Cultural Competence In Physical Therapy: The Road Less Traveled

Various factors such as gender, race, ethnicity, language, nationality, socioeconomic status, physical ability, and occupation influence well-being values, beliefs, and behaviors. [1] Considering the growing diversity of the population, developing cultural competence in rehabilitation is a crucial concern for health-care practitioners [2]. The concept of cultural competence in health care has emerged to deal with racial or ethnic disparities and in delivering the highest quality of care to every patient [1,2]. Health disparities among minorities are caused by socioeconomic inequality as well as additional compounding factors including language difficulties and weak social support networks [1,2]. Physical therapists identified a multitude of barriers/problems in providing culturally competent rehabilitation services [2]. Three major barriers noted were, language barriers, the influence of cultural differences on service delivery, and limited resources [2]. Language barriers made it difficult for health-care providers who could not communicate with their patients in their native language to give recommendations and instructions [2]. Limited resources in providing culturally competent care include western-based practices, linguistically-relative materials, lack of bilingual practitioners, translators, and lack of sufficient training and/or education [2].

It is possible that such challenges will hinder access to primary care services, resulting in sub-optimal treatment compliance and outcomes [2]. In programs of entry-level health-care professional education, it is critical to teach knowledge, attitude, and abilities that enable physical therapists to demonstrate best practices through clinical excellence and social responsibilities, allowing them to diminish and eradicate health inequalities [3]. To address health disparities and the needs of marginalized populations, healthcare professionals must adopt culturally competent practices that take into account the culture, socio-economic status, attitudes, beliefs, and practices of each patient [4].

People from culturally and linguistically diverse (CALD) communities experience higher levels of pain, disability, and psychological distress, and they are more likely to experience adverse health effects, receive subpar care, or be dissatisfied with their care if providers, organizations, and systems do not collaborate to provide culturally competent care [1,2]. Culture is a set of learned behaviors, beliefs, attitudes, and ideals that are unique to a particular society or group of people which has a substantial impact on health behavior, including illness behaviors, help-seeking, and receptivity to medical interventions [3]. Cultural competence is the culmination of multicultural awareness, knowledge sensitivity, skill, and information for patient management and is integrated into clinical work (Figure 1). It is defined as, ‘a set of congruent behaviors, attitudes, and policies that enable effective cross-cultural communication’ [2,3]. A physical therapist cultivates cultural competence by gaining knowledge and adopting attitudes and behaviors specific to culture, language, and communication. Increasing cultural humility is a step toward establishing culturally competent services [2].

Figure 1.

Factors contributing to cultural competency, cultural skill, cultural competence and cultural sensitivity.

Despite the increased emphasis on cultural competency, providing culturally appropriate services can be difficult for a variety of reasons. First, a patient’s cultural background can influence their values, beliefs, and practices about health [5,6]. Second, rehabilitation interventions tend to be tailored to meet the cultural values of the majority population, resulting in the failure to serve all cultural groups [7–9]. Thirdly, assessment bias can lead to misdiagnosis among minority cultures due to inaccurate interpretation of patients’ competence [2].

To be considered culturally competent, components of physical therapy practice should be challenged [2]. Appreciating the problem, setting goals, and pursuing customized therapy are crucial for all patients from different cultures [3]. Involving patients in goal planning enhances their satisfaction, motivation, and physiological outcomes while decreasing functional limitations [2]. A medical and sociocultural assessment of the patient must be performed in order to practice culturally competent physical therapy [2]. Understanding patients’ cultural backgrounds, learning about the histories of cultural groups, learning about the role of religion and traditional healing methods, making patients aware of the role of culture, establishing meaningful relationships, participating in cross-cultural encounters, having respect for cultures, understanding patients’ primary language, and asking patients about their values all helped practitioners deliver more culturally competent practice [2].

For fostering a culturally competent work environment and a more diverse workforce, training on providing services to minorities, registration forms that collect information on linguistic and cultural background, including family members in practices, matching practitioners with patients of a similar cultural background, and incorporating cultural competence into entry-level education were all deemed to be helpful strategies [2].

Physical therapists can make a personal commitment to regularly reflect on their own contextual and multifactorial value systems, prejudices, and preconceived notions [4]. As practitioners, we should examine strategies to improve healthcare delivery that results in more genuine, empathic, and equitable patient experiences by seeking feedback from patients and seeking the patient perspective to identify necessary modifications [4]. It takes a lifetime to become culturally competent. This cultural competency process should begin in entry-level physical therapy programs education curricula [10]. Mistakes and misconceptions are common during the long process of change; nonetheless, they should be addressed honestly and constructively [4].

Conflict of Interest

The authors report there are no competing interests to declare.