Effectiveness of culturally focused interventions in increasing the satisfaction of hospitalized Asian patients: a systematic review

Millicent Alfred, Karolina Ubogaya, Xing Chen, Diana Wint, Priscilla Sandford Worral
JBI Database of Systematic Reviews and Implementation Reports 2016, 14 (8): 219-56

BACKGROUND: Patient satisfaction is a driving force for healthcare organizations to enhance patient services. As the Asian population in the United States is increasing at a significant rate, it is important to understand the needs of this population to implement culturally focused services that will lead to increased Asian in-patient satisfaction.

OBJECTIVE: The objective of the systematic review was to identify the best available evidence on the effectiveness of culturally focused interventions in increasing satisfaction of hospitalized adult Asian patients.

INCLUSION CRITERIA TYPES OF PARTICIPANTS: This review considered studies that included Asian adults, 18 years of age and older, who were admitted to acute-care hospitals in countries where Asians are a minority culture.

TYPES OF INTERVENTIONS: This review considered studies that included any intervention or sets of interventions implemented by hospitals for the purpose of making the hospital experience consistent with the cultural preferences of adult Asian in-patients.

OUTCOME MEASURES: Satisfaction of adult Asian hospitalized patients as measured by self-report satisfaction scales or tools considered by accrediting and/or governing bodies to be acceptable sources of evidence of patients' perceptions of their care.

TYPES OF STUDIES: This review first considered randomized controlled trials (RCTs), non-RCTs and quasi-experimental studies. As no RCTs or quasi-experimental studies were found, the reviewers also considered before and after studies, cohort studies and case-control studies for inclusion. This review also considered 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. Three descriptive studies were selected in the review.

SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in English and Chinese (Mandarin and Cantonese) languages. A search of MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Educational Research Information Clearinghouse (ERIC), the Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Scopus, Excerpta Medical Databases (Embase) and Academic Search Premier was conducted, followed by a reference search of relevant studies and a gray literature search of the Virginia Henderson Library, Google Scholar, Mednar, conference proceedings and websites. The initial key words searched were patient satisfaction, culturally focused, hospitals, Asian-American and adult.

DATA EXTRACTION: Data were extracted using a standardized critical appraisal checklist and data extraction instrument from the Joanna Briggs Institute.

DATA SYNTHESIS: Due to the statistical and methodological heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative summary.

RESULTS: Three descriptive studies were reviewed with sample sizes ranging from 107 to 19,583 and a total of 386 Asian participants. Two of the studies reported on nine measures of patient satisfaction, whereas the third provided data on four measures. The interventions identified were: communication between physician/registered nurse and patient, cultural services, Asian social workers, interpreters, and cultural food. The first study included intervention groups that were exposed to inpatient information on hospitalized Chinese cultural services compared to the "usual care" control. The percentage of patients' satisfaction in the group who knew about the services (95%) was significantly higher (p < 0.01). In the same study, patients' satisfaction with nurses was higher (95%) in patients with nurses who were aware of Chinese cultural services, compared to patients with nurses who were unaware (83%) (p < 0.01). The second study developed a survey measuring 'Level of Top Box' satisfaction of Chinese patients in Chinese unit ('Informed of Chinese Culture Service') and non-Chinese unit ('Usual Care') with the outcome measure for patient satisfaction without p value. The two studies showed an increase in Asian inpatient satisfaction with communication between the physician/registered nurse and patient, as well as with pain control and quietness of the room. Also, two studies used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions as patient satisfaction surveys. The third study was a descriptive/comparative secondary analysis of HCAHPS and Cultural Competency Assessment Tool for Hospitals (CCATH) surveys. There was also no p value for patient satisfaction measurement. The design and analysis of this study was more complex, using hospital wide-cultural competency and addressing factors such as race and language ability (English and non-English speakers). The surveys completed in Chinese were less than 0.1% of the sample size and the Asian data were eliminated. This study also showed that a greater degree of cultural competence in hospitals was positively associated with patient satisfaction with doctors' communication (P < 0.05).

CONCLUSION: Evidence was insufficient to demonstrate cause and effect. Results suggest that culturally competent communication with patients by physicians and registered nurses, quietness of the room, information about treatments and procedures, and cultural foods are associated with increased satisfaction among hospitalized adult Asian patients.

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