Cultural competency in student physical therapists in relation to their

demographics and life experiences.

Shelby Schneider, Raneen Allos, Erin Brink

Research Proposal
ABSTRACT
Introduction: Cultural competence in healthcare is a growing topic with research developing
across all professional fields. One’s perceived cultural competence levels may be distorted by
their personal biases. This study’s aim is to develop a method to analyze participants’ true versus
perceived cultural competency levels and determine if variables such as their demographic
information and/or life experiences influence them.
Methods: A survey containing questions regarding the participants’ demographic information,
life experiences they have participated in and their perceived versus true cultural competency
levels is currently being developed by investigators via modification of an existing validated
survey. The survey will be distributed electronically to student physical therapists at eight
accredited universities. The participants' responses will be reviewed to find potential correlation
between the multiple variables noted above and participants’ cultural competency scores.
Results: Investigators anticipate that there will be a difference between our participants’
perceived and true cultural competency scores. It is also expected that there will be a relationship
between the participants’ demographic information and/or life experiences when compared to
their respective competency scores.
Conclusion: Through the data gathered from our research survey, we expect to find a correlation
between demographics and life experiences as it pertains to the participants’ perceived and true
cultural competency scores. This information will be applied to further research with the aim of
furthering cultural competency training in student physical therapists.
Keywords: cultural competency, physical therapy, life experience, demographics, correlation
INTRODUCTION
Cultural competency, also known as cultural responsiveness, is a topic that has grown in
significance over the past several years.1 Providing culturally competent care can be defined as
the awareness of social and cultural influences a patient has and considering these factors when
delivering health care.2 These factors include the age, gender, race/ethnicity, sexual preference,
and socioeconomic status of each individual. There exist two different measures of cultural
competency: perceived cultural competency and true competency. For Physical Therapy (PT)
students, the two are not often measured, and the research on the matter is still fairly developing.
In addition, potential factors that could contribute to an increased or decreased level of cultural
competency have also not been researched thoroughly. Te et al3 stated, “To date, no literature has
examined factors associated with cultural responsiveness in physiotherapy students.” Research
regarding how to reduce biases held by providers from various health care professions is absent
from available literature as well.4 We believe that life experiences such as clinical rotations,
working in pro bono clinics, volunteering in neighboring communities, attending mission trips,
study abroad opportunities, and/or alternative breaks will have an impact on one’s cultural
competency levels; however, there has been conflicting evidence on whether these experiences
positively or negatively impact cultural competency scores. The discrepancy lies within the
specific type of life experience, discussed by de Diego-Lazaro5 stating, "Service-learning study
abroad programs should not be confused with volunteer tourism trips or ‘voluntourism’.”
Voluntourism can be described as trips advertised as volunteering for individuals who are less
fortunate/residing in third world countries, when in reality, most of the trip is spent participating
in tourist/vacation activities and not providing true service based care to the local community’s
population.5 On the other hand, we found several studies that stated that structured service
learning 6-8 and/or interprofessional clinical experiences 9 have been proven to be positive for
developing culturally competent health delivery skills by students 6-9 and improvements of self-
efficacy scores coupled with awareness of diversity.10 It allows students to become more
prepared for future experiences,9 as well as positively benefits the community receiving the
services.6,7

The amount of cultural competency a student physical therapist (SPT) receives may vary based
upon several factors. SPTs may have learned about what it means to be culturally competent
through attendance of presentations in the classroom at their respective educational institution,
while others gained knowledge through field experiences, such as clinical rotations, or
volunteering through their graduate programs to serve their respective communities through
service learning/community outreach with physical therapy services.11 For example, one study
surveyed 18 physiotherapy students from differing physiotherapy programs to gain more insight
on the students’ respective curricula for development of cultural responsiveness.12 Study results
showed that of the programs surveyed, two had cultural responsiveness classes, fifteen had
cultural competency content dispersed throughout the curriculum, and seven had a combination
of both.12 Te et al12 included that, “Overall, most programs appeared to use didactic teaching
methods, such as lectures, online and films/videos, compared to experiential teaching methods,
such as simulation-based learning and immersion in culturally diverse healthcare communities.”
In addition, out of classroom methods that were emphasized in these programs were study
abroad opportunities, volunteering within the local community, leadership debates, and field trips
to indigenous community areas/centers.12

