Delivering Culturally Competent Care to Migrants by Healthcare Personnel: A Crucial Aspect of Delivering Culturally Sensitive Care

Abstract

The increasing cultural and ethnic diversity within global migrant populations necessitates the provision of culturally competent care by healthcare personnel. This narrative literature review critically analyzes existing literature on the delivery of culturally competent care to migrants, highlighting key theoretical frameworks, empirical findings, and practical strategies to enhance cultural competence in healthcare settings. The review identifies significant health disparities faced by migrants, including barriers to accessing healthcare, communication challenges, and systemic issues within healthcare institutions. It emphasizes the importance of comprehensive training programs, supportive organizational policies, community engagement, and the innovative use of technology and telemedicine. Furthermore, it addresses the future directions and research gaps, calling for longitudinal studies, the development of robust metrics, and targeted strategies to overcome the digital divide and ensure data privacy. By addressing these areas, healthcare providers, educators, and policymakers can improve healthcare delivery, reduce health disparities, and ensure equitable access to care for migrant populations.

1. Introduction

1.1. Overview of Global Migration Trends and Demographics

Global migration trends have significantly increased over the past few decades, driven by factors such as economic opportunities, conflicts, environmental changes, and family reunification. According to the International Organization for Migration (IOM), there were an estimated 281 million international migrants worldwide in 2020, representing 3.6% of the global population (International Organization for Migration 2024). The United Nations Department of Economic and Social Affairs (UN DESA) also reports that the largest number of international migrants reside in Europe, followed by Northern America and Northern Africa and Western Asia (United Nations Department of Economic and Social Affairs 2020). These migratory movements contribute to cultural and ethnic diversity within host countries, highlighting the need for culturally competent care in healthcare systems to address the diverse health needs of migrant populations. Culturally competent care involves understanding and respecting patients’ cultural differences, which can influence their health behaviors, beliefs, and interactions with healthcare providers (Betancourt et al. 2003). Studies have shown that culturally competent care can improve health outcomes and patient satisfaction, reduce health disparities, and enhance the overall quality of healthcare (Beach et al. 2006). Therefore, it is crucial for healthcare personnel to receive adequate training and support to develop cultural competence and effectively address migrants’ healthcare needs (Brach and Fraserirector 2000).

1.2. Definitions and Importance of Culturally Competent Care

1.2.1. Cultural Competence

Cultural competence refers to the ability of healthcare providers to effectively deliver services that meet the social, cultural, and linguistic needs of patients. It involves understanding and respecting cultural differences and incorporating this awareness into practice to improve healthcare delivery and outcomes. Cultural competence encompasses behaviors, attitudes, and policies that enable healthcare systems and professionals to work effectively in cross-cultural situations (Truong et al. 2014). It includes the development of skills and knowledge that allow for better communication and interaction with patients from diverse backgrounds, ultimately aiming to reduce health disparities and enhance patient satisfaction (Jongen et al. 2018). The dynamic nature of cultural competence is emphasized in continuously evolving healthcare environments to address the complexities of modern, diverse populations (Kirmayer 2012).

1.2.2. Migrants

Migrants are individuals who move from one country or region to another in search of better living conditions, employment opportunities, educational prospects, or other reasons, such as, for example, family reunification. This movement can be voluntary or forced, driven by factors such as economic necessity, conflict, persecution, or environmental changes (International Organization for Migration 2020). Migrants encompass diverse groups, including refugees, asylum seekers, labor migrants, and undocumented immigrants, each with distinct legal statuses and challenges (United Nations High Commissioner for Refugees 2021). Understanding migrants’ varied backgrounds and experiences is crucial for providing appropriate and effective healthcare services that meet their unique needs.

1.2.3. Healthcare Personnel

Healthcare personnel encompass a broad range of individuals who deliver healthcare services, including clinical and nonclinical staff working in various healthcare settings. This group includes doctors, nurses, physician assistants, pharmacists, therapists, social workers, and other allied health professionals as well as administrative and support staff who contribute to the overall functioning of healthcare systems (World Health Organization 2020). Healthcare personnel are essential for providing patient care, ensuring effective operation of healthcare facilities, and promoting public health. Their roles and responsibilities vary widely, but, collectively, they aim to improve health outcomes and enhance the quality of care delivered to patients (U.S. Bureau of Labor Statistics 2021).

The significance of delivering culturally competent care to migrants lies in its potential to address and reduce health disparities that disproportionately affect these populations. Migrants often face unique challenges such as language barriers, cultural misunderstandings, and limited access to healthcare, which can impede their ability to receive adequate care (Andrulis and Brach 2007). Culturally competent care can improve communication between healthcare providers and migrant patients, leading to better patient engagement, adherence to treatment plans, and overall health outcomes (Saha et al. 2008). Additionally, providing culturally sensitive care can enhance patient satisfaction and trust in the healthcare system, which is crucial for encouraging migrants to seek medical care when needed (Betancourt et al. 2005). Thus, integrating cultural competence into healthcare practices is essential for ensuring equitable and effective healthcare for all populations.

1.3. Objectives of the Review

The primary objective of this literature review is to critically analyze existing literature on the delivery of culturally competent care to migrants by healthcare personnel. It aims to identify and synthesize key theoretical frameworks, empirical findings, and practical strategies that enhance cultural competence in healthcare settings. Additionally, this review seeks to explore the barriers and challenges faced by healthcare providers in delivering culturally sensitive care and to highlight the best practices and innovative approaches that have proven effective. Ultimately, this review aspires to provide comprehensive insights that can inform policy development, improve training programs, and promote equitable access to healthcare for migrant populations.

