Improvements in Cultural Competence Through Classroom and Local Cross-Cultural Service-Learning Activities

Abstract

INTRODUCTIONPhysical therapist (PT) education programs are challenged with preparing students future practice in a diverse society. Gaps in communication and inadvertent bias may result in a lower quality of health care when the patient and provider are from different cultures.1,2 Additionally, health disparities among in the United States are well-documented.3 Disparities in access health care and the quality of health care services are potentially amenable contributors health disparities. It has been proposed that improving cultural competence can reduce the gap in the quality of health care offered.4,5Campinha-Bacote describes the development of cultural competence as a lifelong process in which health care professionals continually attempt improve their ability provide care within clients' cultural contexts.6 The cultural competence model developed by Campinha-Bacote proposes 5 different areas of cultural competence: awareness, knowledge, skills, encounters, and desire.7 Cultural awareness is defined as the process of examining one's own biases and background, in addition being aware of documented racism and biases in health care delivery. Cultural knowledge is described as the process of students and health care professionals pursuing a knowledge base about culturally diverse groups. Cultural skill is the ability obtain culturally relevant information and perform a cultural-based physical assessment. Cultural encounters involve interactions with clients and community members from culturally diverse backgrounds. Cultural desire is the motivation or passion that may provide energy the process of developing cultural competence.7The results of numerous studies in the physical therapy literature have indicated that international cross-cultural experiences can be effective improving cultural competence.841 The authors could not find published studies, however, demonstrating the effectiveness of local cross-cultural experiences in PT students, though evidence supports their use in medical12,13 and nursing14,15 students. Additionally, PT education programs include didactic cultural competence components in their curricula.11,16 However, extremely limited data have demonstrated the effectiveness of classroom experiences improving cultural competence.17Review of the LiteratureThe American Physical Therapy Association (APTA) recommends PT education programs include components promote cultural competence18 and provides recommendations achieve this.19 The APTA Committee on Cultural Competence published the Blueprint Teaching Cultural Competence in Physical Therapy Education in 2008 with the intention to promote the delivery of health care services that better address the needs of racial and ethnic minorities and for eliminating health disparities that currently exist.19(pl) The committee advocated a theoretical framework based on the works published by Cross et al20 and Campinha-Bacote.7 APTA's Blueprint For Teaching Cultural Competence In Physical Therapy Education focused on outcomes of acquiring attitudes, knowledge, and skill through a variety of classroom and community activities. Core components include: reflective practice promote self-examination, understanding social determinants of health, and promoting patient-centered care and effective communication with people from a variety of cultures by applying knowledge about culture, belief systems, and health behaviors.19Evidence establishing the effectiveness of cross-cultural experiences improving cultural competence has been described international experiences.840 Additionally, PT students participating in a mixed educational model including a combination of classroom activities, an international experience, and reflection activities demonstrated significant improvements in cultural competence11 as measured by the Inventory Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV©) self-assessment tool. …