Multiculturalism in Healthcare: A Review of Current Research into Diversity Found in the Healthcare Professional Population and the Patient Population

  • Nicole Tan Guy's, King's and St Thomas' School of Medical Education, King's College London, UK.
  • Shuangyu Li Guy's, King's and St Thomas' School of Medical Education, King's College London, UK
Keywords: Cultural Competency, Health Services Accessibility, Health Services Needs and Demand, Humans; Language


Culture plays a key role in the way health is perceived and the way healthcare is used. It has been seen that there are many barriers to accessing healthcare, particularly for those who come to the UK with a different background language, religion and healthcare structure. A literature review and content analysis has been performed using 60 articles, selected from the databases PubMed, Scopus and Web of Science, in order to expose how diverse the patient and healthcare professional population truly are, the number of barriers to healthcare and how one can improve access to become culturally competent. Although this is only a small sample of the material present, it is evident that at the present time physical amenities such as having a translator present, as well the training of the healthcare professionals to be able to make the most of the situation and see the patients in a holistic and biopsychosocial approach, reveal an important area to focus more on in practice as well as in research. Thus an increased availability of resources and training needs to be made available for both patients and healthcare professionals in order to ensure competence in accessing healthcare services

Author Biography

Nicole Tan, Guy's, King's and St Thomas' School of Medical Education, King's College London, UK.

Nicole Tan is currently a third-year medical student at the Guy’s, King’s and St Thomas’s Medical School, King’s College London. She took a year out of the 5-year MBBS programme last year to intercalate in Clinical Pharmacology and Translational Medicine.


