The Impact of Health Equity Coaching on Patient’s Perceptions of Cultural Competency and Communication in a Pediatric Emergency Department: An Intervention Design

• Published in: Journal of patient experience Vol. 6; no. 4; pp. 257 - 264
• Main Authors: McMichael, Brianna, Nickel, Amanda, Duffy, Elizabeth A, Skjefte, Lisa, Lee, Lor, Park, Patina, Nelson, Stephen C, Puumala, Susan, Kharbanda, Anupam B
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.12.2019; Sage Publications Ltd; SAGE Publishing
• Subjects: Bias; Pediatrics; clinician–patient relationship; culture/diversity; emergency medicine; implicit bias; pediatrics; health equity; American Indian; community engagement
• ISSN: 2374-3735; 2374-3743
• DOI: 10.1177/2374373518798111

Purpose: American Indian (AI) children experience significant disparities in health-care access. As a result, they are more likely to use the emergency department (ED) for nonemergent visits than white children. In a recent study, pediatric ED providers have shown an implicit bias for white children over AI children. To combat implicit bias in an ED setting, we created a protocol for training ED providers as health equity coaches. Methods: The intervention took place during the fall of 2016 and was composed of 4 educational lectures, 6 to 8 hours of service learning in AI communities, and the participant’s dissemination of what was learned through formal presentations and informal conversations with other ED staff. We measured the impact of this intervention on the intervention participants with a group interview at the completion of the intervention. Results: The findings from the group interview provide feedback on what was learned during the intervention, how it impacted providers, and feedback on the structure of the intervention. Overall ED providers reported the intervention improved awareness of their implicit bias and ways to improve communication and care for AI patients. Additional institutional policy and procedural changes are necessary to effectively and sustainably address health disparities affecting AI populations. Conclusions: The participating providers identified their lack of knowledge regarding AI cultures at the start of the intervention and it became clear that their knowledge, comfort, and relationships with AI communities increased as a result of this intervention.