Cultural competency within healthcare is a rather broad concept which aims to provide

accessibility of health care services to people from various ethnic backgrounds. In addition
to this, it also aims to provide the treating practitioner with the knowledge and awareness
of varying cultural etiquettes (Truong, Paradies & Priest, 2014). Consequences of cultural
competence are satisfaction with care, the perception of quality healthcare, better
adherence to treatments, effective interaction and improved health outcomes (Henderson,
Horne, Hills & Kendall, 2018).

As a third-year chiropractic student at Central Queensland University, this is a topic of

interest that has developed for me over my current semester. The issue that has presented
itself for me is that patients may not be receiving the greatest satisfaction and benefit from
treatment due to the lack of knowledge and understanding I have around cultural
competency and awareness. Regularly during OSCE’s and class activities we ask our ‘mock’
patients to remove their shirt, shoes and other various items for the purpose of improved
physical assessment. This however, could certainly present as an issue in patient care if I
were to have a student or future patient from a cultural background where this doesn’t
align with their ethics.

There have been some previous cases in the past while at university, where I have partnered
with someone new from a different cultural background and been unsure as to how to
approach the physical assessment due to my lack of understanding around cultural
competency. This had made me reflect on my future as a chiropractic practitioner, on how I
can best improve knowledge and awareness around this to ensure that my patient’s feel
safe, understood and better overall patient satisfaction and treatment can be achieved.
Therefore, I undertook some research from accredited journals to assist in my cultural
competency development.

In my quest to find methods to enhance my cultural competency, I found an article

published by Mandy Truong in 2014. The author determined that there are three main
categories of study outcomes: patient-related outcomes, provider-related outcomes, and
health service access and utilisation outcomes (Truong, Paradies & Priest, 2014). The study
found that there was moderate evidence of improvement in provider outcomes such as
knowledge, skills and attitudes in relation to cultural competency. In addition, there was
also improvement of health care access and utilisation outcomes, finding that interventions
using culturally specific patient navigators and community health workers were among the
most successful. However, there was weaker evidence for improvements in patient/client
outcomes (Truong, Paradies & Priest, 2014). This presented me with the realisation that
there are various approaches to improving cultural competency, some more effective than
others. An evidence-based review by L. Govere In 2016, further examined the success of
various methods aimed at increasing cultural competency of health care providers. These
were: standardised patient scenarios, non-verbal communication, patent-reported physician
cultural competency (PRPCC) scale and Self-Assessment of cultural awareness
questionnaires (Govere & Govere, 2016). One reviewed study found to have the most
success in increasing cultural competency, was published by Coelho & Galan in 2012 on
nonverbal communication that included facial expressions and vocal tones. This study
assessed the physician’s ability to read facial expressions and understand vocal tones of
patients from various ethnic backgrounds (Coelho & Galan, 2012).
The patients then also completed a survey which assessed their satisfaction with their
physicians, their adherence to medical treatments, and their desire to continue to see the
same physician. The results showed high level results with a satisfaction rating of (p= .032)
(Govere & Govere, 2016).

In implementing the knowledge I have gained from this research, I believe that initially a
team approach is not necessary. My primary focus will be on developing my own awareness
around various cultural backgrounds. However, in the future I do believe it would be
beneficial to take similar approach to the study done by Coelho & Galan and include patient
feedback as a means to measure my approach. Therefore, a 3-month educational and
training period on cultural competency, including non-verbal and verbal communication
could be undertaken. This then followed by assessing the outcome with patient surveys. In a
clinical setting, this could also be combined with comparing the number of new patients
from differing ethnicities who rebook from before to post training.

Overall, patients expect me to help them with their health by providing the best care
possible. Barriers can present in the deliverance and receptivity of care when cultural
competency is not present. I feel the best way to develop in this area is to undertake
personal study and develop my own understanding, awareness and skills on communication
(verbal and non-verbal) and cultural etiquette. I believe this is both in my best interest as a
developing practitioner, as it enables me to treat more effectively, as well as in the best
interest of the patient. The desired outcome is increased patient care and satisfaction.
References

Coelho, K., & Galan, C. (2012). Physician Cross-Cultural Nonverbal Communication Skills,
Patient Satisfaction and Health Outcomes in the Physician-Patient
Relationship. International Journal Of Family Medicine, 2012, 1-5. doi:
10.1155/2012/376907

Govere, L., & Govere, E. (2016). How Effective is Cultural Competence Training of Healthcare
Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of
Literature. Worldviews On Evidence-Based Nursing, 13(6), 402-410. doi: 10.1111/wvn.12176

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare
in the community: A concept analysis. Health & Social Care In The Community, 26(4), 590-
603. doi: 10.1111/hsc.12556

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency
in healthcare: a systematic review of reviews. BMC Health Services Research, 14(1). doi:
10.1186/1472-6963-14-99