2. Methodology

The narrative review approach was chosen for this review, based on the primary objective to synthesize the literature available on delivering culturally competent care to migrants in a comprehensive way (Sukhera 2022; Paré and Kitsiou 2017; Ferrari 2015). For this narrative review, an extensive literature search across several academic databases, including PubMed, CINAHL, Scopus, Google Scholar, and records from other sources, revealed a large number of publications addressing migrants and healthcare providers and discussing cultural competence and its impact on health outcomes, providing interventions or strategies to enhance it. A structure for this narrative review was designed on the directions of the literature findings. The search was then narrowed down to the last 20 years (to 20 April 2024). Significant literature providing theoretical frameworks or adding a significant point of view to this review was not excluded even if it was prior to this timeframe. This approach ensured that seminal works and foundational studies highly relevant to the topic were not overlooked. Parameters such as publication source, study design, sample size, citations, and relevance to the research question were decisive in the selection of the literature to be included. To further mitigate selection bias, we applied a multi-review system in which at least two of the authors assessed each potential source. The aim was to capture a comprehensive range of studies that address the intersection of cultural competence and healthcare delivery to migrant populations. The findings from the included studies were synthesized thematically, with a focus on common themes such as the application of theoretical models, the challenges faced by healthcare personnel, and the impact of culturally competent care on health outcomes for migrant populations. The aim was to provide the reader with a broad background for understanding current knowledge on delivering culturally competent care to migrants and highlighting the significance of new research on the field.

3. Conceptual Framework

3.1. What Is Culturally Competent Care?

Culturally competent care refers to the ability of healthcare providers to effectively deliver services that meet the social, cultural, and linguistic needs of patients. It involves a multifaceted approach that includes understanding and respecting cultural differences and adapting healthcare delivery to accommodate diverse cultural perspectives and practices. The concept encompasses several key components: cultural awareness, which involves self-reflection on one’s own cultural biases; cultural knowledge, which requires understanding different cultural practices and worldviews; cultural skills, which involve the ability to collect relevant cultural data regarding the patient’s health history and presenting problems; and cultural encounters, which emphasize engaging with patients from diverse backgrounds to build cultural competence through practical experience (Campinha-Bacote 2002).

Extended literature highlights the critical role of culturally competent care in reducing barriers to healthcare access and improving patient satisfaction, particularly among marginalized populations such as migrants (Betancourt et al. 2002; Truong et al. 2014). Migrants often face unique challenges in the healthcare system, including language barriers, unfamiliarity with the healthcare system, and differing health beliefs and practices. By fostering a more inclusive and responsive healthcare environment, culturally competent care aims to ensure equitable treatment for all patients, address disparities in healthcare outcomes, and promote health equity.

Research indicates that healthcare providers who engage in cultural competence training are better equipped to recognize and address the social determinants of health that disproportionately affect migrant populations (Jongen et al. 2018). Furthermore, culturally competent care has been associated with improved clinical outcomes, higher levels of patient trust and adherence to medical advice, and a greater overall quality of care (Saha et al. 2008). As healthcare systems become increasingly diverse, the importance of integrating cultural competence into healthcare education and practice has become paramount.

3.2. Overview of Theoretical Frameworks and Models Related to Cultural Competence in Healthcare

Cultural competence in healthcare is essential for delivering effective and equitable care to diverse populations. Several theoretical frameworks and models guide the development and implementation of culturally competent practices among healthcare providers. These frameworks emphasize understanding and integrating cultural differences into healthcare delivery to improve health outcomes and patient satisfaction.

3.2.1. Campinha-Bacote’s Model of Cultural Competence

One of the most widely recognized models is Campinha-Bacote’s Model of Cultural Competence, which posits that cultural competence is a continuous process involving five interrelated constructs: cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. This model emphasizes that healthcare providers must actively engage in learning about and integrating cultural differences into their practices (Campinha-Bacote 2002).

3.2.2. The Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence provides a comprehensive framework for healthcare providers to understand cultural differences across 12 domains, including communication, family roles, workforce issues, biocultural ecology, and healthcare practices. This model is designed to be adaptable to various healthcare settings and is used to guide the assessment and delivery of culturally sensitive care (Purnell 2016).

3.2.3. The Giger and Davidhizar Transcultural Assessment Model

Giger and Davidhizar’s Transcultural Assessment Model identifies six cultural phenomena that healthcare providers should consider: communication, space, social organization, time, environmental control, and biological variation. This model helps providers assess cultural factors that may influence health behaviors and outcomes, facilitating the delivery of personalized care (Giger and Davidhizar 2002).

3.2.4. The Leininger’s Culture Care Theory

Leininger’s Culture Care Theory is foundational in the field of transcultural nursing science, emphasizing the importance of understanding and respecting cultural differences in healthcare. This theory suggests that culturally congruent care can only be achieved by integrating patients’ cultural beliefs and practices into their care plans. Leininger’s Sunrise Model provides a visual representation of the factors influencing cultural care, including technological, religious, kinship, social, and political (Leininger 2002).

3.2.5. The Cross-Cultural Competence Continuum

This model outlines six stages of cultural competence: cultural destructiveness, cultural incapacity, cultural blindness, cultural pre-competence, cultural competence, and cultural proficiency. Each stage represents a level of awareness, knowledge, and skills in cultural competence, with cultural proficiency being the most advanced level. This continuum is used to assess and guide the development of cultural competence within healthcare organizations and among individual practitioners (Cross 1989, 2020).

3.2.6. The Papadopoulos, Tilki and Taylor Model for Developing Cultural Competence

The Papadopoulos, Tilki, and Taylor Model focuses on the development of cultural competence through a four-stage process: cultural awareness, cultural knowledge, cultural sensitivity, and cultural competence. This model highlights the importance of reflection and critical thinking in developing cultural competence, thus encouraging healthcare providers to evaluate their attitudes and practices continuously (Papadopoulos 2006).

