C&RL News December 2011 648 As the United States becomes more cul-turally diverse, inequities in health care have been identified. It is a sad truth that, for Americans, the quality of health care received varies greatly depending on race, ethnic- ity, ability to speak English, socioeconomic group, or place of residence (especially if it is rural). One organization bridging this gap is the Agency for Healthcare Research and Quality, which for the past eight years has published the National Healthcare Disparities Report detailing trends in health care equity and identifying inequalities. In it, for example, readers can find that Blacks, American Indi- ans, and Alaska Natives received worse care than whites for 40% of the evaluating stan- dards, and that the poor generally received worse care than higher income people in 80% of these standard measures.1 Other U.S. government agencies, educa- tional institutions, and organizations also par- ticipate in the effort to disseminate informa- tion enabling health care providers to acquire and use cultural competency skills in their practice. Many of these groups make their presence and information available online. This article points to these online edu- cational resources, Web sites, and blogs to assist librarians and their patrons, as well as educators, with information to address health care disparities. U.S. government • Culture, Language and Health Lit- eracy. The Health Resources and Services Administration provides links to materials intended to improve communication between providers and clients with diverse cultural, language, and health literacy backgrounds. Resources can be accessed in these catego- ries: General, Race/Ethnicity, Gender, Age, Special Populations, and Research and Educa- tion. One key feature is a section on Essential Health Literacy Tools, with advice on how to produce clear and understandable health education materials. Access: http://www.hrsa. gov/culturalcompetence/index.html. • Minority Health Surveillance – REACH U.S. 2009. The Centers for Disease Control and Prevention administer annual surveys in minority communities to monitor the local health status. Called The Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Sur- vey, this study evaluates health conditions for the following groups: Black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian. Results are compared with data for the general population derived from the “Behavioral Risk Factor Sur- veillance System (BRFSS) for the metropolitan and micropolitan statistical area (MMSA),”2 in these same communities. This data compari- son assists in the development of intervention programs for minority groups. Access: http:// www.cdc.gov/Features/dsREACHUS. • Minority Women’s Health. From the U.S. Department of Health and Human Services Office on Women’s Health, this site identifies government programs that act to improve the health of minority women. It distinguishes particular health risks faced by internet resources K aren Gilber t is reference/instruc tion librarian, e -mail: K aren.Gilber t@eku.edu, and Michelyn W. Bhandar i is associate professor in the College of Health Sciences, e -mail: M ichelyn.Bhandari@ e k u . e d u , a t E a s t e r n K e n t u c k y U n i v e r s i t y © 2011 Karen Gilbert and Michelyn W. Bhandari Karen Gilbert and Michelyn W. Bhandari Cultural competency in health care Web sites for health care providers and educators December 2011 649 C&RL News women of certain ethnic groups (African- Americans, Latinas, Asian-Americans, Na- tive Hawaiians/Pacific Islanders, American Indians/Alaska Natives, and immigrants) and provides links to information resources and organizations that may assist in dealing with these risks. Access: http://www.wom- enshealth.gov/minority-health/government- in-action/index.cfm. • National Healthcare Disparities Report, 2010. The eighth annual report from the Agency for Healthcare Research and Quality seeks to identify the “progress and opportunities for improving health care quality and reducing health care disparities.”3 It presents data for significant health care cat- egories and comparisons in chart form with text explanations. This report provides data on the following health issues: Effectiveness of Care, Patient Safety, Timeliness, Patient Centeredness, Care Coordination, Efficiency, Health System Infrastructure, Access to Health Care, and Priority Populations. Effectiveness of Care is measured specifically for these health topics: Cancer, Diabetes, End Stage Renal Disease, Heart Disease, HIV and AIDS, Maternal and Child Health, Mental Health and Substance Abuse, Respiratory Diseases, Lifestyle