Table 5.

Study design, measures and outcomes

	Study Design and Measures	Outcomes
Abbott (2014) [39]	Content analysis to determine the type and detail of the planned feedback, field notes from workshop discussions and participant evaluations to gain insight into participant confidence in cross cultural supervision.	72% registrars referred to culture or to the patient’s Aboriginality; few (8%) documented plans to utilise national initiatives to support health care access for Aboriginal patients. A lack of supervisor confidence in providing guidance on cross-cultural consultation with Aboriginal patients was identified.
Aboriginal Workforce (2015) [50]	Data analysis of training completions to measure the percentage of health staff who completed training components; staff and participant interviews; and, web-based survey of Chief Executives.	Average of 35% of New South Wales (NSW) Health staff completed online training, with significant variation in completion of face-to-face component across Local Health Districts (LHD). Program implementation was found to be slower than anticipated.
Brathwaite (2006) [40]	Multiple time-series design to measure nurse cultural knowledge as measured by the Cultural Knowledge Scale (CKS).	Quantitative and qualitative data showed in an increase in participants cultural knowledge following the program.
Chapman (2014) [38]	Pre and post questionnaire to measure the cultural awareness (perceptions and attitudes) of staff.	Changes in staff perceptions, but not attitudes which remained neutral. A decrease in ambivalence.
Dingwall (2015) [42]	Pre and post questionnaire to measure participant knowledge and confidence in delivering e-mental health to Indigenous people.	Significantly improved perceived knowledge and confidence in using e-mental health tools with Indigenous clients after training.
Hinton (2012) [41]	Pre-post questionnaire to measure participant knowledge and skills.	Significant improvement in knowledge of the warning signs and treatment of mental illness and levels of confidence to assess, treat and communicate with Indigenous mental health clients.
Khanna (2009) [46]	Retrospective post- then pre- evaluation utilising a non-validated Cultural Competency Assessment (CCA) tool to measure changes in knowledge and skills related to the care of patients from diverse cultural and ethnic backgrounds.	Statistically significant change in participants self-reported knowledge and skills in providing culturally competent care.
Kutob (2009) [47]	RCT measuring changes in scores on the Cultural Competence Assessment Tool (CCAT), a self-assessment tool developed for the study.	Total CCAT scores significantly increased for experimental group participants (83.55 before the course to 192.09 after the course), but did not change for the control group.
Liaw (2015) [52]	Pragmatic pre- and post- evaluation using a practice site audit of cultural respect, health checks and risk factor management for Aboriginal patients in general practice. A Cultural Quotient (CQ) questionnaire was used to measure staff cultural strategic thinking, motivation and behaviour.	Practices improved their readiness to provide culturally appropriate care to Aboriginal patients; an increase in Aboriginal patients post intervention (p < 0.05).; and increase in cultural quotient score 74.8–89.8 (p < 0.05); and individual practice staff improved their cultural strategic thinking.
Lopez-Viets (2009)	Pre- and during intervention evaluation in measures of research productivity, including number of grant applications and awards, publications and professional presentations of mentees.	There was considerable increase in total mentee research productivity: a 200% increase in grant applications and awards, a 336% increase in publications, and a 144% increase in professional presentations.
McElmurry (2009) [45]	Qualitative written evaluations and pre- and post- program focus groups to measure participants experiences/perceptions, and haemoglobin A1c (HbA1c) levels in patients.	Self-reported increased appreciation of cultural interpretations of health, increased knowledge and consideration of Latino health beliefs and practices, improved ability to interact with patients, and greater respect and appreciation for patients cultural views. Improvements in blood glucose control as measured by a drop in HbA1c.
McGuire (2012) [44]	Pre-post self-report survey measuring practitioner knowledge and confidence.	Significant (p < 0.001) improvements in knowledge and confidence.
McRae (2008) [51]	Repeated measures three-phase questionnaire and semi-structured, face-to-face, in-depth interview post-program to evaluate pharmacists confidence. A brief survey to measure acceptability of program to AHWs and an audit of attendance.	Significant improvements in confidence with Indigenous health issues and educating AHWs (p = 0.002); access to resources to deliver education (p = 0.005). Education program delivered to 80% of AHW’s in the region with positive reports of participant satisfaction.
Salman (2007) [48]	Pre-post questionnaire to measure practitioner self-reported cultural awareness and competence.	No effect sizes reported. Increases in proportion of participants rated as culturally aware and competent.
Thom (2006) [49]	Randomised Control Trial (RCT) measuring Patient-Reported Physician Cultural Competence (PRPCC) score, patient satisfaction with and trust in physician, and patient health outcomes of weight, blood pressure and glycosylated haemoglobin.	No significant improvement on any outcome measure for either intervention group. Lack of impact of physician training on health care provision.
Wu (2006) [43]	Comparative study with historical control measuring parent reported satisfaction with interpreter and healthcare experience.	Use of an in-person interpreter significantly increased Latino parents satisfaction (p < 0.001) versus phone interpreter, but a program using an interpreter to educate residents in cultural and language issues increased parents’ satisfaction more.