3.2.7. Application of These Models in Healthcare Settings

These models and frameworks are designed to be applied in various healthcare settings aiming to improve the quality of care of diverse patient populations. Campinha-Bacote’s model is often used in training programs to enhance the cultural competence of healthcare providers by encouraging self-assessment and continuous learning (Campinha-Bacote 2002). The Purnell Model is frequently used in nursing education to teach students about cultural differences and how to integrate this knowledge into clinical practice (Purnell 2016). Leininger’s Culture Care Theory is applied in nursing practice to develop culturally tailored care plans that respect patients’ cultural values and beliefs, leading to improved patient satisfaction and health outcomes (Leininger 2002). The Giger and Davidhizar Transcultural Assessment Model is used in clinical settings to assess the cultural factors that may impact patient care and facilitate the delivery of individualized care (Giger and Davidhizar 2002). The Papadopoulos, Tilki, and Taylor Model is implemented in organizational policies and training programs to promote cultural competence among healthcare staff and foster an inclusive and responsive healthcare environment (Papadopoulos 2006).

3.3. Components of Culturally Competent Care

3.3.1. Awareness, Knowledge, and Skills

Culturally competent care encompasses several critical components that healthcare providers must integrate into their practices to effectively address the diverse needs of patients. These components include cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. Cultural awareness involves the self-examination of one’s own cultural background and biases, which is essential for recognizing how these factors influence interactions with patients from different backgrounds (Campinha-Bacote 2002). Cultural knowledge requires healthcare providers to acquire information about different cultural practices, worldviews, and health-related beliefs, ensuring that they understand the unique needs of their patients (Purnell 2016). Cultural knowledge is the continuous effort to gain understanding about different cultural practices, health beliefs, and disease prevalence, which is crucial for delivering appropriate care (Sharifi et al. 2019). Cultural skills are the ability to collect relevant cultural data regarding a patient’s health history and perform culturally based physical assessments, ensuring that care is personalized and effective (Betancourt et al. 2003). Cultural encounters encourage healthcare providers to directly engage with patients from diverse backgrounds, promoting meaningful interactions that enhance understanding and competency and apply cultural knowledge and skills in real-world scenarios (Saha et al. 2008) (Foronda et al. 2016). Finally, cultural desire is the intrinsic motivation to become culturally aware, knowledgeable, and skillful, driven by genuine care and respect for diversity rather than obligation (Campinha-Bacote 2002; Agency for Healthcare Research and Quality 2019). Together, these components foster a holistic approach to culturally competent care, ultimately improving patient outcomes and satisfaction (Betancourt et al. 2005; Truong et al. 2014; Alizadeh and Chavan 2016). Developing cultural skills involves the ability to conduct culturally sensitive assessments and interventions tailored to the unique needs of patients (Kaihlanen et al. 2019).

3.3.2. Organizational Support and Policy Implications

Organizational support and policy implications play a pivotal role in promoting and sustaining culturally competent care within healthcare settings. To effectively implement culturally competent practices, healthcare organizations must exhibit strong leadership commitment and allocate the necessary resources to foster an inclusive environment. Leadership commitment involves setting a vision that prioritizes cultural competence, which should be reflected in the organization’s mission, values, and strategic goals. Effective leadership also entails appointing dedicated personnel or committees to oversee cultural competence initiatives and ensuring that these initiatives are integrated into a broader organizational framework (Betancourt et al. 2003).

Resource allocation is another critical aspect of organizational support. This includes providing ongoing cultural competence training programs for all healthcare staff, which can enhance their ability to understand and meet the cultural needs of diverse patient populations. Training programs should cover various aspects of cultural competence, including communication skills, cultural awareness, and bias reduction strategies (Truong et al. 2014). Recent literature emphasizes the need for continuous education and institutional commitment to maintain culturally competent practices (Prosen 2018; Horvat et al. 2014). Furthermore, healthcare organizations should invest in tools and resources that facilitate culturally competent care such as multilingual health information, interpreter services, and culturally tailored health interventions (Alizadeh and Chavan 2016).

In addition to training and resources, healthcare organizations must implement policies that support cultural competence. Policies should mandate the inclusion of cultural competence in job descriptions, performance evaluation, and accreditation standards. This ensures that healthcare providers are held accountable for delivering culturally competent care and that these practices become an integral part of the healthcare delivery system (Kaihlanen et al. 2019). Policies should also address the recruitment and retention of a diverse workforce, as diversity within the healthcare workforce can enhance the provision of culturally competent care (Balcazar et al. 2010). Enhanced organizational support ensures that healthcare systems are equipped to handle the diverse needs of migrant populations, fostering an environment in which cultural competence is not just encouraged but expected. This systematic approach can significantly reduce health disparities and improve the quality of care for all patients, particularly those from marginalized communities. The alignment of organizational policies with cultural competence principles is essential for sustainable and effective healthcare delivery.

At the national and institutional levels, policy implications include the development of guidelines and standards that promote cultural competence. The U.S. Department of Health and Human Services has established the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. These standards provide a framework for organizations to deliver equitable and effective care that is respectful of and responsive to the cultural and linguistic needs of all patients (U.S. Department of Health and Human Services 2024). Policies should also address systemic barriers such as language and accessibility, in order to improve patient outcomes and satisfaction. Accreditation bodies, such as The Joint Commission, have also incorporated cultural competence standards into their accreditation criteria, further emphasizing the importance of culturally competent care in achieving high-quality healthcare outcomes (The Joint Commission 2024).

Organizational support and policy implications are essential in creating a healthcare environment that values and prioritizes cultural competence. By committing to these principles and implementing comprehensive policies and training programs, healthcare organizations can improve patient satisfaction, enhance health outcomes, and reduce health disparities among diverse patient populations.

4. Importance of Culturally Competent Care for Migrants

4.1. Common Health Issues Faced by Migrants

Migrants are a social category with particular needs in the health sector, given their generally poor living conditions (both in sending and receiving countries), but also due to additional problems caused by difficulties adapting to a new social and cultural environment (Sassen 2016; Fouskas et al. 2022). They face various health issues that are often exacerbated by the unique challenges they encounter during migration and resettlement. Health concerns include infectious diseases, chronic conditions, mental health disorders, and maternal and child health issues. The cumulative health consequences of contemporary labor migration are highlighted by Mayell and McLaughlin (2016). Labor migrants often endure harsh working conditions, inadequate housing, and limited access to healthcare, all of which contribute to deteriorating health outcomes (Mayell and McLaughlin 2016).

