Mapping of the Diversity and Cultural Competencies in Healthcare and Healthcare Education Through Participatory Action Research (PAR)

This participatory action research (PAR) study explored the diversity and cultural competencies essential for working effectively and appropriately with diverse patients in healthcare and healthcare education. Ninety-four (94) medical students participated in two PAR cycles, engaging in brainstorming, group exercises, collaborative work, discussions, reflections, and role-plays. Together, they addressed the central question regarding the diversity and cultural competencies that are necessary for working effectively with diverse patients in healthcare. Participants identified eight core competencies, namely open-mindedness, empathy and cultural empathy, deep listening, explore further, knowledge, self-reflection, work in partnership, and praise the patient. They also ranked these competencies and explained their significance in healthcare settings. Based on participants’ explanations, a thematic network was developed, illustrating how these competencies interrelate. The analysis highlighted that these competencies must function together to foster a deeper understanding of patients, ultimately contributing to improved health outcomes. This interrelationship is represented in the Wheel Model proposed in the study, showing that empathy and cultural empathy sit at the center of the wheel, supported and reinforced by the other competencies all of which interact to enable the wheel to roll smoothly. Interestingly, the driving force seems to be the competency “open mindedness” as it puts most of the rest competencies in motion. The study also revealed that participants came to appreciate the importance of these competencies gradually, particularly after engaging in specific diversity-related activities and completing the two PAR cycles. This finding highlights that prior experience or knowledge alone might be insufficient for working effectively with diversity, underscoring the need for lifelong training, continuous learning, and the accumulation of relevant experience. In the absence of other PAR on diversity and cultural competencies in healthcare and healthcare education, the findings of this study both align with and diverge from those of Delphi studies, offering new directions for future research.