MedHums 101: Hajara Yakubu Jibril explains why cultural competence is essential to effective patient care, drawing on her experiences in healthcare systems in Nigeria and India.
Healthcare is not just about medicine, it is about people. And people come from diverse cultural backgrounds that shape their beliefs, perceptions, and responses to everything in their lives, including medical care. As someone who has experienced healthcare systems in two culturally different nations, Nigeria and India, I have seen how cultural competence (or its absence), a concept I will explain below, influences healthcare outcomes. In this piece, I argue that cultural competence in healthcare must be recognised as a global necessity rather than a professional choice.
What is cultural competence in healthcare?
Cultural competence in healthcare refers to the ability of medical professionals to provide care that is respectful and responsive to the cultural and linguistic needs of patients (Betancourt et al., 2016). Without it, healthcare providers may misdiagnose illnesses, prescribe treatments that may conflict with a patient’s belief system, or overlook important social determinants of health.
Cultural competence encompasses three key elements: recognising one’s own biases and how culture influences healthcare perceptions (Campinha-Bacote, 2002); understanding cultural beliefs, health practices, and patient expectations (Goode, Dunne and Bronheim, 2006); and effectively communicating and adapting care to meet a patient’s cultural needs, ensuring their comfort and cooperation (Like 2011). For instance, mental ill-health is stigmatised in many African and Asian cultures, leading some patients to choose spiritual healing, which treats psychic experiences as a manifestation of a spiritual attack rather than a health issue, over clinical interventions (Kirmayer et al. 2014). Similarly, dietary restrictions in Islam, Hinduism, and Judaism can affect patient compliance, where patients may reject any form of treatment that violates their cultural or religious beliefs. For example, a patient may refuse any drug from animal sources necessitating culturally appropriate alternatives (Padela and Curlin, 2013).
Why cultural competence matters
Cultural competence goes beyond avoiding misunderstandings between patient and clinician. It actively promotes equitable healthcare delivery. Research has shown that cultural beliefs influence how patients perceive illness, seek treatment, and adhere to medical advice (Betancourt et al., 2016). With increasingly multicultural healthcare systems, cultural competence is no longer a desirable skill but, I argue, a universal requirement. Without cultural competence, even the most advanced medical interventions that employ new technology or go beyond standard treatment options, can fail due to miscommunication, mistrust, and unintentional biases. Such biases persist because of individual psychology, historical legacies, structural inequalities, and systemic silence. Genuine cultural competence must deal with bias within the healthcare workforce and establish systems that welcome diversity rather than just tolerating it.
While I was living in Nigeria, I saw how traditional medicine and spirituality influenced healthcare decisions. Most families rely on herbal remedies, spiritual healing, or community healers before going to the hospital. I knew a woman who experienced chronic hypertension as a spiritual attack rather than a medical issue. By the time she arrived at the hospital, her condition had worsened significantly, and it was too late to save her life. Later, as a student in India, I noticed a cultural dynamic of stronger beliefs in Ayurvedic medicine and homeopathy than I had encountered in Western contexts. In some cases, patients combined traditional and prescribed treatments hoping for better results, sometimes unknowingly creating life-threatening drug interactions. I came across a patient in India who was at the verge of a liver failure attack because he has been combining Methotrexate (a drug used to treat various Cancers and autoimmune conditions) and an unregulated Ayurvedic formulation, for over a year to treat rheumatoid arthritis. As a culturally competent healthcare provider, I immediately referred him to a specialist and provided him with thorough counselling on the risks of combining these treatments. I also educated him on safer alternatives and the importance of coordinating between traditional and Western medicine to prevent future complications.
Benefits of integrating cultural competence in healthcare
Language barriers and cultural misunderstandings often lead to misdiagnoses and failed treatments. Studies have shown that patients with limited proficiency in a country’s dominant language are 70 per cent more likely to fall victim to medical errors (Lindholm et al., 2019). Subsequently, hospitals that have medical interpreters and culturally trained staff report higher patient satisfaction and better patient compliance (Karliner et al. 2007).
Racial and ethnic minorities often receive lower-quality healthcare, despite socioeconomic adjustments- where healthcare systems accommodate the health demands of the people based on their income, education, employment, and social support status. Black patients in the U.S. are 40 per cent less likely to receive adequate pain management due to implicit biases on the biological differences and different pain threshold of racialised people (Hoffman et al., 2016). In contrast, culturally inclusive programmes have been shown to improve health outcomes in marginalised communities. A well-documented example is New Zealand’s Māori Health Model (Te Whare Tapa Whā), which combines spiritual, physical, mental, and family health to address Indigenous health disparities (Durie, 1994).
Challenges and strategies in achieving cultural competence
Although the benefit of a culturally competent healthcare system is undeniable, its effective implementation remains a challenge due to structural, educational, and systemic barriers that prevent culturally inclusive care from becoming standard practice across the globe. These barriers include:
Language and communication barriers
During one of my internships in India, a foreign student struggled to receive urgent care because the hospital staff did not speak English, until my intervention as a trilingual student. According to a research study, language barriers increase negative medical outcomes by 60 per cent (Green et al. 2021). Solutions to this problem can include incorporating AI-driven translation technology and recruiting healthcare professionals from diverse backgrounds. Hospitals in Japan now use AI-driven translation devices, reducing miscommunication incidents by 40 per cent (Yamada et al. 2023).
Implicit bias among healthcare providers
Research has shown that racial and ethnic minorities receive lower-quality healthcare, even when factors like income and insurance are controlled for (Yearby, 2020). Mandatory bias training and diverse hiring practices can tackle this: one study showed bias training improved pain management equality across racial groups by 20 per cent (Staton et al. 2022). Biases arise from a mix of stereotypes, underrepresentation of minority groups in healthcare leadership, and historical legacies of inequality that still shape institutional structures today. The very systems designed to deliver care also mirror the social inequalities of the societies they operate in by reproducing and reinforcing bias.
Lack of cultural training in medical education
In the US, 75 per cent of medical students feel unprepared to navigate cultural differences in patient care (Wieland et al., 2020). For instance, a Western-trained doctor might dismiss spiritual beliefs and herbal medicines in a country like Nigeria leading to mistrust between patients and medical staff. Cultural competence programmes should be incorporated into healthcare education: medical students trained in cultural competence demonstrate better patient communication and diagnostic accuracy (Khanna et al. 2022).
Systemic healthcare inequalities
Even when healthcare providers are culturally competent, systemic barriers like unequal access to care, economic inequalities, and prejudiced policies can still prevent equitable treatment. Many refugee and migrant groups struggle to access healthcare because of legal restrictions or lack of health insurance. In Greece and Italy, migrants and asylum seekers often receive delayed or limited care due to bureaucratic hurdles (Vandvik et al. 2021).
A call to action
It’s high time cultural competence in healthcare became a global necessity rather than a choice. Without this, healthcare inequalities will persist, funds and efforts will be wasted on ineffective patient care, and patient trust will continue to erode. To bridge these gaps, medical institutions, policymakers, and healthcare providers must integrate cultural competence into medical education, which involves structured training on implicit bias, cross-cultural communication, and the social determinants of health, alongside opportunities for immersive, real-world exposure to diverse patient groups.
About the author
Hajara is a graduate of B. Pharmacy. She earned her degree at Lovely Professional University, India where she graduated as the valedictorian. She is passionate about global health advocacy, the larger role of pharmacists in healthcare, and sustainable healthcare policies. She has also submitted her capstone project for publication on the effect of counterfeit drugs on the African population and economy.
About MedHums 101
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