CULTURAL COMPETENCE AND HEALTH DISPARITIES ACADEMIC AWARD
RELEASE DATE: December 12, 2003
RFA Number: RFA-HL-04-012
Department of Health and Human Services (DHHS)
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
PURPOSE OF RFA
The overall objective of this program is to enhance the ability of physicians and other health care professionals, to address disparities in the occurrence, management, and outcomes of cardiovascular, pulmonary, hematological, and sleep disorders among various population groups in the U.S. in a culturally sensitive manner. This academic award provides support to medical institutions in the U.S. to develop core curricula and other educational materials that will increase the overall knowledge and skills of medical students, house staff, and
other professionals, including practicing physicians on the ethnic, cultural, religious, socioeconomic, linguistic and other factors that contribute to health disparities, and on culturally competent approaches to mitigating these disparities.
Racial, ethnic, cultural and linguistic differences that exist in the U.S. population present a unique challenge for the practice of medicine. Despite major improvements in the overall national health in the U.S., major disparities continue to exist in the health status, incidence of illness, and access to health care among different population groups. This is particularly true for minority populations, such as African Americans, Latino/Hispanic Americans, Native Americans, Alaska Natives and Pacific Islanders, who face a disproportionate
burden of disease compared to the non-minority U.S. population. Hypertension, cardiovascular diseases, stroke, sickle cell disease, sleep disorders and asthma are several diseases within the mission of the NHLBI that disproportionately affect minorities.
Among the factors that are believed to be associated with health disparities are national origin, ethnicity, cultural, linguistic and family backgrounds, individual experiences, age and gender, financial status, geographic location, educational level, and occupation. Physician’s lack of knowledge and experience with these factors may further exacerbate their effects. Lack of diversity in the workforce may also contribute to health care industry’s inability to meet the needs of diverse patient populations, thereby affecting the quality of care and contributing to health disparities.
For the purpose of this RFA, cultural competence is defined as the health care provider’s ability to deliver culturally appropriate and specifically tailored care to patients with diverse values, beliefs, and behaviors. Very few programs are currently available to train health care providers on the health implications of cultural diversity and how they shape a person’s approach to health and illness.
Especially lacking are didactic courses and training programs that enhance physician knowledge of the manifold factors that influence the health needs and attitudes of people from diverse backgrounds, and of ways to apply this knowledge in patient care.
This Cultural Competence and Health Disparities Academic Award initiative seeks to fill this gap by promoting the development and use of relevant curricula in medical schools, as well as the training of physicians already in the health care pipeline. This program is designed to provide resources to domestic medical institutions, to develop mechanisms that offer students and physicians, knowledge, sensitivity and experience in understanding and managing cultural
barriers to health care, and to enable institutions to develop “best practices” in the delivery of optimal health care to multiethnic populations with heart, lung, blood or sleep disorders. It is hoped that this program will impact public health by identifying factors that increase risk to specific diseases and help physicians deliver the best possible health care.
This program will be implemented in two phases: Curriculum Development, and Implementation.
1) Curriculum Development Phase: This phase will include: (i) the identification of elements or components of core curricula for medical schools on cultural sensitivity and health disparities, and (ii) the development, testing and utilization of relevant materials and resources in appropriate settings. The course(s), materials and resources will especially: a) focus on the factors (e.g., cultural, religious and geographic backgrounds; beliefs; values; traditions; attitudes; and practices) that affect health, and disease occurrence; b) examine how these factors may influence medical help seeking behavior, compliance, adherence, and response to treatment; and c) identify strategies for delivering culturally sensitive information and interventions to the health care professionals. It is desirable that in addition to medical students, house staff, and other professionals, including practicing physicians are incorporated into the program.
Each applicant will describe: a) plans for the development of curricula and other materials, including procedures to evaluate the process and progress of curriculum development, plans for enlisting the support of professional and other organizations involved in medical education in these efforts; and b) plans and milestones for institutionalizing the curricular changes. These efforts may eventually culminate in the development of a single curriculum, or, if deemed necessary and justified, more than one curriculum. The curricula and any educational materials designed must be suitable for implementation at other sites.
The curricula may be developed in the context of a single or several-multiple ethnic/cultural group(s) and disease category(ies), or some combinations of these to provide one broadly applicable. The curricula may be adaptable into existing courses, or as stand-alone customized course(s). It is expected that this phase will be completed in 24–30 months.
2) Implementation and Training Phase: The curriculum development should be followed by an implementation phase that includes evaluation of products in appropriate settings (e.g., classrooms, professional meetings, focus groups, etc) and dissemination of educational materials, to the medical education community. This will include medical schools, and organizations coordinating residency programs, post-graduate courses, and continuing medical education, etc. It is expected that appropriate outlets will be used to encourage their integration into medical school curricula as well as training programs for physicians in practice, to help enhance their cultural competence and ability to deal with health disparities in the U.S. Each applicant should detail plans for conducting and testing the effectiveness of the proposed curriculum, including benchmarks against which success of the program can be measured.
In addition, to aid in the selection of the “coordinating center” each applicant must indicate how the investigators will coordinate their efforts with those of other participants in this program, expected to number 10-12. The coordination efforts should include, among others, organization of group meetings and conference calls to develop common ideas and plans for completing the two phases of the program as detailed above, and for generating interim and final progress reports.
The NHLBI will designate one of the awardees as the “Coordinating Center” and will provide additional funds earmarked for carrying out the coordinating responsibilities.
MECHANISM OF SUPPORT
This RFA will use the NIH K07 Academic Career Award mechanism. As an applicant, you will solely be responsible for planning, directing, and executing the proposed project. See the SUPPLEMENTARY INSTRUCTIONS section for additional information. An unsuccessful application to this RFA for one receipt date may be submitted as an amended application at a later receipt date. The anticipated award date for the first receipt date is September 30, 2004; for the second is July 1, 2005; and for the third is July 1, 2006.
The NHLBI intends to commit approximately $24 million over a seven-year period in response to this RFA. Ten to 12 applications will be funded per announcement (a total of 30 to 36 applications in response to three announcements). An applicant must request a project period of 5 years and a budget for direct costs (DC) up to $120,000 per year. Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size of each award will also vary. Although the financial plans of the NHLBI provide support for this program, awards pursuant to this RFA are contingent upon the availability if funds and the receipt of a sufficient number of meritorious applications.