regions. Individual and group interviews were conducted with managers or staff who had the lead responsibility for culturally competent programs (n = 15). Interviews were analysed through a thematic analysis. Findings show different concepts of cultural competence to promote equity for migrants’ health, and the role of contextual factors in affecting its organizational implementation. Data show the presence of practices to promote access and quality of care. However, further work is needed to embed cultural competence principles and practices at all levels of the organisation and promote participatory practices involving migrants and stakeholders.
Keywords: Cultural competence, health inequalities, migrants, barriers, manager, healthcare organizations.

  1. Irizarry, C., & Gallant, L. (2006). Managing diversity: Interpretation and enactment in a health care setting. Qualitative Research Reports in Communication, 7(1), 43-50., DOI: 10.1080/17459430600964901
  2. Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC health services research, 18(1), 232.
  3. Kirmayer, L.J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49 (2), 149-164., DOI: 10.1177/1363461512444673
  4. Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoSMedicine, 3(10), 1673-1676.
  5. Levesque, J., Harris, M.F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 12, 18., DOI: 10.1186/1475-9276-12-18
  6. McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature. International journal for equity in health, 16(1), 78. DOI 10.1186/s12939-017-0571-5.
  7. Napier, A. D., Ancarno, C., Butler, B., Calabrese, J., Chater, A., Chatterjee, H., … & Macdonald, A. (2014). Culture and health. The Lancet, 384(9954), 1607-1639.
  8. Nelson, A.R., Stith, A.Y., & Smedley, B.D., eds. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
  9. Norredam, M. & Krasnik, A. (2011). Migrants’ access to health services. In: Rechel B., Mladovsky P., Deville W., Rijks B., Petrova-Benedict R. and McKee M., eds., Migration and health in European Union. Maidenhead, UK: Open University Press McGraw-Hill, 67-78.
  10. NQF (National Quality Forum). (2009). A Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency: A Consensus Report. Washington, DC: National Quality Forum. -- Retrieved from: OIM (Organizzazione Mondiale delle Migrazioni) (2017). 2nd Global Consultation on Migrant Health: Resetting the Agenda. -- Retrieved from: 14.
  11. OMS (Organizzazione Mondiale della Sanita). (2008). 61st Assembly. Resolution WHA61.17 - Health of migrants. Geneve: WHO.
  12. OMS (Organizzazione Mondiale della Sanita). (2009). Resolution WHA62.14. Reducing health inequalities through action on the social determinants of health. Sixty-second World Health Assembly, Geneva, 18-22 May 2009. Resolutions and decisions, annexes. Geneva: WHO, 2009 (WHA62/2009/REC/1), Resolutions: 21-25. OMS (Organizzazione Mondiale della Sanita). (2010). Health of migrants: the way forward: report of a global consultation, Madrid, Spain, 3-5 March 2010
  13. OMS (Organizzazione Mondiale della Sanita). (2017). WHO resolutions and reports. -- Retrieved from:
  14. OMS (Organizzazione Mondiale della Sanita). (2018). Report on the health of refugees and migrants in the WHO European Region: No public health withoutrefugees and migrant health. -- Retrieved from:
  15. Abubakar, I., Aldridge, R. W., Devakumar, D., Orcutt, M., ... & Hargreaves, S. (2018). The UCL–Lancet Commission on Migration and Health: the health of a world on the move. The Lancet, 392(10164), 2606-2654.
  16. Adamson, J., Warfa, N., & Bhui, K. (2011). A case study of organisational cultural competence in mental healthcare. BMC health services research, 11(1), 218., DOI: 10.1186/1472-6963-11-218
  17. Aggarwal, N.K., Cedeno, K., Guarnaccia, P., Kleinman, A., & Lewis-Fernandez, R. (2016). The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SpringerPlus, 5, 384.
  18. Anthias, F. (2013). Intersectional what? Social divisions, intersectionality and levels of analysis. Ethnicities, 13(1), 3-19., DOI: 10.1177/146879681246354
  19. Aries, N.R. (2004). Managing diversity: The differing perceptions of managers, line workers, and patients. Health care management review, 29(3), 172-180., DOI: 10.1097/00004010-200407000-00002
  20. Betancourt, J., Corbett, J., & Bondaryk, M. (2014). Addressing disparities and achieving equity: Cultural competence, ethics, and health-care transformation. Chest, 145(1), 143–148.
  21. Rinaldi, A., Civitelli, G., Marceca, M., & Paglione, L. (2013). Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia. Revista Interdisciplinar da Mobilidade Humana, 21(40), 9-26.
  22. Saha, S., Beach, M.C., & Cooper, L.A. (2008). Patient centeredness, cultural competence, and healthcare quality. Journal of the National Medical Association. 100(11), 1275–1285.
  23. Seeleman, C., Essink-Bot, M.L., Stronks, K., & Ingleby, D. (2015). How should health service organizations respond to diversity? A content analysis of six approaches. BMC health services research, 15(1), 510.
  24. Thackrah, R.D. & Thompson, S.C. (2013). Refining the concept of cultural competence: building on decades of progress. Medical Journal of Australia, 199 (1), 35-38.
  25. Truong, M., Paradies, Y., & Priest., N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research, 14, 99., DOI: 10.1186/1472-6963-14-99
