An opportunity for transformative change in the US Healthcare System—cultural safety: a scoping review protocol

Abstract

Objective

We aim to collate and analyze current evidence for implementing cultural safety measures among patients, health professionals, in the education of health professionals, and within healthcare organizations. A second aim is to understand how to best assess the effectiveness of cultural safety interventions. Our third aim is to provide guidance on how culturally safe environments can be implemented in the US healthcare system.

Introduction

Culturally safe environments can improve health inequities among underrepresented groups. However, there is a paucity of evidence on how cultural safety can be implemented among patients, health professionals, in the education of health professionals, and within healthcare organizations in the United States (US).

Inclusion criteria

This scoping review will examine the US and international literature on cultural safety implemented by healthcare professionals and the experiences of their patients; educational interventions to improve cultural safety in health professional education; and the organization and systems-level initiatives that create culturally safe environments. Physician groups will not be included as power differentials between physician groups and patients are different from those among other health professionals and patients. Due to the wealth of experience and cultural safety literature in this area from countries outside of the US, international studies will be included.

Methods

This review will search national and international literature to inform cultural safety practices in the US and will be conducted in accordance with the JBI methodology and PRISMA-ScR extension. Key search sources will include CINAHL, MEDLINE, the Cochrane Library, PsycINFO, Social Work Abstracts, and GoogleScholar from 1988–2022. Reviewed sources will be in English and will include unpublished studies and grey literature. All sources will be reviewed by at least two independent reviewers, with a third independent reviewer to achieve consensus when necessary. Results will be presented in alignment with the four conceptual layers that create culturally safe environments: patients, health professionals, health professionals’ education, and healthcare organizations and systems.

Dissemination

This scoping review aims to collect, analyze, and disseminate an extensive overview of cultural safety in healthcare to inform guidance on how best to implement culturally safe healthcare and education for health professionals in the US.

Keywords:

• Health professions
• allied health
• anti-racism
• critical consciousness
• cultural competence
• health inequity

Acknowledgements

The authors would like to thank Amy Lapidow for aiding the research team in its development and execution of all search strategies.

Disclosure statement

There is no conflict of interest in this project.

Additional information

Funding

No funding has been provided for this scoping review.

Notes on contributors

Tara Dickson

Tara Dickson is the Director of Clinical Education for the Tufts DPT-Phoneix program. Her prior and current research areas include the impacts on higher education policy on the production and funding of research endeavors and the impacts of faculty and curriculum development on student learning. Recent areas of study include cultural safety, assessment of interprofessional education programs, the financial literacy of physical therapy students, and stress associated with student loan debt.

Tawna Wilkinson

Tawna Wilkinson serves as core faculty and the Director of Curriculum and Assessment for the Tufts Doctor of Physical Therapy Program-Phoenix. She has been in academia in instructional and clinical education leadership roles since 2004 and practicing in pediatric physical therapy since 1999. Her areas of research interest include student success and clinical education.

Kim D. Dao

Kim Dao serves as core faculty with primary responsibilities in clinical neuroscience and neurologic practice management. She is a board-certified clinical specialist in neurologic physical therapy with more than fifteen years of clinical practice in acute care, rehabilitation, and outpatient settings.

Linda J. Woodhouse

Linda J. Woodhouse has an international reputation with more than 30 years of experience as a researcher, educator and clinician. She has worked predominantly in the musculoskeletal area, developing and evaluating innovative models of integrated interprofessional care. Her research focus is on reducing pain and improving physical function in adults with musculoskeletal, endocrine and autoimmune disorders. Dr. Woodhouse's research focus has recently shifted towards developing, implementing and evaluating new models of appropriate care to build sustainable health care systems.

Eric J. Hegedus

Eric Hegedus has had a notable 30-year career as a leader and innovator in physical therapist education, research, and clinical practice. As a scholar, he is driven to answer relevant clinical questions in the orthopedic and sports diagnosis and rehabilitation realm and translate the findings to clinical practice. This singular passion has driven his scholarly agenda resulting in publication of over 80 peer-reviewed articles, 20 abstracts, and 5 book chapters. He currently is helping to complete the new clinical practice guidelines for shoulder instability for the profession of physical therapy.

Angela Spontelli Gisselman

Angela Spontelli Gisselman serves as the director of admissions and is an ABPTS-certified orthopaedic specialist. She has ten years of clinical practice in outpatient orthopedics and sports settings. Her primary area of scholarship focuses on the role of monitoring the autonomic nervous system via heart rate variability, and its applications in rehabilitation.