WH ‘SCULTURE

IS IT ANYWAY??
Cultural issues in
the delivery of
physical therapy
care.
Emily Held, Nicole Liu,
Madison Mertz, &
Lara Nasser
 Diversity within the Realm of Physical Therapy

➔ 80% of Physical
Therapists are
White, making
that the most
common race or
ethnicity in the
occupation.
➔ 70.4% of physical
therapists are
Female.
 Rural v. Urban
Mount Pleasant
➔ Population size: 25,847
➔ 86.2% of the population are white.
➔ 3.8% African American.
➔ 41% poverty rate
➔ 1,899 of Mount Pleasant, MI citizens are
speakers of a non-English language, which
is lower than the national average of 21.1%.
➔ In 2015, the most common non-English
language spoken in Mount Pleasant, MI
was Arabic.
Detroit
➔ Population size: 673,104
➔ 13.6% of the population are white.
➔ 79.7% African American.
➔ 35.7% poverty rate
➔ 66,840 of Detroit, MI citizens are speakers
of a non-English language.
➔ In 2015, the most common non-English
language spoken in Detroit, MI was
Spanish.
 Future Patient Population
➔ By 2060, nearly one in three Americans
will be Hispanic (the term used by the
U.S. Census), up from one in six today.
The Hispanic population will more than
double, to 128.8 million.
➔ The number of international migrants is
expected to grow by 41.2 million.
➔ The U.S. population is aging. By 2060, the
number of Americans age 65 and over is
expected to double to 92 million. Those 85
and older will make up 4.3 percent – 18.2
million — of the overall population.
 Diversity Dimensions
Primary Diversity Dimensions: Secondary Diversity Dimensions:
➔ Work background
➔ Age
➔ Race ➔ Income
➔ Gender ➔ Marital Status
➔ Sexual Orientation ➔ Geographic Location
➔ Ethnicity/Nationality ➔ Family Background
➔ Mental/Physical Ability ➔ Education
➔ Socioeconomic status
➔ Religion
 Note to the Audience
The following cases are either fictional or aspects of the scenario have actually occurred…
 Maddy - PT Outpatient Clinic
Scenario 1: Young high school football player came in to PT after an ankle sprain
and did not want to work with an “old” physical therapist.

Question: How would you handle the first treatment session with this patient?
Would you try to address the issue head on or wait things out and see how things
go?

Cultural Issue: Age

How it was handled...
● Made the first PT session fun and engaging
● Involved the boy’s dad to help gain respect
● Gave the boy time to warm up to the situation on his own time

Research Keys: Give patients a sense of respect and autonomy and this can lead
to improved health outcomes.
 Nicole - PT Inpatient Rehab
Scenario 2: Interacting with a patient who is of a different racial/cultural
background than your own. Mike was a pt I had been seeing in inpatient rehab
who had undergone a right BKA. As a physical therapist, not only do we have to
be sensitive to and aware of our patient’s cultural backgrounds that are different
from ours, but we also need to be able to professionally and effectively address
situations where our patients are not appropriate to the PT’s cultural
background.

Question: As a professional how do you address Mike’s statement? Do you let it

slide?

Cultural issue: Race

How it was handled...
Primary barriers to culturally competent care includes language barriers,
cultural barriers, and limited resources.

In this scenario, there was a cultural barrier between Mike and I and what was
affected was practitioner-patient communication. In contrast, promoting
cultural awareness improves patient-practitioner communication, facilitates the
establishment of rapport, increases attendance and compliance, creates a
comfortable atmosphere, and increases benefits of treatment and compliance
(Grandpierre et al., 2018).

Research key: promote effective practitioner-patient communication. Keeping in

mind that views of independence vary across cultures and that cultural
differences in gender roles can also impact care delivery and pt receptiveness.
 Emily - SPT Clinical Rotation
Scenario 3: As a student physical therapist on your first clinical rotation, you
assume everyone is going to be comfortable allowing you to lead or assist in their
appointment. Or in the more complex cases, observe the case and information
for educational reason. Due to religious reasons, this is not always the case.

Question: How can you gain a patient’s trust if you are never given the option?

Cultural Issue: Religion

How it was handled...
The patient was given the option and consented* to allowing the SPT to observe
treatment. First visit was purely observational and second visit allowed for some
assistant of SPT after trust* was gained. Treatments were also completed behind
the curtain. Treatments were limited based upon the equipment that could be
brought within the curtain, but the patient was willing to try new things and be
creative.

Research Keys - Develop communication positive behaviors. Allow the patient to

be involved in all decision making and build trust with your patient by respecting
their decisions and beliefs.
 In conclusion

“Achieving cultural
Diversity is not
competence is a
simply one’s culture
process, not an end
or race.
point” - APTA
 APTA - Developing Diversity in PT

http://www.apta.org/CulturalCompetence/
References
U.S Census Bureau (2017) https://www.census.gov/quickfacts/fact/table/mountpleasantcitymichigan/PST045217

Blueprint For Teaching Cultural Competence in Physical Therapy Education. American Physical Therapy Association.August
2014. https://www.apta.org/Educators/Curriculum/APTA/CulturalCompetence/.

Grandpierre V, Milloy V, Sikora L, Fitzpatrick E, Thomas R, Potter B. Barrier and facilitator to cultural competence in
rehabilitation services: a scoping review. BMC Health Serv Res. 2018;18:23. Doi: 10.1186/s12913-017-2811-1

Lee YY, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient–physician relationships
and health outcomes. Soc Sci Med. 2010. 71(10), 1811-1818. Doi: 10.1016/Jj

Tang C, Tain B, Zhang X, et al. The Influence of Cultural Competence of Nurses on Patient Satisfaction and the Mediating
Effect of Patient Trust. J Adv Nurs. 2018. Doi:10.111/jan.13854

Weech-Maldonado R, Elliott MN, Pradhan R, Schiller C, Hall A, & Hays R D. Can hospital cultural competency reduce
disparities in patient experiences with care? Medical care. 2012. Doi: 10.1097/MLR.0b013e3182610ad1

Cultural Competence in Physical Therapy. American Physical Therapy Association. http://www.apta.org/CulturalCompetence/