Culturally safe healthcare: changing the lens from provider control to patient agency

Figures & data

Figure 1. Procedure for selecting articles.

Table 1. Summary of studies on culturally safe healthcare (CSH).

Authors	Journal	Country	Type of study	Participants	Outcomes/findings
1. Best et al., 2022	Nurse Education Today	Australia	Educational intervention	26 health educators	3 workshops to teach CSH to educators were conducted and assessed understanding of CSH.
2. Browne et al., 2021	International Indigenous Policy J	Canada	Educational intervention	Leaders and policy makers in Canada	San’yas Indigenous Cultural Safety Training & consulting program for leaders and policy makers in several domains
3. Burgess et al., 2019	Health Communication	United States	Experimental study	53 healthcare providers	Providers read a success/failure narrative; Those who read the high failure attribution narrative showed resistance to their role in disparities.
4. Cargo et al., 2019	Int J for Equity in Health	Australia and New Zealand	Conceptual article	70 members of the Advisory Group	Conceptual mapping of CSH healthcare based on discussion at advisory meetings
5. Cipollina et al., 2020	Stigma & Health	United States	Experimental Study	Study1, 238 adults Mturk; Study 2, 156 students	Provider judged culturally competent when brochures showed racially diverse clientele compared to all White clientele
6. Curtis et al., 2019	International J. Equity in Health	New Zealand	Conceptual article	Women talking to midwives	Compares cultural competence with CSH; offers a definition for CSH
7. Doran et al, 2019	Contemporary Nurse	Australia	Mixed methods study	23 nursing instructors	Instructors embraced CSH and anti-racism training but were unsure how to teach this
8. Karbeah et al., 2019	J of Midwifery & Women’s Health	United States	Thematic Analysis	Interviewed 10 providers serving Black women	4 themes of CSH: patient cultural ID; provider commitment to racial justice; patient agency; cultural humility
9. Lokugamage et al., 2021	Journal of Medical Ethics	United Kingdom	Conceptual article	Marginalized people and institutions	Ask marginalized people what CSH means. Institutions must commit to end structural bias.
10. Maar et al., 2022	Medical Education Curricular Develop	Canada	Educational intervention	9 faculty tutors 9 ‘animators’ 63 med students	Northern Ontario School of Medicine is known for innovative instruction. Interventions used simulated cultural scenarios to teach CSH.
11. McGough et al., 2022	Contemporary Nurse	Australia	Conceptual article	Health policy	Misconceptions about CSH and slow implementation of CSH policies have occurred.
12. Mithen et al., 2021	Health Promotion J. of Australia	Australia	Thematic analysis	50 medical charts 50 surveys 3 interviews	4 themes: negative care recipient experiences, care receiver uncertainty; interpreter challenges, interpreter roles
13. Monchalin et al., 2020	J. of Racial & Ethnic Health Disparities	Canada	Content Analysis	11 Métis women in Toronto Canada were interviewed	Métis, indigenous people with European ancestry, reported experiencing discrimination in health and social services.
14. Muise, 2019	Healthcare Management	Canada	Content Analysis	Descriptions from Learning Circle	Indigenous people prefer community-based clinics and healthcare centers.
15. Pimentel et al., 2022	BMC Medical Education	Colombia	Educational intervention	268 medical students	During an 8-hour game jamming medical students designed CSH games and posted their rationales analyzed using Dedoose.
16. Pirhofer et al., 2022	BMC Nursing	Austria, Germany & Switzerland	Content Analysis	29 Advance practice nurses	These countries have greater diversity with new immigrants and nurses recognized that traditional medicine needs to be revamped.
17. Radl-Karimi et al., 2022	Patient Education and Counseling	Denmark	Content Analysis	13 immigrants and refugees in a Danish hospital	Patients described need for a safe space where they could experience good healthcare and a therapeutic alliance with caregivers.
18. Williamson et al., 2019	J. of Health Communication	United States	Experimental study	198 students, 85 White, 63 Black	Medical mistrust higher for Black students exposed to the implicit discrimination condition than the control
19. Withall, 2021	Australian J. of Rural Health	Australia	Content Analysis	7 nurses and 3 midwives	They showed some understanding of how to engage in CSH Barriers
20. Wylie et al., 2021	International J of Indigenous Health	Canada	Content Analysis	31 care providers	Assessed their experience of CSH training programs
21. Yaphe & Richer, 2019	International J. of Indigenous Health	Canada	Educational intervention	45 nurses, social workers & doctors	Created indigenous cultural safety program with care providers in Montreal, Canada

Table 2. Features of culturally safe healthcare and medical racism presented chronologically.

• Marginalized patients experienced rushed medical consultations, denial of medication, excessively long wait time for treatment, neglect, and even abuse resulting in medical mistrust (Williamson et al., 2019).
• The recipient of care determines whether care is culturally safe for them (Curtis et al., 2019).
• Providers need to practice cultural humility and respect cultural practices (Karbeah et al., 2019).
• 5 CSH concepts: reflexivity, dialogue, reducing power differences, decolonization, and regardful care (Mackean et al., 2019).
• Being in a safe environment: physically, emotionally, and spiritually safe (Doran et al., 2019).
• CSH is a state of feeling safe and supported (Radl-Karimi et al., 2020).
• CSH = ‘tense social dynamics resulting from vigilance required in anticipation of medical racism’ (Browne et al., 2021).
• Previous racism has long-term intergenerational traumatic effects on well-being of future generations (Browne et al., 2021).
• A commitment to challenging existing practice and beliefs and to focus on health equity (McGough et al., 2022).
• Recognize that healthcare providers operate from a position of privilege (McGough et al., 2022).
• Recognize that for some people health services are alien and unwelcoming (McGough et al., 2022).
• Attention must be given to how to implement CSH (McGough et al., 2022).
• Becoming a culturally safe practitioner is an ongoing journey (McGough et al., 2022).
• Racial, ethnic, religious, and gender minorities adopt resistance strategies (avoidance, anger, distrust) to counter medical racism and survive ongoing discrimination (Rousseau et al., 2022).
• Providers’ claim of cultural neutrality/impartiality supports the status quo of ethnocentric healthcare (McGough et al., 2022).
• ‘Cultural safety addresses issues of inequality rooted in historical and structural violence and discrimination that have led to power differences and inequalities’ (McGough et al., 2022, p. 35).

Figure 2. Proposed model for the communications of culturally safe healthcare.

Data availability statement

Data are available from the corresponding author.