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University of California, San Francisco

“...[I]t's important to understand how different cultural issues, how different cultural competency issues effect how families learn about asthma and interpret asthma...”

Michael Cabana, M.D., Principal Investigator, University of California, San Francisco (San Francisco, CA)

Michael Cabana, M.D. discusses how the University of California, San Francisco helped providers communicate more effectively with culturally diverse patients and families.

Project Snapshot

Stephen C Lazarus, M.D., UCSF, and Michael Cabana, M.D., UCSF, attend a NACI meeting in Baltimore, MD.

Applying the PACE Program to Underserved Clinics (APPUC) Cultural Competency Module, a project of the University of California, San Francisco (UCSF), combined evidence-based asthma guidelines and best practices in culturally competent patient education to improve asthma care and outcomes. UCSF developed the module as a supplement to the well-established Physician Asthma Care Education (PACE) program, now updated with the six priority messages of the Guidelines Implementation Panel (GIP) Report. While PACE included key educational messages and communication strategies for working with patients who have asthma, it lacked a specific cultural competency component.

UCSF’s APPUC module provided techniques for enhancing the ability of health care providers to work effectively in situations where the language, customs, beliefs or values of the provider differ from that of the patient. To develop the module, UCSF researched evidence-based best practices in culturally competent patient education, consulted with national experts in cultural competency, and enlisted the assistance of practitioners in the field to review the new materials developed. It then tested the effectiveness of the module in two face-to-face seminars with primary care providers who serve children who have asthma in the racially and ethnically diverse San Francisco Bay Area.

The final APPUC slide deck and speaker’s manual are available online. UCSF designed this site to describe the APPUC project and to make its module readily accessible to providers working in other underserved and/or minority communities.

Project Goals

  1. Evaluate the effectiveness of the PACE curriculum in improving primary care provider asthma counseling for minority and underserved families.
  2. Assess what type of PACE curriculum supplementary materials are needed to improve provider asthma education for minority and underserved children.
  3. Develop additional PACE curriculum supplementary materials to improve primary care provider interactions with minority and underserved children.

Dr. Michael Cabana in dialogue with another participant at a NACI meeting in Baltimore, MD.

Challenges & Solutions

Challenge: Provider participation in APPUC seminars. Due to the busy schedules of pediatric asthma care providers, UCSF found it challenging to recruit these providers to help test the APPUC module. Beyond attending the seminar and providing initial feedback on the new module, UCSF was asking physicians to commit to providing additional feedback several times over the course of a year after the training to help UCSF assess its effectiveness in real-world practice.

Solution:  Expand recruitment efforts with the help of a regional partner. UCSF partnered with the Regional Asthma Management and Prevention (RAMP), enabling UCSF to extend its recruitment efforts beyond San Francisco into the rest of the Bay Area. As a result, UCSF recruited 36 participants who participated in the seminars and agreed to a one-year evaluation commitment. Many of these participants were also pediatric residency directors who influence the training of other physicians.


UCSF developed an additional module and speaker’s guide that addresses cultural competency in provider-patient interactions that is an additional component for the PACE program.

UCSF staff developed an extensive partnership with the RAMP to help with program implementation and training session recruitment.


UCSF shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:

UCSF joined the University of Michigan Center for Managing Chronic Disease (CMCD), a NACI Strategic Partner, in conducting an introductory webinar on the updated PACE program for more than 200 participants. The archived webinar is available online.

UCSF applied PACE to improve physician-patient communication in asthma care and asthma outcomes, in order to meet its project goals.

Other NACI-funded projects that used UCSF-type approaches are:

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Last Updated February 2015