***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Increasing clinician awareness of racial disparities and improving communication may enhance diabetes care among black patients . OBJECTIVE To evaluate the effect of cultural competency training and performance feedback for primary care clinicians on diabetes care for black patients . DESIGN Cluster r and omized , controlled trial conducted between June 2007 and May 2008 . ( Clinical Trials.gov registration number : NCT00436176 ) SETTING : 8 ambulatory health centers in eastern Massachusetts . PARTICIPANTS 124 primary care clinicians caring for 2699 ( 36 % ) black and 4858 ( 64 % ) white diabetic patients . INTERVENTION INTERVENTION clinicians received cultural competency training and monthly race-stratified performance reports that highlighted racial differences in control of hemoglobin A(1c ) ( HbA(1c ) ) and low-density lipoprotein ( LDL ) cholesterol levels and blood pressure . MEASUREMENTS Clinician awareness of racial differences in diabetes care and rates of achieving clinical control targets among black patients at 12 months . RESULTS White and black patients differed significantly in baseline rates of achieving an HbA(1c ) level less than 7 % ( 46 % vs. 40 % ) , an LDL cholesterol level less than 2.59 mmol/L ( < 100 mg/dL ) ( 55 % vs. 43 % ) , and blood pressure less than 130/80 mm Hg ( 32 % vs. 24 % ) ( all P < 0.050 ) . At study completion , intervention clinicians were significantly more likely than control clinicians to acknowledge the presence of racial disparities in the 8 health centers as a whole ( 82 % vs. 59 % ; P = 0.003 ) , within their local health center ( 70 % vs. 51 % ; P = 0.020 ) , and among their own patients ( 63 % vs. 43 % ; P = 0.037 ) . Black patients of clinicians in the intervention and control groups did not differ at 12 months in rates of controlling HbA(1c ) level ( 48 % vs. 45 % ; P = 0.24 ) , LDL cholesterol level ( 48 % vs. 49 % ; P = 0.40 ) , or blood pressure ( 23 % vs. 25 % ; P = 0.47 ) . LIMITATION 11 % of primary care teams did not attend cultural competency training sessions . CONCLUSION The combination of cultural competency training and race-stratified performance reports increased clinician awareness of racial disparities in diabetes care but did not improve clinical outcomes among black patients As the percentage of older adults of diverse ethnicities increases in the United States , the call for culturally sensitive health care service strategies that target the special needs of older people grows . The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well , older M and arin-speaking Chinese residents of Los Angeles . The specific qualitative research procedures that we used to adapt the treatment program are described , along with the particular adaptations that emerged . Additionally , outcomes from a r and omized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older M and arin-speaking men and women . The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders Objectives . Aboriginal communities have a high prevalence of diabetes and heart disease , and limited re sources to address them . The objective of this study was to test the effectiveness of prioritizing care with audit and feedback on cholesterol management of diabetic patients . Study design . A controlled before-after intervention trial was conducted among health care providers in Oji-Cree reserves in Sioux Lookout Zone , Ontario . Two communities were r and omized to receive an interactive educational workshop and chart audit with feedback on cholesterol management ;  2 control communities  received usual care . Methods . The primary outcome measure used was the proportion of patients on  statins  , and the secondary outcome measure was the proportion of patients with LDL>2.5 mmol/L or TC/HDL>4.0 on statins . Outcomes were assessed by chart review at baseline and 10 months post-intervention . Results . Patients in the 2 intervention communities ( n=170 ) and the 2 controls ( n=170 ) were comparable at baseline . The intervention did not increase the proportion of diabetic patients on statins overall or in the subset of patients with elevated cholesterol . The proportion of patients with elevated cholesterol on statins went from 46 % to 53 % ( p=0.48 ) in the intervention group and from 47 % to 50 % ( p=0.25 ) in the control group . Conclusions . Audit and feedback listing patients requiring treatment did not increase  statin prescription rates in diabetic patients in remote Aboriginal setting s. This may be due to elevated baseline rates , the low intensity of feedback and the constraints of the practice environment , such as low staffing and high staff turnover INTRODUCTION Although depression can be treated effectively with Cognitive Behaviour Therapy ( CBT ) , only a small percentage of Chinese Australians access evidence -based treatment due to practical and cultural barriers . The present study examined the efficacy and acceptability of an Internet delivered CBT ( iCBT ) program to treat Chinese Australians with depression . METHODS The Chinese depression iCBT program ( the Brighten Your Mood Program ) is a culturally adapted version of the clinical ly efficacious Sadness iCBT Program . Fifty-five Chinese Australians with depression were r and omly allocated to either an immediate treatment group or to a waitlist control group . Treatment consisted of an 8 week program with 6 CBT online educational lessons , homework assignments , additional re sources presented in Chinese and English , and weekly telephone support with M and arin/Cantonese-speaking support personnel . An intention-to-treat model was used for data analyses . RESULTS Seventeen of twenty-five ( 68 % ) treatment group participants completed all lessons within the timeframe . Compared to controls , treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory ( CBDI ) and Patient Health Question naire-9 item ( CB-PHQ-9 ) . The within- and between-group effect sizes ( Cohen 's d ) were 1.41 and 0.93 on the CBDI , and 0.90 and 0.50 on the CB-PHQ-9 , respectively . Participants rated the procedure as acceptable , and gains were sustained at three-month follow-up . LIMITATIONS The study included several sub clinical participants and some measures that have not been previously vali date d with Chinese Australians . CONCLUSIONS Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians BACKGROUND To investigate the feasibility and effectiveness of a needs-led , community-based intervention for treating individuals from black minority ethnic ( BME ) groups with common mental disorders . METHOD Forty eligible individuals from BME groups were r and omised to a needs-led package of care ( therapy based on the principles of cognitive behaviour therapy and ethnically matched therapists , advocacy and mentoring ; ' rapid access ' ) or to a 3-month waiting list