Modification, Functional Status Pres- ervation and Rehabilitation, and Supportive and Palliative Care. Methodology is explained in the introduction and in four appendices. The 2010 report’s priority population research emphasis includes analysis of heath care in inner-city and rural communities. Noting that the quality of health care varies across the country, this report directs readers to a “snapshot” of health by state.4 Each state’s health care strengths or weaknesses, and op- portunities for improvement, are detailed in key categories as compared to states in their region and to the nation. Access: www.ahrq. gov/qual/nhdr10/nhdr10.pdf. • The Office of Minority Health, Cultur- al Competency (OMH). The OMH’s mission is to improve “the health of racial and ethnic minority populations through the develop- ment of health policies and programs that will help eliminate health disparities.”5 The site aims to be an en- c o m p a s s - ing source of cultural a n d l i n - g u i s t i c competen- cy information and resources. Among the many significant features included here are the National Standards on Culturally and Linguistically Appropriate Services (CLAS), 14 standards of which four are mandatory for any organization receiving federal funds. The Guides and Resources page offers wide- ranging content, such as “A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations.” The Training Tools for Physicians and Others page contains useful links such as “Cultur- ally Competent Nursing Care: A Cornerstone of Caring.” There is also a page of relevant Policies, Initiatives and Laws. Users may wish to browse OMH’s offerings outside of the Cultural Competency tab. Pages on Data and Statistics, Minority Populations, Publica- tions, and a searchable Knowledge Center all support OMH’s effort to improve health care for disadvantaged populations. The Think Cultural Health: Advancing Public Health at Every Point of Contact pages offer Continuing Education and Communication Tools. Much of this site’s content is available in Spanish. Access: http://minorityhealth.hhs.gov/tem- plates/browse.aspx?lvl=1&lvlID=3. Educational institutions • National Center for Cultural Com- petence (NCCC). The National Center for Cultural Competence is hosted by George- town University’s Center for Child and Hu- man Development. This site offers a very rich array of re- sources for individuals and organi- zations in- terested in developing C&RL News December 2011 650 cultural competency practice. NCCC describes its mission as “to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persis- tent disparities, and to promote health and mental health equity.”6 NCCC’s site provides an abundant range of publications and other resources organized alphabetically or by type (for example, Guides and Planning Tools). Additionally, these resources may be ac- cessed by target audience: Organizations and Programs, Providers and Practitioners, Faculty and Trainers, and Families and Communities. The Family and Youth Perspectives link leads to articles designed to increase awareness of the cultural challenges families may face in seeking care, and some of the personal sto- ries are very affecting. Self-assessment tools for organizations and individuals wanting to gauge sensitivity to, and knowledge of, cultural competence are available on a page with links to assessment resources, notably the Cultural Competence Health Practitioner Assessment (CCHPA). NCCC partners with government agencies, foundations, and orga- nizations in providing resources and services. Current HRSA- and SAMHSA-Funded Projects and Initiatives include Children and Youth with Special Health Care Needs, the National SUID/SIDS Project, the Division of Research, Training and Education, and the Child and Adolescent Mental Health Initiative. NCCC can connect organizations with consultants to assist them with training and technical support. Consultants are available either geographically or by specialty. The Links to Other Resources is a valuable index of cul- tural competency information sources. Much of this site’s content is presented in Spanish. Access: http://nccc.georgetown.edu/. Associations and private or nonprofit organizations • The Cross Cultural Health Care Pro- gram (CCHCP). Located in Seattle, CCHCP offers training and consultation in the area of health care cultural and linguistic compe- tency. Their outreach on a national level in- cludes cultural competence train-the-trainers programs, as well as medical interpreting education. CCHCP sells a range of moderately priced bilingual medical glossaries, books, videos, and articles on the subject of cultural and linguistic