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On the other hand, some SPTs receive no formal and/or non formal cultural competency training,
and “reported feeling particularly unprepared regarding the cultural context of care.”13 It could be
speculated that this could potentially lead to these individuals not being at the same level with
patient care capabilities as their peers post-graduation in the workforce who have had
competency training. Within these two extremes of culturally competent versus culturally
incompetent, there are also individuals who claim they are culturally competent but are unable to
provide concrete examples that could support their claim. Molerio et al14 discovered that when
individuals were asked to rate their level of cultural competence, they tended to provide a
number higher than their capabilities. A vast percentage of working PTs are unable to recall
receiving formal cultural competency training, or if they did it was minimal, nor are they able to
describe specific example(s) where they utilized cultural competency skills when treating
patients of differing genders, races, ethnicities, sexual preferences, and/or socioeconomic
statuses.11 Unfortunately, this could in turn misguide the employees’ employers in thinking their
employee was prepared to work with culturally diverse clients when they were not, which could
negatively alter their patient’s care.13

In order to bridge the identified gap between true cultural competency capabilities and one’s
perceived levels, our research will attempt to identify if there are specific demographics that
have a discrepancy between these two cultural competency levels. While there is research on
cultural competency within various medical professions (i.e., Physical Therapists, Physician
Assistants, Nursing),3,4, 11-13 the research is unclear if the cultural competency results are true
results or merely perceived personal notions of one’s cultural competency levels and what the
exact demographics and life experiences are associated with their cultural competency results.
Due to this, the investigation into our research questions has been deemed as unique because it is
not adequately supported in the scientific literature. The aim of our study is to identify potential
differences in our participants’ perceived versus their objective, true cultural competency scores.
These results will be analyzed with the addition of investigating if demographics and/or
experiences (i.e., the individuals’ curriculum, extracurricular opportunities, or the individuals
themselves) have an influence on the participants’ cultural competency scores.

We have several hypotheses for our research. First, we expect a difference in responses for at
least 50% of our participants when comparing their perceived versus true cultural competency
scores. Second, we are also hypothesizing that there will be a relationship between the
demographics of the survey participants and their cultural competency scores. Third, we
hypothesize that SPTs who receive formal cultural competency training, complete field
experiences and/or participate in service learning/community outreach opportunities will have
higher true cultural competency scores. If the results of this study show that individuals who
receive cultural competency training/experiences demonstrate true cultural competency,
universities should take this into consideration and implement these strategies. This will provide
tools to their respective students to in turn promote more effective and competent care to their
current and future patients.

Our two research questions are: Compare and contrast the demographics of individuals who self-
rate themselves as highly culturally competent but score low on true cultural competency tests

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(Q1). The second question asks if life experiences, clinical experiences, or a mixture of both lead
to a more culturally competent individual (Q2)?

METHODS
This methods section is a plan for how we have determined to distribute information and receive
data for our study.
Participants
Participants will be currently enrolled, healthy physical therapy students in accredited programs
in the United States. Outreach plans are to disperse survey materials to SPTs at Central Michigan
University, Grand Valley State University, Oakland University, University of Michigan Flint,
Andrews University, Western Michigan University, Wayne State University, and the University
of South Florida. The number of students within each of these doctoral programs listed will be
taken from the Physical Therapist Centralized Application Service (PTCAS) website directory.
Once these numbers are retrieved, they will then be added up to provide the total number of
potential respondents our survey could have. Participants must be: over 18 years of age, currently
enrolled in an accredited physical therapy program, and be able to complete an online survey via
Google Forms. Participants will be recruited by emailing the survey to program directors and
requesting the materials be shared with their respective cohorts.
Experimental Procedure
For our research, we plan to make an electronic survey on Qualtrics that will contain our
questions pertaining to the participants’ demographics, perceived cultural competency, and life
experiences. A link to our survey on Qualtrics will be sent to the program directors of the
indicated Doctor of Physical Therapy (DPT) programs and will then be dispersed to their
respective first through third year students via email for them to take on their own. With
Qualtrics, the participants’ identification information will not be viewable by the researchers,
leaving the responses confidential and anonymous. The participants will receive the following
instructions: “Please complete the survey below presenting with questions regarding cultural
competency. Please answer all the questions to the best of your ability, with the option of ‘not
applicable’ or ‘prefer not to answer’.”