control with information on local mental health services ( ' st and ard access ' ) . RESULTS At 3-month follow-up , individuals in the rapid access group showed significantly improved levels of depression ( GHQ-28 adjusted p<0.05 ) although there was no evidence for difference in general functioning ( GAF , p=0.87 ) . The intervention was found to be culturally appropriate and acceptable among users and did not result in significantly increased costs . LIMITATIONS The exploratory study sample was small with low power and therefore the statistical certainty may be limited . CONCLUSIONS Effective and culturally acceptable psychosocial interventions can be delivered in the community to individuals from BME groups with anxiety and depression with no significant cost implication Introduction : Although numerous studies have examined cultural competence training , debate still exists about efficacious approaches to this training . Furthermore , little focus has been placed on training and evaluating practicing physicians . Methods : A skills‐based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state 's Medicaid program . We hypothesized that physicians completing the course would show higher levels of self‐reported cultural competence as measured by a Cultural Competence Assessment Tool ( CCAT ) than those in the control group . Differences in CCAT subscale scores were also compared . Results : Ninety physicians completed the study , with 41 in the control and 49 in the intervention group . Most were female ( 66 % ) , with an average age of 44 , and 12 years in practice . There were no significant differences on total CCAT score ( 212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention , p = .444 ) or subscales measuring cultural knowledge . There were significant positive differences on the subscales measuring physicians ' nonjudgmental attitudes/behaviors ( subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention , p = .004 ) and future likelihood of eliciting patients ' beliefs about diabetes and treatment preferences ( 3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention , p = .014 ) . There was , however , a significant negative difference on the subscale measuring cultural self‐awareness ( 3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention , p = .018 ) . Discussion : A predominantly skills‐based approach to training physicians did not change aggregate measures of cultural competence , but did affect key attitudes and behaviors , which may better reflect the goals of cultural competence training BACKGROUND Patient navigators may increase colorectal cancer ( CRC )  screening rates  among adults in underserved communities , but prior r and omized trials have been small or conducted at single sites and have not included substantial numbers of Haitian Creole-speaking or Portuguese-speaking patients . METHODS We identified 465 primary care patients from 4 community health centers and 2 public hospital-based clinics who were not up-to- date with CRC screening and spoke English , Haitian Creole , Portuguese , or Spanish as their primary language . We enrolled participants from September 1 , 2008 , through March 31 , 2009 , and followed them up for 1 year after enrollment . We r and omly allocated patients to receive a patient navigation-based intervention or usual care . Intervention patients received an introductory letter from their primary care provider with educational material , followed by telephone calls from a language -concordant navigator . The navigators offered patients the option of being screened by fecal occult blood testing or colonoscopy .  The primary outcome was completion of any CRC screening within 1 year . Secondary outcomes included the proportions of patients screened by colonoscopy who had adenomas or cancer detected . RESULTS During a 1-year period , intervention patients were more likely to undergo CRC screening than control patients ( 33.6 % vs 20.0 % ; P < .001 ) , to be screened by colonoscopy ( 26.4 % vs 13.0 % ; P < .001 ) , and to have adenomas detected ( 8.1 % vs 3.9 % ; P = .06 ) . In prespecified subgroup analyses , the navigator intervention was particularly beneficial for patients whose primary language was other than English ( 39.8 % vs 18.6 % ; P < .001 ) and black patients ( 39.7 % vs 16.7 % ; P = .004 ) . CONCLUSIONS Patient navigation increased completion of CRC screening among ethnically diverse patients . Targeting patient navigation to black and non-English-speaking patients may be a useful approach to reducing disparities in CRC screening . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01141114 PURPOSE The purpose of this study was to examine the effects of a cultural competence improvement program for maternity nurses . METHODS A quasi-experimental study using a non-equivalent control group pre and posttest design was used . Participants were 67 maternity nurses caring for multicultural pregnant women in G city . The cultural competence improvement program was developed based on the 3-D Puzzle Model and was provided using case-based small group learning methods for the experimental group ( n=31 ) . The control group ( n=36 ) did not receive any intervention . Data were collected using self-report structured question naires at two time points : prior to the intervention and after the intervention and were analyzed with descriptive statistics , χ²-test , and t-test . RESULTS Compared to the control group , the experimental group reported significant positive changes for cultural knowledge ( t=6.39 , p<.001 ) , cultural awareness ( t=3.50 , p<.001 ) , and cultural acceptance ( t=4.08 , p<.001 ) . However , change in cultural nursing behaviors ( t=0.92 , p=.067 ) was not significantly different between the two groups . CONCLUSION Findings from this study indicate that a cultural competence improvement program with case-based small group learning is a useful intervention strategy to promote multicultural maternity care . Further , strategies to improve cultural nursing behavior should be developed to promote culturally congruent nursing care OBJECTIVE Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers ( LHWs ) in Sindh , Pakistan . METHODS A baseline study on mothers and children provided local evidence for risk communication tools design ed and tested by LH 
    Output:
    
Sensitivity analyses using different values for the Intra-cluster coefficient ( ICC ) did not substantially alter the magnitude or significance of summary effect sizes .
All four domains of the conceptual framework were addressed , suggesting agreement on core components of cultural competence education interventions may be possible .
There was positive , albeit low- quality evidence , showing improvements in the involvement of CALD patients .
Findings either showed support for the educational interventions or no evidence of effect .