4.1.1. Infectious Diseases

Migrants are particularly vulnerable to infectious diseases such as tuberculosis, HIV/AIDS, and hepatitis due to factors such as crowded living conditions, poor sanitation, and limited access to healthcare during their journey and in their host countries (World Health Organization 2022). The risk of previous exposure of refugees to endemic diseases of their countries of origin depends on the regions and their living conditions in these countries, and it can vary significantly between those who come from the same country (Scales et al. 2023).

4.1.2. Chronic Conditions

Migrants often suffer from chronic diseases, including asthma, diabetes, hypertension, and cardiovascular diseases. The stress of migration, changes in diet, and lack of continuous healthcare contribute to the prevalence and poor management of these conditions (Shahin et al. 2021; Scales et al. 2023).

4.1.3. Mental Health Disorders

Mental health issues are prevalent among migrants due to the trauma and stress associated with migration. Common disorders include depression, anxiety, and post-traumatic stress disorder (PTSD). These issues are often compounded by social isolation, discrimination, and the difficulty of adapting to a new culture (United Nations 2023). Mayell and McLaughlin (2016) emphasize the psychological stress associated with migration, including the trauma of separation from family and the anxiety of legal and economic uncertainties. These stressors can lead to a higher prevalence of chronic diseases and mental health issues among migrant populations (Mayell and McLaughlin 2016).

4.1.4. Maternal and Child Health

Migrant women frequently lack access to adequate prenatal and postnatal care, resulting in higher rates of maternal and infant mortality and morbidity. Issues such as unintended pregnancies and complications during childbirth are also more common among migrant populations (World Health Organization 2022). Minor refugees in Greece often arrive with a range of acute and chronic health problems, exacerbated by the stress and trauma of their migration journeys—diabetes, inadequate oral hygiene, and unknown vaccination coverage are some of them (Tzavella et al. 2020). Many refugee women experience physical and mental health issues that are often exacerbated by the harsh conditions of refugee camps and the lack of specialized medical care (Tzavella and Sakellaridis 2020).

4.1.5. Occupational Health

Migrants often work under hazardous conditions without adequate safety measures, leading to occupational injuries and illnesses. They are also more likely to experience exploitation and abuse in the workplace, which further impacts their health (Fouskas 2018; World Health Organization 2022; Zhang et al. 2022).

4.1.6. Nutritional Deficiencies

Migrants may experience malnutrition and related health problems due to limited access to nutritious food during transit and upon arrival in host countries (Khuri et al. 2022). This can lead to conditions such as anemia and other vitamin deficiencies.

4.2. Barriers Faced by Migrants to Accessing Healthcare

Migrants encounter numerous complex barriers to accessing healthcare, impacting their overall health and well-being. These barriers span the structural, cultural, linguistic, socioeconomic, legal, geographic, and psychosocial domains (United Nations 2023).

Structural barriers include difficulties navigating unfamiliar healthcare systems, lack of information on available services, and complex bureaucratic procedures. These challenges are compounded by policies that restrict access to care, particularly for undocumented migrants, who may fear deportation or legal consequences. A recent study (Sherif et al. 2022) highlights that fragmentation of healthcare service delivery and unfamiliar systems impede access to migrants.

Cultural differences between migrants and healthcare providers can lead to misunderstanding and mistrust. Migrants’ health beliefs and practices may differ significantly from those of the host country’s healthcare system, affecting their willingness to seek care or adhere to treatment. Nyikavaranda et al. (2023) discusses how cultural competence in healthcare settings is crucial for effective engagement with migrant populations.

Language barriers are among the most significant obstacles. Limited proficiency in the host country’s language can hinder communication regarding symptoms, diagnoses, and treatment plans (Flores 2006). This gap could lead to misdiagnosis and poor treatment adherence. The need for interpreter services and language support in healthcare settings is imperative.

Economic challenges, including low income, unemployment, and unstable housing, significantly limit migrants’ access to healthcare. The high cost of healthcare services and lack of health insurance further restrict access, forcing migrants to prioritize basic healthcare needs. Socioeconomic constraints are major factors in preventing migrants from accessing necessary healthcare (Sherif et al. 2022). Migrant concentration in precarious, low-status/low-wage jobs affects access to healthcare, especially in the case of irregular migrants, who are severely affected (Fouskas 2018). Precarious work is employment that lacks all the standard forms of labor security, typically takes the form of wage work, and is characterized by exceptionally limited social benefits and legal rights, job insecurity, low wages, and a high risk of ill health (Vosko 2006).

Legal frameworks and policies in host countries often pose significant barriers to migrants’ access to healthcare. Restrictive immigration policies can deter migrants, especially those who are undocumented, from seeking healthcare because of the fear of deportation (Martinez et al. 2015). These policies may also limit access to essential health services and create bureaucratic hurdles that migrants struggle to navigate (World Health Organization 2022). For example, it is common practice in many countries that proof of legal residency is required to access public health insurance or healthcare services, which excludes undocumented migrants from receiving necessary medical care. Joseph (2017) suggests that restrictive federal policies and national-level anti-immigrant sentiment can undermine inclusive subnational policies in socially progressive places. Additionally, policies that mandate reporting undocumented individuals to immigration authorities can lead to a chilling effect, whereby migrants avoid healthcare facilities altogether to prevent detection and potential deportation (Young et al. 2023). This creates a public health risk as migrants may delay treatment for communicable diseases, leading to broader health implications for the host community (Connolly et al. 2004). Furthermore, the lack of cultural competence in policy design can exacerbate these barriers, as migrants may face additional challenges related to language differences and cultural misunderstandings when navigating complex healthcare systems. Addressing these systemic barriers requires a shift in policy focus toward inclusive healthcare practices that prioritize the health rights of all individuals regardless of their immigration status (Lebrón et al. 2023). Comprehensive reforms that promote access to healthcare for migrants are essential for fostering equity and ensuring the well-being of diverse populations (World Health Organization 2010).

