Cultural safety in patient education

Cultural safety is an important consideration across our physiotherapy practice, particularly when it comes to patient education.

Saha et al. (2008) presents several interprofessional features that define a health professional’s patient-centredness and cultural competence, including:

1. Understanding patients’ beliefs, values, explanatory model for their illness (how they make sense of their condition) and learning needs
2. Building therapeutic rapport
3. Aligning the treatment plan with patients’ perspectives
4. Being aware of personal biases
5. Recognising cultural differences and expanding cultural knowledge
6. Acknowledging differences in health outcomes for minority groups
7. Effectively utilising interpreter services

Patient-centred care and cultural competence overlap significantly as they both treat the patient as an individual, explore their beliefs and values, and engage in shared decision making. They differ in that patient-centred care is not directly address cultural differences, while cultural competence focuses on how we can self-reflect on our biases, appreciate diversity, and build cultural knowledge as further stepping stones to optimising our patient care.

Culturally competent or culturally tailored patient education has been shown to be effective at improving knowledge, self-management behaviours and treatment outcomes for patients with a variety of chronic conditions (Joo & Liu, 2020; Zhang et al., 2024). Given the important role of physiotherapists in promoting positive health behaviours, the use of culturally tailored education is useful for helping us engage with people from diverse backgrounds.

The diverse presentation of pain

Often as physiotherapists, our priority of treatment is to assess and manage pain. The experience and presentation of pain can vary significantly across cultures, as cultural norms influence how individuals express, interpret, and respond to pain. For effective patient education and management, it is essential to develop an accurate understanding of each patient’s unique pain experience. Davidhizar and Giger (2004) propose several strategies to bridge this gap, these include:

1. Appropriate choice of pain assessment tools that allow patients to indicate their experience in various ways. This includes the translated Brief Pain Inventory, Faces scales, Visual Analog Scale or translated Numerical Rating Scale.
2. Awareness of variation in emotional responses or meanings of pain. We should consider if the patient may be minimally responsive or stoic vs highly emotive or expressive with their pain experience that reflect their cultural norms.
3. Awareness of different communication styles across cultures. For example, individuals may be reluctant to discuss their pain or request management.

Key contributors to cross-cultural miscommunication

To prevent miscommunication in patient interactions, we must be mindful of several considerations, including:

1. Cultural differences in explanatory models of health and illness
2. Differences in cultural values
3. Racism and unrecognised biases
4. Linguistic barriers.

Notably, healthcare workers at large feel unconfident in providing culturally competent patient education (Minnican & O’Toole, 2020). Much of this confidence can be improved by engaging in cultural competency professional development, conducting needs assessments of relevant cultural groups, building connections with the community and engaging in shared decision making.