competency. In particular, their Resource Center/Resource Guides contain an extensive group of links to information sources and organizations in the fields of cul- tural competence, health disparities, language access, medical interpreter services, the Cul- turally and Linguistically Appropriate Services (CLAS) standards and strategies for addressing CLAS, as well as a glossary of terms. Access: http://www.xculture.org/about.php. • Cultural Competency in Nursing Education. On this site, the American As- sociation of Colleges of Nursing publishes recommendations on Cultural Competency in Baccalaureate Nursing Education and Cultural Competencies for Graduate Nursing Students. Each document includes a rationale for inclu- sion of cultural competency in nursing educa- tion and identifies specific end-of program competencies enabling provision of cultur- ally competent care. Both are accompanied by a toolkit of resources to assist educators implementing these objectives. Access: http:// www.aacn.nche.edu/Education/cultural.htm. • Diversity RX. A nonprofit organization, DiversityRX focuses on improving accessibil- ity and quality of health care for minority, immigrant, and indigenous populations. The site is highly interactive, building affin- ity groups through such innovations as the Your Voice Initiative, which facilitates net- working and collaboration online, monthly Webinars, communities of practice, and peer learning networks. Readers may choose to take advantage of a free membership, which enables them to network with others on the site’s blog. This membership also allows readers to suggest new resources, comment on resources they have used, or participate in one of the communities of practice or peer learning networks. DiversityRX offers a searchable resource and organization data- base, and also features information resources December 2011 651 C&RL News on their Topics tab. Key topics and issues include: Organizational Cultural Competence, Culturally Competent Care, Cultural Compe- tence Training, Language Access, Policy, and Research. Access: http://www.diversityrx.org. • National Alliance for Hispanic Health (NAHH). Organized in 1973, NAHH is a network of providers whose mission is to provide health and human services to the Hispanic population. It advocates for health care reform supporting health care equity and for culturally inclusive medical research. NAHH has developed programs that promote community education and improved health in the areas of arthritis, cancer, community outreach, depression, diabetes, environmen- tal health, heart health, physical activity, science and education, and women’s health. It also offers a Resource Library with health publications and access to help lines. Access: http://www.hispanichealth.org. • Transcultural C.A.R.E. Associates. Originated by Josepha Campinha-Bacote, Transcultural C.A.R.E. Associates is a private organization specializing in the provision of training and consultation in cultural compe- tence, transcultural health care, and mental health. Campinha-Bacote maintains an active presentation schedule, as well as publishes considerably in the field. Her site features Models of Cultural Competence and Assess- ment Tools, some of which explicitly reflect a Christian viewpoint. The author offers books and assessment instruments for sale on the site. She also provides a series of useful links to other cultural competence information and resources. Access: http://www.transcul- turalcare.net. • Transcultural Nursing Society (TCNS). TCNS was founded in 1975 by the nursing theorist Madeleine Leininger, who is called on her Web site the founder of the worldwide Transcultural Nursing movement.7 This society aims to provide nurses and other health care professionals with the tools to en- sure equity in health care on an international basis, by supporting and providing standards on culturally congruent health care research, education, practice, and administration. TCNS publishes the peer-reviewed Journal of Transcultural Nursing (JTCN). It also of- fers a page on related theories of cultural competence. Since 1987, TCNS has offered a Certification in Transcultural Nursing for practitioners. Access: http://www.tcns.org. Blogs • Andromeda Transcultural Health. Andromeda Transcultural Health is a com- munity health organization located in Wash- ington, D.C. Founded by Ricardo Galbis in 1970, it originally targeted Washington’s Hispanic community. Its mission is to provide access to quality health care for underserved populations, regardless of cultural or linguis- tic background or ability to pay. This blog is of interest particularly as it demonstrates