Geographic isolation and environmental factors also play crucial roles. Migrants in rural or underserved urban areas often face long distances to healthcare facilities, lack transportation, and live in areas with few healthcare resources. These challenges are further compounded by poor living conditions and environmental hazards (Coumans and Wark 2024).

Psychosocial factors, including stigma, discrimination, and social isolation, affect migrants’ access to healthcare. Experience of discrimination in healthcare settings can reduce trust in medical institutions and discourage migrants from seeking care. Social isolation and the stress associated with migration further deteriorate mental health and hinder healthcare utilization (Nyikavaranda et al. 2023).

The issue of delivering culturally competent care to migrants is particularly complex for undocumented patients. Undocumented immigrants face significant barriers to accessing healthcare, including lack of insurance and unfamiliarity with the healthcare system. These barriers exacerbate health disparities and prevent many undocumented migrants from seeking necessary medical care. Healthcare personnel must be aware of these challenges and work to create a safe and welcoming environment for all patients, regardless of their legal status. This involves not only providing culturally sensitive care but also advocating policies that protect the health rights of undocumented individuals (Berlinger and Gusmano 2013). By addressing these systemic issues and fostering trust within the vulnerable population, healthcare providers can improve health outcomes and contribute to a more equitable healthcare system.

Refugee groups crossing into host countries often comprise some of the most vulnerable populations, such as children and women. In their exploration of refugee women’s experiences and human rights in Greece, Tzavella and Sakellaridis (2020) provide a poignant account of the myriad challenges faced by female refugees. This study, based on testimonies from refugee women, underlines the systemic barriers that prevent these women from receiving adequate protection and support, such as bureaucratic inefficiencies and cultural insensitivity within the healthcare system (Tzavella and Sakellaridis 2020). Unaccompanied refugee minors face several challenges associated with managing health problems. These sensitive young individuals encounter numerous administrative obstacles that hinder their access to essential healthcare and social services (Tzavella et al. 2020).

4.3. Impact on Health Outcomes

4.3.1. Culturally Competent Care Related to Delivering Better Health Services

Culturally competent care, which involves recognizing and respecting the cultural background and needs of patients, has been shown to play a crucial role in improving health outcomes. It encompasses understanding patients’ cultural beliefs, values, and practices and integrating this understanding into the care process. In doing so, healthcare providers can improve communication, foster trust, and enhance patient satisfaction, which are critical components of effective healthcare delivery.

Studies have demonstrated that culturally competent care is associated with better health outcomes in various populations. For instance, Beach et al. (2006) found that healthcare providers who received training in cultural competence were more likely to engage in behaviors that promote patient-centered care, leading to improved patient outcomes. Patient-centered care that respects and responds to migrants’ cultural needs can improve patient engagement and satisfaction. Cultural competence encourages healthcare providers to consider cultural factors in their treatment planning and decision-making processes. This might involve understanding traditional healing practices, dietary restrictions, and family dynamics, which can significantly impact healthcare choices and adherence (Saha et al. 2008).

Similarly, a systematic review by Truong et al. (2014) concluded that culturally competent interventions are effective in reducing health disparities and improving the quality of care for minority populations. Building trust is also crucial, as migrants might have different expectations from healthcare providers and may be wary due to previous negative experiences or differing healthcare practices in their countries of origin (Kankaanpää et al. 2024; Kirmayer et al. 2011).

One significant aspect of culturally competent care is its impact on patient–provider communication. Migrants may speak different languages and have varying levels of proficiency in the host country’s dominant language. Cultural competence involves the use of trained interpreters and culturally tailored health education materials to ensure clear communication (Puthoopparambil et al. 2021). Effective communication is essential for an accurate diagnosis, treatment adherence, and patient satisfaction. In addition, Schwei et al. (2016) indicate that culturally competent care can mitigate communication barriers, such as language differences and cultural misunderstandings, thereby enhancing the overall quality of care. Improved communication not only facilitates a better understanding of patients’ health needs but also encourages active patient participation in their own care, leading to better health outcomes.

Migrants often experience higher rates of certain health conditions, such as infectious diseases, mental health issues, and chronic diseases, partly due to the stress of migration and socioeconomic factors. Culturally competent care can help to identify and address these health disparities by considering the social determinants of health that affect migrant populations. For example, culturally sensitive screening and preventive measures can be tailored to migrants’ specific needs, leading to better health outcomes.

Moreover, culturally competent care has been shown to reduce health disparities in minority populations. Minority groups often experience poorer health outcomes owing to factors such as socioeconomic status, limited access to healthcare, and cultural barriers. Implementing culturally competent care can address these disparities by ensuring that healthcare services are tailored to meet the unique needs of diverse patient populations (Saha et al. 2008). For instance, interventions that include culturally adapted health education materials and community health workers who share cultural backgrounds with patients have been successful in improving health behaviors and outcomes in minority communities.

Recent studies have emphasized the growing need for cultural competence in the context of increasing global migration. For instance, a study by Lanari and Bussini (2023) highlights that culturally competent interventions are crucial in addressing the health needs of elderly migrants, who often have different healthcare needs compared to younger populations. Moreover, the COVID-19 pandemic has underscored the importance of culturally competent care, as migrant populations have been disproportionately affected by pre-existing health disparities and barriers to healthcare access (Drefahl et al. 2020).

Health literacy plays a significant role in migrant healthcare. According to a study by Ugas et al. (2023), there are strong associations between health literacy and health outcomes among populations with limited language proficiency. Migrants with low health literacy are more likely to experience adverse health outcomes due to misunderstandings about medical instructions, reduced ability to navigate the healthcare system, and less effective management of chronic diseases. Improving health literacy through culturally tailored education and communication strategies can significantly enhance the health and well-being of migrant populations (Ugas et al. 2023).

In conclusion, culturally competent care is a critical component of high-quality healthcare that can lead to improved health outcomes. As the population becomes increasingly diverse, integrating cultural competence into healthcare practices is essential to reduce health disparities and achieve better health outcomes for all patients.