1. Kai J, editor. Ethnicity, health and primary care. Oxford: Oxford University Press; 2003.
2. Beagan BL. ‘Is this worth getting into a big fuss over?’ Everyday racism in medical school. Med Educ. 2013 Oct;37(10):852-60.
3. McHale JV. Faith, belief, fundamental rights and delivering health care in a modern NHS: an unrealistic aspiration? Health Care Anal. 2013 Sep;21(3):224- 36.
4. Jacobs E, Chen AH, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in health care: a proposed research agenda. Millbank Q. 2006;84(1):111-33.
5. SR International Pty Ltd. NVivo qualitative data analysis Software. Version 10; 2012.
6. Aggarwal NK, Desilva R, Nicasio AV, Boiler M, Lewis-Fernández R. Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communica¬tion? A qualitative exploratory study from the New York site. Ethn Health. 2015;20(1):1-28.
7. Kantaris M, Theodorou M, Galanis P, Kaitelidou D. Access and utilisation of health services by domestic helpers in Cyprus. Int J Health Plann Manage. 2014 Oct-Dec;29(4):e383-93.
8. Giacco D, Matanov A, Priebe S. Providing mental healthcare to immi¬grants: current challenges and new strategies. Curr Opin Psychiatry. 2014 Jul;27(4):282-8.
9. Patel MR, Thomas LJ, Hafeez K, Shankin M, Wilkin M, Brown RW. Study pro¬tocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training. BMC Med Educ. 2014 Jun 16;14:118.
10. Ochoa SC, Sampalis J. Risk perception and vulnerability to STIs and HIV/ AIDS among immigrant Latin-American women in Canada. Cult Health Sex. 2014;16(4):412-25.
11. Komaric N, Bedford S, van Driel ML. Two sides of the coin: patient and provider perceptions of healthcare delivery to patients from culturally and linguistically diverse backgrounds. BMC Health Serv Res. 2012 Sep 18;12:322.
12. Higginbottom GM, Vallianatos H, Forgeron J, Gibbons D, Mamede F, Barolia R. Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study. BMC Pregnancy Childbirth. 2014 Dec 3;14:370.
13. Palmer VS, Mazumder R, Spencer PS. Interprofessional global health edu¬cation in a cosmopolitan community of North America: the iCHEE experience. Acad Med. 2014 Aug;89(8):1149-52.
14. Haskell BS, Segal ES. Ethnic and ethical challenges in treatment planning: dealing with diversity in the 21st century. Angle Orthod. 2014 Mar;84(2):380-2.
15. Minkov M, Bond MH. Genetic polymorphisms predict national differences in life history strategy and time orientation. Pers Individ Dif. 2015 Apr;76:204- 15.
16. Dawson A, Turkmani S, Fray S, Nanayakkara S, Varol N, Homer C. Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: a review of global experience. Midwifery. 2015 Jan;31(1):229-38.
17. Daher M, Chaar B, Saini B. Impact of patients’ religious and spiritual beliefs in pharmacy: from the perspective of the pharmacist. Res Social Adm Pharm. 2015 Jan-Feb;11(1):e31-41.
18. López-Sierra HE, Rodríguez-Sanchez J. The supportive roles of religion and spirituality in end-of-life and palliative care of patients with cancer in a cul¬turally diverse context: a literature review. Curr Opin Support Palliat Care. 2015 Mar;9(1):87-95.
19. Tomlinson E, Stott J. Assisted dying in dementia: a systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these. Int J Geriatrc Psychiatry. 2015 Jan;30(1):10-20.
20. Davison SN, Jhangri GS. Knowledge and attitudes of Canadian First Nations people toward organ donation and transplantation: a quantitative and quali¬tative analysis. Am J Kidney Dis. 2014 Nov;64(5)781-9.
21. Jacob KS. Insight in psychosis: an independent predictor of outcome or an explanatory model of illness? Asian J Psychiatr. 2014 Oct;11:65-71.
22. Good MJ, Hannah SD. “Shattering culture”: perspectives on cultural com¬petence and evidence-based practice in mental health services. Transcult Psychiatry. 2015 Apr;52(2):198-221.
23. Hooker C, Noonan E. Medical humanities as expressive of Western culture. Med Humanit. 2011 Dec 1;37(2):79-84.
24. Cunningham BA, Marsteller JA, Romano MJ, Carson KA, Noronha GJ, McGui¬re MJ, et al. Perceptions of health system orientation: quality, patient cente¬redness, and cultural competency. Med Care Res Rev. 2014 Dec;71(6):559-79.
25. Vidaeff AC, Kerrigan AJ, Monga M. Cross-cultural barriers to health care. Southern Med J. 2015 Jan;108(1):1-4.
26. Shefer G, Rose D, Nellums L, Thornicroft G, Henderson C, Evans-Lacko S. ‘Our community is the worst’: the influence of cultural beliefs on stigma, relationships with family and help-seeking in three ethnic communities in London. Int J Soc Psychiatry. 2013 Sep;59(6):535-44.
27. Read SC, Carrier M, Whitely R, Gold I, Tulandi T, Zelkowitz P. Comple¬mentary and alternative medicine use in infertility: cultural and religious influences in a multicultural Canadian setting. J Altern Complement Med. 2014 Sep;20(9):686-92.
28. Strong KL, Folse VN. Assessing undergraduate nursing students' knowle¬dge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, and transgender patients. J Nurs Educ. 2015 Jan;54(1):45-9.
29. Smith MD, Jennings L, Lakhan S. International education and service lear¬ning: approaches toward cultural competency and social justice. Couns Psy¬chol. 2014 Nov 3;42(8):1188-214.
30. Ballantyne PJ, Yang M, Boon H. Interpretation in cross-language research: tongues-tied in the health care interview? J Cross Cultural Gerontol. 2013 Dec;28(4):391-405.
31. Amati R, Hannawa AF. Physician-perceived contradictions in end-of-life communication: toward a self-report measurement scale. Health Commun. 2015;30(3):241-50.
32. Koffman J Servicing multi-cultural needs at the end of life. J Ren Care. 2014 Sep;40 Suppl 1:6-15.
33. Ahmad B, Ramadas A, Kia Fatt Q, Md Zain AZ. A pilot study: the develo¬pment of a culturally tailored Malaysian Diabetes Education Module (MY-DE¬MO) based on the Health Belief Model. BMC Endoc Disord. 2014 Apr 8;14:31.
34. Saloner B, Carson N, Lê Cook B. Explaining racial/ethnic differences in adolescent substance abuse treatment completion in the United States: a decomposition analysis. J Adolesc Health. 2014 Jun;54(6):646-53.
