Our scoping review focused on cultural competence in rehabilitation services. Rehabilitation services included in this review were: audiology, speech-language pathology, physiotherapy, and occupational therapy. A search strategy was developed to identify relevant articles published from inception of databases until April 2015. Titles and abstracts were screened by two independent reviewers according to specific eligibility criteria with the use of a liberal-accelerated approach. Full-text articles meeting inclusion criteria were then screened. Key study characteristics were abstracted by the first reviewer, and findings were verified by the second reviewer.
To our knowledge, this review is the first to summarize barriers and facilitators to cultural competence in rehabilitation fields. Insufficient studies were found to draw any conclusions with regards to audiological services. Minimal perspectives based on patient/caregiver experiences in all rehabilitation fields underscore a research gap. Future studies should aim to explore both patient/caregiver and practitioner perspectives as such data can help inform culturally competent practices.
Developing cultural competence in physical therapy practice pdf
An evaluation of whether services effectively address the needs of minority culture populations is therefore required to improve cultural competence in rehabilitation services. Before such an evaluation can take place, there needs to be an understanding of how culture can affect services [23]. Yet, experts have stated that research in cultural competence in the rehabilitation fields is often outdated, anecdotal, and may reflect stereotypical views [20, 24]. Additionally, there appears to be a need for evidence-informed culturally competent services. For example, Aboriginal Early Childhood Development practitioners and parents have expressed frustration about the lack of culturally appropriate assessment tools [19, 21, 25]. Without culturally competent interventions, chances for optimal outcomes may become reduced.
This review was therefore undertaken to review and assess the state of knowledge with respect to barriers and facilitators of cultural competence in rehabilitation services. In order to address this objective, this review considered literature from several fields within the broad area of rehabilitation services. This included services in both adults and pediatric care. The research question addressed in this review was: What are the barriers and facilitators to cultural competence in rehabilitation services?
In consultation with a librarian (LS) within the health sciences field, the rehabilitation services chosen for this review were: audiology, speech-language pathology, physio/physical therapy, occupational therapy, and nursing articles related to any of these four fields.
Eligible articles were considered if they: 1) discussed health care practitioners in rehabilitation and/or recipients of rehabilitation health care services and where appropriate, their caregivers; and 2) reported on perceived barriers and facilitators to cultural competence in the context of practitioner-patient interactions.
Major concepts in the search strategy were cultural competence, rehabilitation services, and sociocultural barriers and facilitators. A sample of subject headings and key words used in the search strategy include: cultural competence, cultural sensitivity, minority health, physiotherapy, occupational therapy, audiology, nursing, sociocultural barriers, healthcare disparities, and culturally responsive care. Relevant articles found in the field of nursing were screened to ensure that the fields included rehabilitation.
A data abstraction form was piloted amongst a random sample of 10% of included articles to see whether the content was sufficient to answer the research questions. Abstracted items included: study characteristics and outcomes related to the barriers and facilitators of cultural competence in rehabilitation services. This pilot was performed by the same independent reviewers (VG and VM). All remaining articles were abstracted using the improved form by the first reviewer. Completed forms were then verified by the second reviewer.
Speech language pathologists, physical therapists, and occupational therapists reported cultural differences affected service delivery. In a pediatric context, cultural differences were seen in child-rearing strategies. Interacting with fathers was reported to be challenging due to gender attitudes varying across cultures [45]. Occupational therapists also identified cultural differences in play. Therapists spoke of cultures where parents do not play with their children. This was seen to complicate service delivery as therapists felt conflicted about encouraging parents to use play in therapy [39].
Views of independence were also said to vary across cultures [12, 39, 40, 46, 47]. Western-based practices value the promotion of independence however the assumption that this is a universal value has limited the provision of culturally competent care. Yang [47] described challenges experienced by occupational therapists where patients did not believe achieving independence was important as it was the responsibility of their families or maids to care for their children. Additionally, activities of daily life used in occupational therapy were not seen as meaningful within some cultures [40, 47].