4.3.2. Case Studies or Examples of Successful Culturally Competent Care Practices

There are multiple examples in the literature of successful initiatives to promote culturally competent care. Community Health Workers (CHWs) have been effectively utilized to provide culturally competent care, particularly in underserved and minority communities. These workers often share the same cultural background as the patients they serve, which enables them to bridge cultural and linguistic gaps. For example, a program in Massachusetts employed CHWs to assist Hispanic women in diabetes management. The CHWs provided culturally tailored health education, facilitated communication with healthcare providers, and helped to navigate the healthcare system. This program resulted in improved diabetes control and increased patient satisfaction (Brownstein et al. 2007).

The Indian Health Service (IHS) developed a culturally tailored diabetes prevention program for Native American communities. This program included lifestyle changes such as diet and exercise, integrated with traditional Native American practices and values. A key component was the involvement of tribal leaders and inclusion of culturally relevant educational materials. The program demonstrated a significant reduction in diabetes risk factors among participants (Jiang et al. 2013).

Bellevue Hospital in New York City has implemented comprehensive language access services to cater to its diverse patient population. The hospital provided on-site interpreters, telephone interpretation services, and translated materials in more than 20 languages. These services improve communication between healthcare providers and patients, leading to better health outcomes and higher levels of patient satisfaction. Evaluation of the program showed reduced emergency room visits and shorter hospital stays for non-English-speaking patients (Diamond et al. 2010).

The Refugee and International Health Program in Minneapolis, Minnesota, offers culturally sensitive mental health services to refugees from various countries. The program employs mental health professionals trained in cultural competence and interpreters to ensure effective communication. One of the successes of the program is its approach to treating post-traumatic stress disorder (PTSD) in Somali refugees. By incorporating traditional healing practices and providing education about mental health in a culturally relevant manner, the program has achieved notable improvements in mental health outcomes (Kroll et al. 2011).

The SISTA (Sisters Informing Sisters about Topics on AIDS) program is an evidence-based HIV prevention intervention specifically designed for African American women. The program includes culturally relevant discussions on gender and power dynamics, sexual health, and HIV prevention strategies. Participants reported increased knowledge about HIV, improved condom use, and a greater sense of empowerment. The program’s success underscores the importance of cultural tailoring in health interventions to address the unique needs of specific populations (DiClemente et al. 2004).

5. Challenges in Delivering Culturally Competent Care

5.1. Systemic and Institutional Challenges

The delivery of culturally competent care remains a significant challenge within the healthcare system, primarily because of systemic and institutional barriers. Despite the recognized importance of culturally competent care in improving health outcomes, many healthcare institutions struggle with inadequate training and resources necessary to implement effective practices.

One of the primary systemic challenges is the lack of comprehensive training programs for healthcare professionals. Many medical and nursing schools have historically neglected cultural competence as a core component of their curriculum (Beach et al. 2005). Consequently, healthcare providers often enter the workforce without the necessary skills to interact effectively with patients from diverse cultural backgrounds. This gap in education leads to misunderstandings, reduced patient satisfaction, and poor health outcomes. A study by Lie et al. (2011) highlights that even when training is available, it is often insufficient, sporadic, or not integrated into the ongoing professional development of healthcare staff.

Furthermore, the institutional resources dedicated to cultural competence are often inadequate. Healthcare organizations may lack the financial resources to hire interpreters, cultural liaisons, or community health workers who can facilitate better communication and understanding between providers and patients (Jacobs et al. 2004). Additionally, there is often a scarcity of culturally appropriate educational materials and tools that healthcare providers can use to enhance patient care. The absence of these resources can hinder the ability of providers to offer care that is respectful of and responsive to the cultural needs of patients (Spinner et al. 2021).

Institutional policies and practices play a critical role in supporting or obstructing culturally competent care. Many healthcare institutions lack clear policies and frameworks that prioritize and integrate cultural competence into their operations (Truong et al. 2014). Without strong institutional support, efforts to promote cultural competence can become fragmented and ineffective. For example, institutions might implement cultural competence training as a one-time event rather than an ongoing process, reducing its impact on long-term care practices.

Moreover, though tools to assess the cultural competence of healthcare personnel do exist, they are often not translated, nor standardized to be used in other settings than the ones they were created for. The lack of standardized metrics for evaluating cultural competence poses a significant challenge. Institutions often struggle to measure the effectiveness of their cultural competence initiatives due to the absence of reliable and validated assessment tools (Jongen et al. 2018). This lack of evaluation impedes the ability to identify successful strategies and areas requiring improvement, ultimately affecting the quality of care provided to diverse populations.

Financial constraints further exacerbate these challenges. Healthcare institutions operating with limited budgets may prioritize other pressing needs over cultural competence training and resources (Saha et al. 2008). This prioritization often results in cultural competence being viewed as an ancillary rather than an essential component of healthcare delivery. Consequently, initiatives aimed at improving cultural competence may receive insufficient funding and support.

In conclusion, the delivery of culturally competent care is hindered by systemic and institutional challenges, primarily due to a lack of training and resources. Addressing these barriers requires a multifaceted approach, which includes comprehensive education, adequate resource allocation, clear institutional policies, and effective evaluation metrics. By overcoming these challenges, healthcare institutions can improve the quality of care for diverse populations and achieve better health outcomes.

5.2. Personal and Interpersonal Challenges

Healthcare providers’ biases and attitudes can significantly impact the quality of care provided to migrants, often exacerbating health disparities and creating barriers to effective healthcare. Several studies have explored these issues, offering insights into the challenges and potential solutions to improve culturally competent care for migrant populations.

A recent study by Zghal et al. (2021) highlights the significance of healthcare providers’ self-perceptions of cultural competence. This study found that providers often offer biased judgments of their own abilities, which can affect the quality of care they deliver. It emphasizes the need for unbiased self-assessment and ongoing education to ensure that providers can meet the cultural needs of their patients effectively (Zghal et al. 2021).