35. Shannon PJ. Refugees’ advice to physicians: how to ask about mental health. Fam Pract. 2014 Aug;31(4):462-6.
36. Rogers C, Earnest J. Sexual and reproductive health communication among Sudanese and Eritrean women: an exploratory study from Brisbane, Australia. Cult Health Sex. 2015;17(2):223-36.
37. Abe M, Turale S, Klunklin A, Supamanee T. Community health nurses’ HIV health promotion and education programmes: a qualitative study. Int Nurs Rev. 2014 Dec;61(4):515-24.
38. Chien SC, Yeh YP, Wu JY, Lin CH, Chang PC, Fang CH, et al. Factors as¬sociated with intensiveness of use of child preventative health services in Taiwan: a comparative study between cross-cultural immigrant families and native-born families. Ethn Health. 2013;18(1):1-17.
39. Kulwicki A, Ballout S, Kilgore C, Hammad A, Dervartanian H. Intimate part¬ner violence, depression, and barriers to service utilization in Arab American women. J Transcult Nurs. 2015 Jan;26(1):24-30.
40. Fisher J, Hinchliff S. Immigrant women’s perceptions of their maternity care: a review of the literature. Part 2. Pract Midwife. 2013 Feb;16(2):32-4.
41. Dewell JA, Owen J. Addressing mental health disparities with Asian Ame
¬rican clients: examining the generalizability of the common factors model. J Couns Dev. 2013;93(1): 80-87.
42. Liu X, Rohrer W, Luo A, Fang Z, He T, Xie W. Doctor-patient communication skills training in mainland China: a systematic review of the literature. Patient Educ Couns. 2015 Jan;98(1):3-14.
43. Hart PL, Mareno N. Cultural challenges and barriers through the voices of nurses. J Clin Nurs. 2014 Aug;23(15-16):2223-32.
44. Nicholas DB, Hendson L, Reis MD. Connection vs disconnection: examining culturally competent care in the neonatal intensive care unit. Soc Work Health Care. 2014;53(2):135-55.
45. Williams B, Perillo S, Brown T. What are the factors of organisational cultu¬re in health care settings that act as barriers to the implementation of eviden¬ce-based practice? A scoping review. Nurse Educ Today. 2015 Feb;35(2):e34-41.
46. Simplican SC, Leader G, Kosciulek J, Leahy M. Defining social inclusion of people with intellectual and developmental disabilities: an ecological mo¬del of social networks and community participation. Res Dev Disabil. 2015 Mar;38:18-29.
47. Abbott P, Reath J, Gordon E, Dave D, Harnden C, Hu W, et al. General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients – is cultural competence adequately considered? BMC Med Educ. 2014 Aug;14:167.
48. Logan S, Steel Z, Hunt C. Investigating the effect of anxiety, uncertainty and ethnocentrism on willingness to interact in an intercultural communica¬tion. J Cross-Cult Psychol. 2015;46(1):39-52.
49. Popper-Giveon A, Liberman I, Keshet Y. Workforce ethnic diversity and culturally competent health care: the case of Arab physicians in Israel. Ethn Health. 2014;19(6):645-58.
50. Merchant J, Omary MB. Clogged up. Efforts to train more minority doctors remain stalled as population diversifies. Mod Healthc. 2010 Feb 22;40(8):24.
51. Iglehart JK. Diversity dynamics–challenges to a representative u.s. medical workforce. N Engl J Med. 2014 Oct 16;371(16):1471-4.
52. Dahl-Michelson T. Curing and caring competences in the skills training of physiotherapy students. Physiother Theory Pract. 2015 Jan;31(1):8-16.
53. French JC, O’Rourke C, Walsh RM. A current assessment of diversity cha¬racteristics and perceptions of their importance in the surgical workforce. J Gastrointest Surg. 2014 Nov;18(11):1936-43.
54. Vaughan S, Sanders T, Crossley N, O’Neill P, Wass V. Bridging the gap: the roles of social capital and ethnicity in medical student achievement. Med Educ. 2015 Jan;49(1):114-23.
55. Nichols P, Horner B, Fyfe K. Understanding and improving communication processes in an increasingly multicultural aged care workforce. J Aging Stud. 2015 Jan;32:23-31.
56. Nunez-Smith M, Pilgrim N, Wynia M, Desai MM, Jones BA, Bright C, et al. Race/ethnicity and workplace discrimination: results of a national survey of physicians. J Gen Intern Med. 2009 Nov;24(11)1198-204.
57. Leyerzapf H, Abma TA, Steenwijk RR, Croiset G, Verdonk P. Standing out and moving up: performance appraisal of cultural minority physicians. Adv Health Sci Educ Theory Pract. 2015 Oct;20(4):995-1010.
58. Stütz A, Green W, McAllister L, Eley D. Preparing medical graduates for an interconnected world: current practices and future possibilities for inter-nationalizing the medical curriculum in different contexts. J Stud Int Educ. 2015;19(1)28-45.
59. Klein GO, Kajbjer K. eHealth tools for patients and professionals in a mul¬ticultural world. Stud Health Technol Inform. 2009;150:297-301.
60. Simpkins SD, Riggs NR. Cultural competence in afterschool programs. New Dir Youth Dev. 2014 Dec;2014(144):105-17.
61. Perry A, Woodland L, Brunero S. eSimulation: a novel approach to enhan¬cing cultural competence within a health care organisation. Nurse Educ Pract. 2015 May;15(3):218-24.
62. Long T. Influence of international service-learning on nursing student self-efficacy toward cultural competence. J Nurs Educ. 2014 Aug;53(8):474-8.
63. Saunders JA, Haskins M, Vasquez M. Cultural competence: a journey to an elusive goal. J Soc Work Educ. 2015;51(1):19-34.
64. Holland AE. The lived experience of teaching about race in cultural nursing education. J Transcult Nurs. 2015 Jan;26(1):92-100.
65. Mobula LM, Okoye MT, Boulware LE, Carson KA, Marstellar JA, Cooper LA. Cultural competence and perceptions of community health workers’ effecti¬veness for reducing health care disparities. J Prim Care Community Health. 2015 Jan;6(1)10-5.
How to Cite
Tan, N., & Li, S. (2016). Multiculturalism in Healthcare: A Review of Current Research into Diversity Found in the Healthcare Professional Population and the Patient Population. International Journal of Medical Students, 4(3), 112-119.