Overview
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations (APTA). 4 Culture is vital to a person’s existence and shapes how they view the world; therefore, it must be acknowledged and incorporated into healthcare practice. Health care practitioners need to understand how cultural learned values and customs affect people’s health beliefs and practices.”3
By 2060 the US population will be significantly older and more racially and ethnically diverse.1More explicitly, the 65 and older population will double and the 85 and older group will triple by 2060. The United States will become majority-minority for the first time in 2043, and no group will make up a majority.1 As society grows older and becomes more diverse healthcare must accommodate these changes to provide optimal care that meet the needs of each patient. Health disparities are extensive among ethnic groups and are often attributed to a lack of access that results from health care provider insensitivity to cultural needs of the patient.2
I view cultural competence as not only personal development, but also professional development. Therefore, I wanted to explore the development of cultural competence among physical therapy students, more specifically the impact of international-service learning on this development since I am participating in the Guatemala service-learning trip.
Literature Review
I initially generated a PICO question in Evidence Based Practice II that read: Among health professional students, particularly DPT students, is clinical education more effective than international immersion in developing cultural competence? However, for my capstone I narrowed my focus to the development of cultural competence through international service-learning; in order to, make my research findings applicable to the Guatemala trip. My final PICO question was the impact of international immersion experiences on the development of cultural competence among Physical Therapy students.
Current research regarding cultural competency among physical therapy students is burgeoning; however, minimal research exists regarding this subject matter and no study exist that compares clinical experience with international immersion in developing cultural competence. Moreover, only a single method of developing cultural competency, primarily service-learning is explored in each article. Also, every study existed as a qualitative study that collected data in various ways (i.e., observation, journaling, interviews, blogging, etc.) and subsequently the data was then analyzed in order to generate patterns or themes within the data that can be used for future data collection. For example, one study by Sawyer et al investigated the perceived impact of a 1-week physical therapy clinical education experience in Jamaica on the 8 DPT students from Arcadia University who participated.5 Students’ perceptions were grouped into four general categories: (1) an expanded worldview, (2) an expanded view of physical therapy, (3) changes within themselves, and (4) changes within themselves in the role of PT student.5 Overall, each article demonstrates that service-learning generated positive results for students; and students developed various aspects of cultural competence.
A great body of literature exists from many health professional programs like medicine, nursing and social work that have established initiatives and restructured curricula to teach cultural competence and better prepare students to treat the growing non-majority cultures as future healthcare providers. For that reason, I included articles from other healthcare professions that may serve as a future guideline for physical therapy programs.
Final Products
To succinctly summarize my literature review I created an Evidence table utilizing articles from the Evidence Based Practice II course and capstone course. I utilized the Cultural Competence Assessment (CCA), which assesses cultural competence behaviors, cultural awareness and sensitivity. This tool was used to gauge the development of cultural competence at pre-trip and post-trip among PT students and 2 faculty members. The findings from this assessment may also be utilized by the UNC DPT program in their current and future research endeavors on service-learning and cultural competence.
I also created an Evaluation Form to assess the success of my project and my ability to effectively present my research findings via my Power Point presentation. My evaluation form consists of 6 questions and a comments section; and a 4-point likert scale.
Evaluation & Reflection
After my presentation to DPT students traveling to Guatemala this spring and 2 faculty members I distributed an evaluation form and the Cultural Competence Assessment. I received positive feedback from everyone regarding my presentation along with a few suggestions that I can utilized for future presentations.
I really enjoyed researching this topic! I am passionate about the development cultural competence and international travel, and thankful that I was able to produce a project based on these interests. Though research is burgeoning regarding cultural competence among PT students I am hopeful that research will continue and cultural competence will be a major aspect of professional development for all DPT programs in the future.
Special Thanks
I want to give a HUGE thanks to my capstone advisor Katie Ollendick for listening to my numerous ideas, helping me narrow my focus and providing great feedback! Additionally, I want to thank my committee members Darcy Little and Tara Marshall for providing helpful information about their past experiences in Guatemala and providing feedback on my presentation!
Please feel free to provide your thoughts and feedback by utilizing the comments section below.
Visit http://uncptoutreach.blogspot.com/ to follow our experiences with UNC PT Outreach in Guatemala April 22-April 30, 2014!
References:
- U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. U.S. Department of Commerce: United States Census Bureau. Available at: http://www.census.gov/newsroom/releases/archives/population/cb12-243.html Posted December 12, 2012. Accessed November 14, 2013.
- Saver, C. Cultural Competency benefits patients, therapists. Therapy Insider. June 2007; 6-9.