In a study by Dauvrin and Lorant (2015), researchers discuss the challenges posed by international migration and the necessity for healthcare leaders to be culturally competent. This study underscores that healthcare professionals must be sensitive to the cultural backgrounds of their patients to provide effective and respectful care. This research points out that cultural competence is not only about understanding different cultures but also about leadership in healthcare settings to foster an inclusive environment (Dauvrin and Lorant 2015).

Another insightful study by Drewniak et al. (2017) provides an integrative literature review on how healthcare professionals’ attitudes and behaviors can contribute to health disparities among immigrant and minority groups. These findings indicate that cultural insensitivity and biases can lead to unequal treatment and poorer health outcomes. This study calls for greater cultural sensitivity and training to reduce these disparities and ensure that all patients receive high-quality care (Drewniak et al. 2017).

A systematic review by Suphanchaimat et al. (2015) discusses the various obstacles healthcare providers face when delivering care to migrant populations. It highlights that health professionals often perceive mistrust from immigrant patients, which can hinder effective communication and care delivery. This mistrust is frequently rooted in negative past experiences with healthcare systems that are not culturally competent. The study stresses the importance of building trust through culturally sensitive care practices to improve health outcomes for migrants (Suphanchaimat et al. 2015).

These studies collectively illustrate that healthcare providers’ biases and attitudes play a crucial role in delivering culturally competent care to migrants. Addressing these biases through targeted cultural competence training and fostering an inclusivity environment are essential steps toward reducing health disparities. Healthcare professionals must engage in continuous education and self-reflection to ensure that they effectively serve diverse patient populations and provide equitable care.

In a study by Schloemer et al. (2023), the importance of clear and trust-intensive communication with migrants is highlighted, particularly those from Turkish or Moroccan backgrounds. The study indicates that barriers related to language and cultural differences can hinder effective communication, making it difficult for migrants to access and effectively utilize healthcare services. This study underscores the need for healthcare systems to address these barriers to improve vaccination uptake and overall health outcomes in underserved communities (Schloemer et al. 2023).

Kompothanasi et al. (2022) explore the experiences of female migrants, refugees, and asylum seekers within the midwifery-led continuity care model. The study reveals that communication and language barriers significantly affect the relationship between healthcare providers and migrant women. These barriers often lead to misunderstanding, reduced trust, and reluctance to seek care. The findings emphasize the critical role of effective communication in building trust and ensuring that migrant women receive appropriate and timely healthcare services (Kompothanasi et al. 2022).

Lai (2023) discusses the challenges faced by Chinese-American immigrants in accessing high-quality healthcare in the United States. This study identifies language barriers as a primary obstacle to effective communication with healthcare providers (Lai 2023). This communication gap could lead to misdiagnosis, inappropriate treatments, and overall dissatisfaction with healthcare services. Addressing these language barriers is essential for improving the healthcare experience and outcomes of Chinese-American immigrants.

Tirado (2024) examines sexual and reproductive health and rights (SRHR) among newly arrived migrants in Sweden. This study highlights trust issues and language barriers as significant challenges in communicating SRHR information to migrants. Both healthcare providers and migrants often struggle with effective communication, leading to gaps in understanding and care provision. This study suggests that targeted interventions are needed to bridge these communication gaps and build trust between providers and migrant patients (Tirado 2024).

Shabnam (2023) focuses on the provision of palliative care for non-Western migrants in Denmark. This study points out that migrants face various challenges, including language and communication barriers, when navigating the healthcare system. These barriers can result in a lack of understanding of palliative care options and services, thereby leading to inadequate care. This study calls for culturally sensitive communication strategies to ensure that migrants receive the support they need (Shabnam 2023).

In conclusion, communication barriers, biases, self-perceptions, and trust issues between healthcare providers and migrants significantly affect the delivery of culturally competent care. Addressing these challenges through targeted interventions, charismatic leadership, language support, and culturally sensitive communication strategies is essential for improving healthcare outcomes and reducing disparities among migrant populations. These efforts can help build trust, enhance understanding, and ensure that migrants receive quality care.

6. Strategies for Enhancing Cultural Competence in Delivering Care to Migrants

6.1. Education and Training Programs

Effective education and training programs aimed at enhancing cultural competence among healthcare personnel are crucial to improve the quality of care provided to migrant populations. These programs address the diverse cultural needs of migrants and equip healthcare professionals with skills necessary to deliver culturally sensitive and effective care. Several strategies can be implemented to achieve this goal, according to recent studies in the field.

One notable strategy involves simulation-based training programs. Crawford et al. (2023) give us insights into the “La Oportunidad” project, which employs simulation to enhance language proficiency and cultural competence among healthcare providers. This study indicates that simulation-based training significantly improves perceived proficiency and healthcare delivery. Simulation allows healthcare professionals to practice real-world scenarios in a controlled environment, thereby enhancing their ability to communicate effectively with patients from diverse cultural backgrounds (Crawford et al. 2023).

Another effective approach is to incorporate culturally responsive teaching methods into healthcare education. Nashwan (2024) emphasizes the importance of integrating such methods into nursing education to address the challenges posed by the global migration of healthcare professionals. This study advocates cultural competence training as a core component of nursing and other healthcare education programs, ensuring that providers are well prepared to meet the needs of culturally diverse populations (Nashwan 2024).

Interdisciplinary training programs that focus on social inclusion and anti-discrimination are also essential. Perla et al. (2023) highlight the “AHEAD” project, which aims to combat discrimination and hate speech against ethnic minorities, including migrants. The project emphasizes enhancing the capacity of healthcare providers to support social inclusion and deliver equitable healthcare. Training programs that encourage healthcare professionals to reflect on their biases and adopt inclusive practices can significantly improve their interactions with patients (Perla et al. 2023).

