Cultural competence in occupational therapy to reduce health disparities: a systematic literature review

Abstract

Despite agreement about the relationship between cultural competence and health equality, there is a lack of clear guidance within occupational therapy about what it means to be culturally competent and how it can be achieved. This literature review aims to critically appraise qualitative research to explore occupational therapists' experience of working cross culturally. By comparing these experiences, this review aims to identify ways in which occupational therapists individually, and occupational therapy as a profession, can increase the efficacy of the interventions they provide within cross-cultural situations, so all clients can be supported to achieve equal health outcomes. The following databases were searched between 2010 and 2020: ASSIA (Applied Social Science Index), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, Medline Pubmed. The resultant papers were appraised using the Critical Appraisal Skills Programme checklist and thematic analysis was used to identify three themes. The six papers included in this review present the experiences of occupational therapists and occupational therapy students working in cross-cultural situations in the UK, Canada, South Africa, USA, Australia and Ireland. Three major themes emerged that explore the relationship between client-centred practice and cultural competence, theory–practice links, and strategies and barriers to working in a culturally competent way. Cultural competence is strongly aligned with some of the core principles of occupational therapy: occupational justice and occupational identity. However, theoretical knowledge and confidence among occupational therapists in this area is lacking, implying that their impact could be greater if there was a more concrete definition of cultural competence and standardised guidelines for practice. Further research is needed to build on the strategies and overcome barriers, so that occupational therapists can fulfil the professional obligation they have to work effectively with all populations.