The demographic questions will include the participants’ age, gender, race, ethnicity, sexual
preference/orientation, what languages they speak, highest level of education they’ve obtained,
socioeconomic status of the participants’ family. See Appendix A (attached at end of text). The
life experiences portion of the survey will include one question asking the participant to indicate
whether they have participated in the following life experiences with each life experience listed
underneath as separate subsections. There will be an option to select yes or no. Subsequently if
yes is selected, an explanation can be provided by the participant. See Appendix B. For the
perceived cultural competency portion of our survey, we will utilize an already validated cultural
competence instrument15 that contains 48 questions. This validated survey is divided up into five
different categories with their own respective scaling/scoring systems. See Appendix C.

In order to score the participants’ true cultural competency levels, the investigators will pose less
than ten short answer questions that encourage the participant to describe in words situations
where they had to utilize cultural competence while interacting with an individual of the general
public, providing patient care, etc. Examples of the questions we plan to ask our participants
have been written and included in Appendix D. The questions will be validated prior to sending
out the survey to participants. The participants’ responses will then be scored by the three

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investigators with a predetermined coding system. Their responses will be scored as either being
culturally competent or not. This scale is still being developed by the investigators. For the sake
of the research course, Google Forms was utilized for the survey questions found in Appendix A
and C; however, once the survey is distributed within the next year a more specific survey
program such as Qualtrics, will be used to ensure further protection and security for the
participants’ identifiable information. All appendices are attached at the end of the text after the
reference page.
Data Collection and Statistical Analysis
The data for this survey will be collected once a statistical number of results are obtained. The
data used for this research will be finding if there is any correlation between true and perceived
cultural competence. The data will also be further analyzed to find if (1) certain demographics
can be correlated with specific true or perceived scores and (2) if life experiences have a
relationship with competency scores. If it is found that there is a relationship between cultural
competency scores and life experiences, then it will be determined by the investigators if the
participants’ life experiences were based on voluntourism trips or volunteering and true
community immersion.

The survey was electronically distributed to the respective participants. Once we determine the
total number of students within each doctoral program, the required amount of responses in order
to be statistically significant (p-value<0.05) will be calculated. To calculate the significant
number of responses needed for a p-value<0.05, the researchers will be utilizing G*Power, a
statistical program to complete the calculations. We anticipate that we will receive this minimum
number of responses in return.

Once we receive the survey responses, Laerd, an online statistical tutorial program, will be
utilized to teach us how to use IBM SPSS Version 28.0.1.0 (142). This online statistical analysis
program will perform a two-way ANOVA analysis once the number of participants along with
their respective coded variables are inputted. A two-way ANOVA will determine if there is a
correlation between the following variables: the participants’ demographics, life experiences,
perceived and true cultural competency scores.

RESULTS
We expect to receive the minimum amount of responses in return that has been deemed as being
statistically significant, as described in the Data Collection and Analysis section of our proposal.
We foresee that there will be a difference between demographics outlined in our survey (i.e., age,
gender, ethnicity, race, socioeconomic status, sexual orientation, and first language) and their
cultural competency scores. It is also expected that we will see higher perceived cultural
competency scores rather than true cultural competency scores due to lack of life experiences
and formal training. Due to the amount of literature in support of the impact that life experiences
have on cultural competency, we believe that life experiences will have a higher, more positive
impact on cultural competency scores compared to individuals who have not participated in these
experiences.