Speech language pathologists, physical therapists, and occupational therapists cited limited resources in providing culturally competent care. This included Western-based practices, linguistically-relative materials, lack of bilingual practitioners, lack of interpreters, and a lack of sufficient training and/or education.
In terms of linguistically-relative materials, offering information and recommendations to service recipients in English created challenges in providing therapy [35]. These limitations affected relationship-building opportunities [12]. Regarding service materials, several studies discussed challenges with providing appropriate assessment materials, treatment planning, treatment materials, and treatment goals [33, 36, 38,39,40, 42, 46, 47, 49, 50, 52]. In particular, studies reported a lack of appropriate assessment/screening instruments creating barriers to culturally competent service delivery [33, 36, 38, 40,41,42, 49, 50, 52]. Such limitations become increasingly worrisome when there are already difficulties in differentiating a language difference from a language disorder [41, 42].
Learning about the role of religion and traditional healing methods was also seen as an important facilitator. Unlike Western medicine where illness and religion are separate entities, cultures exist where religious and traditional healing roles govern perceptions of illness as well as every day practices [46, 48]. Having an awareness of the ties between religion and health may allow practitioners to better tailor care to meet the needs of their minority patients. Practitioners seeking to gain knowledge about cultural differences, cultural histories, and/or the roles of religion and traditional healing methods can educate themselves with the use of books and media [33, 37, 40].
Engaging in cross-cultural encounters was also viewed as a useful strategy to developing cultural awareness. This can involve creating links with cultural agencies, attending cultural events, interacting with communities, or simply engaging in day-to-day interactions with culturally diverse individuals [49, 54,55,56].
Finally, being reflective was noted by numerous studies as an important requirement for developing cultural awareness. This involved practitioners examining their own cultural identity, values, prejudices, biases, and/or assumptions and the influence it can have on service delivery [39, 49, 51, 55, 56].
Patients/caregivers expressed an appreciation for services that incorporated cultural awareness into practice protocols. This involved services that used culturally appropriate materials and tailored care to meet the needs of minority patients/caregivers.
Patients/caregivers expressed the need for understanding rehabilitation services. Specifically, the purpose of therapy, how long it will take, the roles of family members in supporting it, and the benefits of compliance, particularly if aspects of treatment (e.g. exercise) are not a part of their culture [49, 59, 60]. Practitioners who possess cultural awareness and are able to offer such explanations are therefore in a better position to provide culturally competent care.
There was much overlap in the barriers and facilitators reported by both adult and pediatric services, however there were a few notable differences. Barriers listed in articles discussing pediatric care were reportedly due to the influence of cultural differences. Specifically, cultural differences in child rearing [45] and play [39] presented challenges to intervention practices. Differences in the understanding of disability were also seen to impact service delivery. Practitioners reported how perceptions of disabilities were difficult to manage as these views sometimes extended to expectations of how it can be fixed as opposed to managed [12, 45].
This scoping review summarized barriers and facilitators to cultural competence in rehabilitation services. While several studies on this topic were found in the fields of speech-language pathology, physiotherapy, and occupational therapy, insufficient studies were found to draw any conclusions with regards to audiological services. Minimal perspectives based on patient/caregiver experiences in this field underscore a research gap. Future studies should aim to explore both patient/caregiver and practitioner perspectives on service provision and reception as such data can help inform evidence-based practices when providing services to cultural minorities.
Clinicians can engage in more culturally aware practice by assessing, collecting data, and testing hypotheses rather than accepting their own experiences and biases as the norm (Sue 1998). Scientific mindedness is a characteristic of clinicians and human service providers who develop theories about client behaviors by analyzing data rather than by dependence on their personal assumptions (Sue 1998), and may reduce bias and foster better understanding of client behavior. A reliance on scientific, behavior analytic knowledge when working with clients is also required by the Professional and Ethical Compliance Code for Behavior Analysts (BACB 2015). 2ff7e9595c
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