  26. Weech-Maldonado, R., Dreachslin, J. L., Brown, J., Pradhan, R., Rubin, K. L., Schiller, C., & Hays, R. D. (2012). Cultural competency assessment tool for hospitals: Evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards. Health care management review, 37(1), 54-66.
  27. Weech-Maldonado, R., Dreachslin, J. L., Dansky, K. H., De Souza, G., & Gatto, M. (2002). Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals. Journal of Healthcare Management, 47(2), 111-124., DOI: 10.1097/00115514-200203000-00009
  28. Weech-Maldonado, R., Dreachslin, J. L., Epane, J. P., Gail, J., Gupta, S., & Wainio, J. A. (2018). Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project. Health care management review, 43(1), 30-41., DOI: 10.1097/HMR.0000000000000128
  29. Whaley, A. L., & Longoria, R. A. (2008). Assessing cultural competence readiness in community mental health centers: A multidimensional scaling analysis. Psychological Services, 5(2), 169.
  30. Yin, R. K., (2005). Lo studio di caso nella ricerca scientifica: progetto e metodi. Roma: Armando Editore.
  31. Bhui, K., Warfa, N., Edonya, P., McKenzie K., & Bhugra, D. (2007). Cultural competence in mental health care: a review of model evaluations. BMC Health Serv Res, 7, 15-22., DOI: 10.1186/1472-6963-7-15
  32. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77-101.
  33. Cattacin, S., Chiarenza, A., & Domenig, D. (2013). Equity Standards for Health Care Organisations: a Theoretical Framework. Diversity and Equality in Health and Care, 10 (4), 249- 258.
  34. Chiarenza, A. (2015). Equity in health care: from assessment to action plans. Equity Standards in Healthcare: actions for change. Bruxelles, 27 November 2015.
  35. Chiarenza, A. et al.(2014). Standards for equity in health care for migrants and other vulnerable groups self-assessment tool for pilot implementation. HPH Task Force on Migrant-Friendly and Culturally Competent Health Care., DOI: 10.13140/RG.2.2.27349.93928
  36. Chiarenza, A. (2018). Strategie innovative per rispondere alla diversita nei servizi sanitari: dalla ‘competenza culturale’ alla capacita di garantire equita e rispetto delle differenze. Politiche sanitarie, 19(3), 123-131., DOI: 10.1706/3022.30198.
  37. Chiarenza, A., Horvat, L., Lanting, K., Ciannameo, A., & Suurmond, J. (2019). Addressing healthcare for migrants and ethnic minorities in Europe: A review of training pr ogr amme s . Health Education Journal, 78( 1 ) , 9 - 2 3 . DOI : g/10.1177/0017896918793164.
  38. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care: a monograph on effective services for minority children who are severely emotionally disturbed. Vol. 1. Washington, DC: Georgetown University Child Development Center.
  39. Dauvrin, M. (2013). Cultural competence in health care: challenging inequalities, invo l v i n g i n s t i t u t i o n s ( D o c t o r a l d i s s e r t a t i o n ) . – Retrieved from:
  40. De Freitas, C., Garcia-Ramirez, M., Aambo, A., & Buttigieg, S. C. (2014). Transforming health policies through migrant user involvement: Lessons learnt from three European countries. Psychosocial Intervention, 23(2), 105-113.
  41. Dell’Aversana, G., & Bruno, A. (2018). Servizi sanitari culturalmente competenti: prospettive emergenti nel contesto italiano. Uno studio esplorativo/Culturally competent health services: trends and perspectives in the Italian context. An explorative study. Psicologia della Salute, 2, 115-136., DOI: 10.3280/PDS2018-002010
  42. DelVecchio Good, M.J.D., & Hannah, S.D. (2015). “Shattering culture”: perspectives on cultural competence and evidence-based practice in mental health services. Transcultural Psychiatry, 52(2), 198-221., DOI: 10.1177/1363461514557348
  43. Dogra, N., Dogra, J. R., Betancourt, N., Park, E. R., & Sprague-Martinez, L. (2009). The relationship between drivers and policy in the implementation of cultural competency training in health care. Journal of the National Medical Association, 101(2), 127-133.
  44. Dotson, E., & Nuru-Jeter, A. (2013). Setting the stage for a business case for leadership diversity in healthcare: History, research, and leverage. Journal of Healthcare Management, 57, 35-46., DOI: 10.1097/00115514-201201000-00007
  45. Fung, K., Lo, H. T., Srivastava, R., & Andermann, L. (2012). Organizational cultural competence consultation to a mental health institution. Transcultural Psychiatry, 49(2), 165-184., DOI: 10.1177/1363461512439740
  46. Guerrero, E. G., Fenwick, K., & Kong, Y. (2017). Advancing theory development: exploring the leadership-climate relationship as a mechanism of the implementation of cultural competence. Implementation Science, 12(1), 133.
  47. Harper, M., Hernandez, M., Nesman, T., Mowery, D., Worthington, J., & Isaacs, M. (2006). Organizational cultural competence: A review of assessment protocols. Making children’s mental health services successful series, FMHI. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health. -- Disponibile online:
  48. Ingleby D. (2011). Good practice in health service provision for migrants. In: Rechel B., Mladovsky P., Deville W, Rijks B., Petrova-Benedict R. and McKee M., editors, Migration and health in European Union. Maidenhead, UK: Open University Press McGraw-Hill, pp. 227-242.

Giuseppina Dell’Aversana, Andreina Bruno, Health services, migration and diversity. Perspectives on the implementation of cultural competence in "RICERCHE DI PSICOLOGIA " 1/2020, pp. 275-299, DOI:10.3280/RIP2020-001013


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