Developing cultural competence in occupational therapy and physical therapy education: a field immersion approach.

Abstract

NEARLY 50% OF THE U.S. population will consist of ethnic minorities by 20501: Native Americans, Alaska Natives, Asians, Pacific Islanders, African Americans, Hispanics, and Latinos are expected to increase from 25% of the U.S. population in 1990 to 32% by 2010 and 48% by 2050. By 2080, for the first time in U.S. history, minority subgroups will comprise most of the total population and are predicted to account for 55.6% of the total population.2,3 Recognizing that the U.S. population is becoming increasingly diverse, the Pew Commission34 listed the provision of culturally sensitive care to a diverse society as one of its 21 competencies for health care professionals for the 21st century. To provide appropriate and effective care, health care practitioners (HCPs) need to understand how culturally learned values and customs affect people's health beliefs and practices. They use this knowledge to collaborate with individuals and communities to provide health care that is sensitive to and consistent with cultural values, beliefs, and customs.4 Given the growing multicultural and minority populations in the United States and the movement of health care delivery from hospital to community settings, HCPs, including practitioners in occupational therapy (OT) and physical therapy (PT), must be culturally sensitive to their clients' values, attitudes, beliefs, and behaviors to provide appropriate and effective interventions.5 Yuen and Yau5 suggested that knowledge of the factors that influence ill health beliefs and behaviors of a particular cultural group leads to a better understanding of how clients perceive and manage their illness and enhances clinical judgment and management decision-making skills. Effectiveness and quality of services improve through the selection of culturally relevant occupations and the development of plans of care that are meaningful to clients and compatible with their values and traditions.6,7 Clients' motivation to accomplish goals when therapeutic interventions are culturally relevant and meaningful to their cultural contexts also may be enhanced, in addition to the HCP's effectiveness in reaching the client.8 HCPs must possess the ability to understand how culture influences their clients' health and illness perspectives and behaviors, family decisions concerning care, and treatment expectations and compliance. The OT and PT faculty involved in the research and study abroad program described in this article conduct research in southern Belize biannually and regularly have HCP students assist in field data collection. The purpose of this article is to describe the educational strategies used and to explore student learning and cultural competence skill development that occurred before, during, and after a 1-week immersion experience in a small Mayan village in southern Belize. Literature Review Before describing the field immersion research project and the students' reflections of their experiences, a review of the literature on cultural competence is necessary to emphasize the importance of providing cultural awareness experiences in HCP entry-level curricula to prepare students for clinical practice in the 21st century. Occupational therapists value the importance of understanding clients' cultural values and beliefs in developing effective and appropriate interventions that will meet the needs of each individual. Pursuant to the American Occupational Therapy Association Accreditation Council's Standards for an Accredited Educational Program,9 foundational program content shall require the student to show knowledge and appreciation of the role of socioculturel, socioeconomic, diversity factors, and lifestyle choices in contemporary society and appreciate the influence of social conditions and ethical context in which humans choose and engage in occupations. The article entitled Core Values and Attitudes of Occupational Therapy Practice10 affirms the need to treat all health care recipients with equality and dignity, being respectful of their cultural beliefs and values. …