DISCUSSION

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Our novel study aimed to investigate if specific demographics and/or life experiences influenced
an individual’s cultural competency scores. The perceived versus true cultural competency
scores of our participants were also analyzed to see if they aligned or if there was a discrepancy
between the two. We anticipate that our hypotheses that demographics and life experiences will
affect our participants’ cultural competency scores and that our participants’ perceived versus
their true cultural competency scores will not be in alignment will be supported by our results.
Once we have an answer to our hypotheses, right or wrong, evidence within the available
literature to support our results will be cited. If our hypotheses are proven correct, we suggest
that not only should cultural competency courses be included in the program curriculum, but life
experiences such as clinical rotations, working in pro bono clinics, volunteering in neighboring
communities, and attending mission trips, study abroad opportunities and/or alternative breaks
should also be encouraged and/or mandated for SPTs to complete before graduating.

LIMITATIONS
The first major limitation found in the research was the lack of a scale of true cultural
competency. For the purpose of this proposal, a validated survey was chosen to begin the data
collection. The survey chosen did not include questions regarding life experiences and did not
have any measure of true competency, only perceived. To close the gap in these limitations,
questions about life experiences and true competency must be validated and added into the
survey. True competency has the potential to be measured in “fill in the blank” example
questions or Likert scale style questions, but until validated, the researchers cannot be sure of the
optimal way to ask questions.

A second limitation to the validated survey we proposed is that there are no questions regarding
the LGBTQ+ community. Research regarding the LGBTQ+ community has grown over the past
couple of decades and should be included in this research; however, there are “No known studies
have assessed LGBT cultural competency of Occupational Therapy, Pharmacy, Physical
Therapy, and Physician Assistant students.”16 The questions asked in the survey were pertaining
to our participants’ overall culture, which can be inferred as asking about their heritage,
ethnicity, and/or race. To make the survey more inclusive, the researchers would add questions
regarding sexual orientation with the demographics and/or working with the LGBTQ+
community in the participants’ life experiences portion of our survey.

The third limitation to our study is the potential for the directors of the doctoral programs, we
have indicated our intent to survey, to refrain from distributing the survey to their program’s
student body. We plan to send each of the directors an email prior to the survey distribution to
explain the investigators’ purpose for the study, the novelty of the research, and how the research
could positively influence the future of the profession if significant results are extracted from the
survey. If there are a limited number of participants for the survey and the number of responses
is not statistically relevant, as outlined in the Data Collection and Analysis section of our
proposal, then the findings of the survey may not be deemed as significant.

CONCLUSION
The researchers are hopeful the data received in this study can be applied to future research,
furthering the importance of cultural competence training in SPTs as well as other medical and
health professional students. The topic of cultural competency is not a new one, but it is

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continuously growing and changing. The definition may encompass more and more as society
grows and changes, and it is hopeful the research will follow and grow with it.

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University; 2021
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15. Schwarz JL, Witte R, Sellers SL, et al. Development and psychometric assessment of the
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Appendix A: Demographic Survey

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10
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 Appendix B: Life Experience Survey

1. Please indicate whether you participated in the following experiences. If answering

“yes,” please describe.
a. Volunteer opportunities
i. Yes
ii. No
iii. Explain
b. Clinical experience
i. Yes
ii. No
iii. Explain
c. Study abroad
i. Yes
ii. No
iii. Explain
d. Mission trip
i. Yes
ii. No
iii. Explain
e. Working in clinics
i. Yes
ii. No
iii. Explain
f. Alternative breaks
i. Yes
ii. No
iii. Explain

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Appendix C: Validated Cultural Competency Survey

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Appendix D: True Cultural Competency Questions

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1) Describe in 250 words or less, a time you provided a patient with culturally competent
care.
2) Describe in 250 words or less, a time where you educated yourself on a patient who had
needs different than your own, and thus required culturally competent care.
3) Describe in 250 words or less, how you personally define cultural competence when
related to working with patients.

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