creative outreach to the community. Access: http://athdc.wordpress.com. • Bringing Health Information to the Community (BHIC). From the National Network of Libraries of Medicine, this blog contains information on health issues in underserved communities. Information is organized by topic, such as Minority Health Concerns, Rural Health, or Health Literacy. Information can also be accessed by month of posting. BHIC provides information on relevant conferences, as well as scholar- ships and grants. Users must register to post a reply to any entry. Access: http://nnlm. gov/bhic/2010/12/20/cultural-competency- resources-2. Notes 1. Agency for Healthcare Research and Quality, 2011, “2010 National Healthcare Disparities Report,” retrieved from www. ahrq.gov/qual/nhdr10/nhdr10.pdf (accessed November 9, 2011). 2. Centers for Disease Control and Pre- vention, 2011, “Minority Health Surveillance (continues on page 706) C&RL News December 2011 706 has been jointly acquired by the University of South Carolina (USC) Libraries, in conjunc- tion with the South Carolina State Museum. Donated by Robert B. Ariail of Columbia, South Carolina, the collection comprises more than 5,200 rare books and star atlases, scientific journals, rare offprints, and manu- scripts from the past 450 years. The Robert B. Ariail Collection of Historical Astronomy will be jointly held, with the telescopes and sci- entific equipment to be housed at the South Carolina State Museum and the books and manuscripts housed at USC’s Ernest F. Hol- lings Special Collections Library. Among the highlights of the collection is a 1752 manu- script by William Stukeley, a contemporary and colleague of Sir Isaac Newton. In the manuscript, “On the Via Lactea,” Stukeley expands on his conversations with New- ton and provides detail on his theory of the Milky Way, which predates other scholarship on the topic by 30 years. The collection also includes the earliest printed star atlas, com- piled in 1540 by Alessandro Piccolomini, a 1718 copy of Newton’s Optics, and a copy of John Bevis’s 1786 Atlas Celeste, one of about 25 copies issued. Political activist Doris “Granny D” Had- dock’s collection of letters, photographs, and memorabilia has been donated to Keene State College. These materials will be available at the Keene State College’s Mason Library to students, faculty, the lo- cal community, and the public at large as a vital resource on social justice. The col- lection includes letters from musician Peter Seeger, Vice President Joe Biden, “Patch” Adams, and former U.S. Senator Russ Fe- ingold. This collection will be available to use in research as part of Mason Library’s New Hampshire Social Justice Collection. New Hampshire Governor John Lynch pro- claimed March 10, 2011, as “Remembering Granny D Day” in the state, honoring Had- dock’s unrelenting advocacy for campaign finance reform, civic education, and envi- ronmental protection, and her U.S. Senate run at the age of 94. During her life, Had- dock amassed an extraordinary archive, in- cluding her journal from her walk across the United States, the campaign reform banner she carried, and a pair of her iconic campaign shoes. These archives will be ac- tively used by students, scholars, and citi- zens, who will work with the archival items to develop new scholarly and community- based work. Ariel Dorfman, the Chilean-American writ- er, human rights activist, and international figure has placed his archive with Duke Uni- versity. Dorfman holds the Walter Hines Page Chair of Literature and Latin American Studies at Duke, where he has taught since 1985. His award-winning novels, essays and poetry, writ- ten both in Spanish and English, have been translated into more than 40 languages. –REACH U.S. 2009,” retrieved from www. cdc.gov/Features/dsREACHUS/ (accessed November 9, 2011). 3. Agency for Healthcare Research and Quality, 2011, “2010 National Healthcare Disparities Report,” retrieved from www. ahrq.gov/qual/nhdr10/nhdr10.pdf (accessed November 9, 2011). 4. See http://statesnapshots.ahrq.gov /snaps10/index.jsp. 5. U.S. Department of Health & Human Services, The Office of Minority Health, 2010, “Cultural Competency,” retrieved from minorityhealth.hhs.gov/templates/browse. aspx?lvl=1&lvlID=3 (accessed November 9, 2011). 6. Georgetown University Center for Child and Human Development, n.d., “Cul- tural Competence,” retrieved http://gucchd. georgetown.edu/67212.html (accessed No- vember 9, 2011). 7. Madeleine Leininger, 2011, “Home Page – Madeleine Leininger,” retrieved from www. madeleine-leininger.com/en/index.shtml (ac- cessed November 9, 2011). (“Cultural competency...” cont. from page 651)