Exploration of cultural competency training in UK healthcare settings: A critical interpretive review of the literature

Abstract

What is known? • Racial and ethnic disparities in health are extensively documented. Training in 'cultural competence' has originated as a response to managing the complexity of a cultural diverse UK patient population. • Cultural competency training (CCT) is widely practiced in UK healthcare settings, and has been deemed mandatory for mental health professionals. • There remains a lack of conceptual clarity around what 'cultural competency' training is and whether or not is it beneficial to health professionals and patient outcomes. What this paper adds • To date, there has not been a systematic review of the UK literature regarding cultural competency training in healthcare settings. It provides a critical analysis of UK health literature on CCT, and illustrates practical implications in policy, research and practice that can inform and improve future trainings. ABSTRACT Cultural competency training (CCT) has been proposed as a strategy for eliminating racial inequalities and ensuring culturally appropriate services. However the literature illustrates inconsistencies in the usage, understanding and implementation of cultural competency training. The study aimed to understand how cultural competency training is conceptualised in UK healthcare settings, through a critical interpretive review of the literature. The search strategy involved the use of five electronic databases, supplemented by citation tracking, consultation with academic experts and library searches. Of 748 papers, 36 satisfied the inclusion and exclusion criteria. Critical interpretive synthesis (CIS) was used to analyse these papers. The study design assimilated methods adopted in conventional systematic reviews within the format of CIS, to combine the entire body of literature and generate theoretical categories. Two synthetic constructs (over-arching themes) were produced from the analysis; 'conflicting concepts' and 'incongruence between theory and practice'. Together these constructs generated an outlined theoretical framework ('synthesising argument') defined as 'institutional commitment' towards CCT, which collectively explained the findings of the review. 'Institutional commitment' provided an explanation for the inconsistencies in the practice of CCT. It illustrated the internal tensions towards those actively committed to CCT versus those who are not and the lack of institutional buy-in to the concept and practice of CCT throughout the healthcare system.