During one of my junior internships, I met a patient whose care challenged not so much my medical knowledge as my understanding of culture. Mr. L., a 20-year-old university student originally from China, presented to the clinic with complaints of low back pain. He firmly believed his back pain was caused by an “improper” posture. During our discussion aimed at clarifying this misconception, I encountered considerable resistance. After speaking with my supervisor in greater depth, I realized that his resistance wasn’t due to any distrust in medical guidance. Instead, it stemmed from childhood experiences of being repeatedly scolded by his parents for his posture. At our second appointment, he explained that in his culture, the views and decisions of parents are not typically challenged. This experience highlighted that patient beliefs and behaviors are influenced by their cultural background; therefore, intercultural competence ought to be a core skill for any clinician.
Before exploring intercultural competence, it is essential to first define culture. According to research, “Culture is a set of guidelines (both explicit and implicit) which individuals inherit as members of a particular society, and which tell them how to view the world, how to experience it emotionally, and how to behave in relation to other people.” Underlying this definition is the understanding that culture belongs to a group or society, is learned throughout life, and exists across multiple dimensions, ranging from the more visible to the less visible.
Intercultural competence is not merely cultural awareness. “Intercultural competence is the ability to communicate effectively and appropriately in intercultural situations based on one’s intercultural knowledge, skills, and attitudes.” These relational competencies have always been fundamental for health care professionals, and by developing intercultural sensitivity, health care professionals can apply these competencies more effectively when caring for patients from diverse cultural backgrounds. In relation to health care, “cultural competence is the ongoing process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community).” In Campinha-Bacote’s model, cultural competence is presented as a dynamic process encompassing Awareness, Skill, Knowledge, Encounters, and Desire (ASKED). To provide care that is both respectful and effective across cultural boundaries, clinicians need to cultivate self-awareness, strive to constantly improve their clinical skills, acquire cultural knowledge, and have the desire and motivation to explore different cultures.
The development of intercultural competence is paramount for improving the overall effectiveness of health care and the relationship between providers and patients. Globalization has driven the increase in population diversity. Moreover, it is a major factor highlighting the importance of developing intercultural sensitivity among health care providers. Studies conducted in 2018 showed that international migrants comprised over 10 percent of the population in several European nations. International migration trends continue to rise globally, with international migrants comprising approximately 14 percent of the European population as of 2024. A defining principle for any progressive country is equitable access to health care for all members of society, including geographical, religious, sexual, and gender minorities.
As diversity increases, so does the need for clinicians to communicate effectively across cultural differences. Health care professionals who are not culturally competent may encounter communication barriers that significantly compromise the quality and effectiveness of care. For example, according to Edward T. Hall’s theory, cultures can be divided into “high context,” relying heavily on indirect communication, assumptions, and non-verbal cues, and “low context,” which focus on literal and direct expression. If a clinician neglects these cultural characteristics, they risk misunderstandings and patient disengagement. The TOPOI model by Edwin Hoffman identifies the levels in communication where “noise” (difference in communication) can arise. These levels include language (verbal and non-verbal), the ordering of logic and values, relational roles, organizational structures, and underlying intentions or needs. If cultural differences in context, space, time, language, relational expectations, or organizational norms are not identified and addressed, they can create significant barriers between health care providers and patients. Fundamentally, intercultural competence provides the foundation for a safe environment where patients can express themselves openly and be truly understood.
Developing intercultural competence is not a linear process composed of a set of rules and guidelines, but rather a journey that begins with self-awareness. Health care providers need to first explore and understand their own cultural influences. Past experiences, social environments, and upbringing shape how we communicate and interpret the behavior of others. Clinicians working towards intercultural competence must critically reflect on these influences and understand how they shape their social interactions. Once becoming familiar with their own cultural background, they must also accept that differences exist. Differences may manifest in communication styles, values, or social expectations, and occasionally they may at times contrast their own beliefs. As a result, prejudices can arise. However, an interculturally competent health care provider is able to recognize these biases and prevent them from becoming barriers to care.
Once clinicians cultivate self-awareness, the next step involves applying this understanding in patient interactions through openness, active listening, and flexibility in communication. Each patient encounter should be approached with empathy. Health care providers have a responsibility to provide supportive, patient-centered care. Even when a patient’s beliefs differ from the clinician’s perspective or appear inconsistent with clinical knowledge, those beliefs represent the patient’s lived reality. Clinicians must first seek to understand the patient’s viewpoint and acknowledge its significance. Subsequently, they need to adapt their communication and therapeutic approach accordingly. Through this process, clinicians learn to navigate ambiguity with greater ease and deepen their capacity for sustained empathy over time.
My encounter with Mr. L. taught me that health care extends far beyond the provision of medical assistance. To heal effectively, clinicians must listen across cultures and embrace diversity. Cultivating the competence to face cultural differences with empathy and openness is essential for achieving professional excellence. As health care becomes ever more globalized, intercultural competence must stand beside clinical skill as a defining pillar of good practice. I urge every health care provider to continue developing their intercultural awareness so that our care reaches every person with dignity, equity, and understanding.
Evangelos Chavelas is a physiotherapy student.
