IMPROVING CULTURAL HUMILITY WITHIN MUSCULOSKELETAL PHYSIOTHERAPY WHEN WORKING WITH A DIVERSE PATIENT POPULATION

K. Land¹, G. Yeowell¹

¹Manchester Metropolitan University, Department of Health Profession, Manchester, United Kingdom

Background: Global migration and medical tourism have brought diversity of patient populations accessing healthcare, thereby demands on healthcare organisations to meet the needs of culturally diverse patients. Commonly, the dominant culture within healthcare organisations establish the standards of care that determine healthcare priorities. This can lead to disparities in healthcare and reduced health outcomes for some cultural groups. Cultural humility is one approach for achieving culturally adaptive and responsive healthcare services. The need for physiotherapists to practice cultural humility is essential for meeting patient needs. Whilst some studies have begun to explore wider aspects of patient culture and healthcare, to date no studies have investigated cultural humility and musculoskeletal physiotherapy. Due to the limited research within physiotherapy, this study was undertaken from the broader healthcare perspective.

Purpose: To explore healthcare professionals’ perceptions of achieving cultural humility and apply this to a musculoskeletal physiotherapy setting.

Methods: A systematic review of qualitative literature was conducted in accordance with ENTREQ guidelines. A systematic search of six databases available through the EBSCOhost platform was undertaken, along with backwards citation. To identify relevant studies SPIDER (Sample, Phenomenon of Interest, Design, Evaluation and Research type) and PEO (Population, Exposure and Outcome, or themes) tools were used to identify relevant studies. Eligibility criteria were applied. Included studies were qualitative primary studies that explored healthcare professionals’ perceptions of cultural humility (or similar terminology) in a hospital or clinical environment to ensure applicability to a musculoskeletal physiotherapy setting. The CASP tool was used to assess quality. Thematic analysis was used to analyse the data.

Results: 11 studies were identified, including a total of 212 participants, predominantly nursing staff, from Northern America, Asia, Australasia, the Middle East, and Europe. CASP scores ranged between 8 and 10, indicating they were medium to high quality. Three themes were found, ‘Cultural preparation’, ‘Professional partnerships’ and ‘Holistic care’. Cultural preparation included consideration of knowledge and awareness of cultural factors; the need for education and training; inclusivity, and critical self-awareness. Professional partnerships concerned working together; establishing connections through trust, respect and understanding. Holistic care included individualised, patient centred care; and professional and organisational culture.

Conclusions: This study highlights the importance of providing holistic healthcare which incorporates cultural humility. Healthcare professionals’ perceptions of delivering cultural humility has provided insight into ways physiotherapy can apply this in a musculoskeletal setting. The findings of this study support the necessity of good, effective communication, in addition to being prepared, having self-awareness of our own cultural values and how these may impact our patients.

Implications: Whilst the study aim was to explore cultural humility within musculoskeletal physiotherapy, the lack of literature within physiotherapy meant this study had to be expanded to healthcare professions. However, this enabled for greater diversity of healthcare professional perspectives. Furthermore, as included studies were from 5 continents, this allowed for cultural diversity to be explored holistically. The lack of research in the area from a physiotherapy perspective indicates a need to further explore this topic within this field.

Funding acknowledgements: This study was unfunded.

Keywords:
Cultural humility
Musculoskeletal physiotherapy
Diverse population

Topics:
Musculoskeletal
Professional issues: diversity and inclusion
Service delivery/emerging roles

Did this work require ethics approval? No

Reason: Ethical approval was not required for the completion of this systematic review.