- Ekelman B et al. Developing Cultural Comptence in Occupational and Physical Therapy Education: A Field Immersion Approach. Journal of Allied Health. 2003; 32(2):131-137.
- APTA. Cultural Competence in Physical Therapy. APTA. Updated September 12, 2013. Accessed February 13, 2014.
- Sawyer KL, Lopopolo R. Perceived impact on physical therapist students of an international pro bono clinical education experience in a developing country. J Phys Ther Educ. 2004; 18(2):40-47.
4 Responses to “The Journey of Cultural Competence: The Development of Cultural Competence among Physical Therapy Students”
Tomislav Cotic
Beverly,
First and foremost, what a wonderful idea for a capstone project! The concept of cultural competence, which you decided to investigate, is of utmost importance to all healthcare providers at the national, and global level for that matter. After a brief review of all your capstone materials, I have to tell you that I truly enjoyed and appreciate all that you put into this successful and extremely beneficial final product. Just a great job Beverly. I wanted to briefly reflect on my personal experience with various cultures, and why I also think cultural competence is critical to optimal patient care, as you have discussed throughout your project.
As you know, I was born and raised in Toronto, Canada, and I believe I have been lucky enough to live in one of the most multicultural countries in the world, having had the opportunity to experience a mixture of ethnic groups, languages, and cultures. Canada is considered a “cultural mosaic,” promoting the diversity of cultural heritages and encouraging people to retain their original cultural identity. I think because of this I have had the privilege of forming relationships with people from different cultures and heritages. As you talk about in your overview, I believe this experience of interacting with people, who have a different set of values and beliefs, has not only allowed me to grow personally, but it has helped me professionally, in the clinic and in the classroom. I think it’s cliché to say, but every person is different and everyone is subject to his or her own personal values and beliefs. And because of this, when we interact with others, we influence each other. I think every culture and every individual has his or her own morals. Some may be positive and benefit us, while some may make us worse off. When we interact with people who may be different than us, we should try to recognize these principles, adopting some of the positive values and avoiding the negative ones, all the while remaining respectful.
This same approach should be undertaken in the clinic while in contact with individuals. By doing so, we will enrich our own personal identity and perhaps mature professionally as every individual will respond to a variety of strategies in different manners.
Again Beverly, just a great job on this, and I think you should definitely continue to investigate this subject area and perhaps develop some research of your own.
Tracy Taylor
I just noticed that in your project title, there’s a “p” missing in the word “competence” – the first time in the title. Thought you might want to fix that. 😉
Kenneth Ngwu
Beverly,
I enjoyed looking through your CAPSTONE and strongly agree with your thoughts related to the importance of cultural competence in professional development. After reading through your literature review, I’m convinced that the impact of international immersion can help develop cultural competence for the professional development of PT students. As an African-American born to Nigerian parents, I’ve had several experiences in life that sort of resemble international immersion. Although I had a strong cultural influence from my parents while being raised in the US, I believe that I mostly developed my sense of cultural awareness while living in Nigeria. Therefore, I believe my time spent living in Nigeria is similar to an international immersion experience, which is likely more effective in promoting growth of cultural competence when compared to only discussing it in class. However, the international immersion experience may not be affordable for many students and PT programs. Therefore, I’m curious to know your thoughts on how effective the curriculum models for cultural competence in other health professional programs were.
Tracy Taylor
Hi Beverly –
Great job on your Capstone!!! I really enjoyed going through all of your materials. I find it exciting that by 2043 our country will no longer have a Caucasian majority, and that no group will fall into this category.
I wanted to ask you where you all will be staying during your trip to Guatemala? It has been my personal experience of traveling the world for one year that, when you stay with families in the community where you are visiting, you get a stronger sense of what the culture is truly like, as opposed to if staying in a hotel/motel, for instance. It can be especially challenging (but fun!) when you don’t speak the language of the country you are visiting. When given the opportunity to travel in this method, one truly gets a better sense of the world – the differences, the similarities, the challenges, and the triumphs! We can also gain a better appreciation of our own country while traveling abroad… perhaps we do have a lot of great things going on in this country of ours. And how can we help to improve the countries we are visiting when going on these international service learning trips? I think part of the improvement can be through bringing back your experiences and sharing them with others. And realizing that change is dynamic!
Your cultural competence assessment was spectacular! It will be interesting to see the changes when you get the post-test results back. The questions were extremely insightful and a few of them made me think long and hard.
I completely agree with you that cultural competence should be a major aspect of professional development for all DPT programs. How do you foresee this being integrated into the academic curriculum? As part of an existing class? Or as a free-standing Cultural Competence class that lasts through the semester? Again, great project!
Tracy