Ongoing professional development is critical to maintaining and enhancing cultural competence. Continuous educational programs that provide healthcare professionals with up-to-date information on cultural competence and best practices are vital. These programs include workshops, seminars, and online courses that focus on cultural awareness, communication skills, and the provision of culturally appropriate care. The American Medical Association (AMA) offers several continuing medical education (CME) courses aimed at improving cultural competence among healthcare providers (American Medical Association 2024).

In conclusion, education and training programs that emphasize simulation-based learning, culturally responsive teaching, interdisciplinary approaches, and continuous professional development are essential for enhancing cultural competence among healthcare personnel. These strategies not only improve the quality of care provided to migrant populations but also promote social inclusion and equity in healthcare delivery.

6.2. Organizational Initiatives

Healthcare institutions can adopt various policies and procedures to support culturally competent care, and address organizational culture, training, resources, and leadership. Recent literature provides insights into effective strategies and examples from practice.

Healthcare institutions should establish clear policies to promote cultural competence. These policies should mandate cultural competence training for all healthcare staff, incorporate cultural considerations into patient care protocols, and ensure that all organizational practices are inclusive. For instance, a study by Dewez (2023) discusses policies that support cultural sensitivity and inclusivity, emphasizing the need for healthcare systems to create accessible and acceptable services for refugees and asylum seekers. Such policies can help mitigate barriers and enhance the quality of care provided (Dewez 2023).

Instituting procedures that operationalize cultural competence policies is critical. These procedures may include regular cultural competence training, use of interpreters, and development of culturally appropriate health education materials. Nashwan (2024) highlights the importance of integrating culturally responsive teaching into the healthcare curriculum to prepare providers for the cultural needs of their patients. Procedures should also ensure that healthcare providers are trained to recognize and address their own biases, fostering a more inclusive care environment. Another procedural aspect is the establishment of protocols for utilizing language services, such as professional interpreters, to overcome language barriers. This ensures clear communication between providers and patients, which is essential for an accurate diagnosis and effective treatment.

Allocating adequate resources is essential for supporting culturally competent care. This includes providing financial resources for training programs, hiring interpreters, and developing educational materials. Crawford et al. (2023) discuss the implementation of simulation-based training programs that serve as a resource for enhancing cultural competence among healthcare providers. Such programs provide practical experience and improve the ability of healthcare personnel to handle diverse patient populations effectively (Crawford et al. 2023). Healthcare institutions can also create resource centers that offer information and tools for culturally competent care, ensuring that providers have access to necessary support to deliver high-quality care to all patients.

Effective leadership is crucial for fostering a culture of cultural competence within healthcare organizations. Leaders must advocate for cultural competence initiatives, model inclusive behaviors, and engage with diverse communities to understand their needs. Perla et al. (2023) highlight the role of leadership in promoting initiatives that combat discrimination and enhance social inclusion in healthcare settings. Leaders can drive organizational change by supporting policies and procedures that prioritize cultural competence (Perla et al. 2023). Leaders should also establish accountability mechanisms to ensure that cultural competence policies and procedures are implemented effectively and that progress is regularly evaluated.

6.3. Community Engagement and Collaboration

Enhancing cultural competence in healthcare delivery for migrants is crucial, and community engagement and collaboration play a vital role in achieving this goal. Effective community engagement fosters trust, improves communication, and ensures that healthcare services are responsive to the cultural and linguistic needs of the migrant population. Recent literature provides valuable insights into strategies and examples of successful community engagement and collaboration.

One key strategy for enhancing cultural competence is the active involvement of community leaders and organizations in healthcare initiatives. Engaging community leaders helps bridge cultural gaps and ensures that healthcare providers understand the specific needs and preferences of the migrant communities they serve. For instance, a study by Karman et al. (2023) on Indonesian migrant workers in Malaysia highlights the importance of community engagement programs aimed at enhancing self-development and collaboration. These programs not only support migrants but also strengthen partnerships between healthcare providers and community organizations, fostering a more inclusive healthcare environment (Karman et al. 2023).

Collaboration with community-based organizations is another effective approach. These organizations often have deep-rooted connections within migrant communities and can provide critical insights into cultural practices and health beliefs. Gathen (2023) emphasizes the role of organizations of interest in representing vulnerable populations, including migrants. This study suggests that healthcare providers can enhance their cultural competence by working closely with these organizations to develop and implement culturally sensitive health interventions (Gathen 2023).

Educational initiatives that involve community participation are essential. Blaise (2023) discusses the revitalization of language programs through community engagement, demonstrating how collaboration with community partners can enhance intercultural competence and problem-solving skills among healthcare providers. Such initiatives not only improve language proficiency but also foster a deeper understanding of cultural nuances, ultimately leading to better patient care (Blaise 2023).

Furthermore, providing culturally appropriate health education and resources tailored to the migrant communities is crucial. Mudi (2023) highlights the need for targeted educational materials and interactive sessions to improve the engagement of developing country immigrants with physiotherapy services. By tailoring educational resources to the specific cultural and linguistic needs of migrants, healthcare providers can improve patient understanding and compliance with treatment plans (Mudi 2023).

Another important aspect is the involvement of migrants in the development and evaluation of healthcare services. Engaging migrants in feedback mechanisms and decision-making processes ensures that their perspectives are considered, leading to more effective and culturally appropriate healthcare interventions. Hemmati and Imani (2023) discuss how the interaction between individual and societal aspects shapes the quality of life of Afghan immigrants in Isfahan. This study underscores the importance of considering migrants’ experiences and feedback in healthcare planning and delivery (Hemmati and Imani 2023).

In conclusion, community engagement and collaboration are essential for enhancing cultural competence in delivering healthcare to migrants. By involving community leaders, collaborating with community-based organizations, implementing educational initiatives, and incorporating migrants’ feedback, healthcare providers can develop more culturally responsive and effective healthcare services. These strategies not only improve health outcomes for migrants but also contribute to a more inclusive and equitable healthcare system.

6.4. Innovative Approaches-Use of Technology and Telemedicine

The use of technology and telemedicine is increasingly being recognized as a critical strategy for enhancing cultural competence in healthcare delivery to migrant populations. These tools can help bridge gaps in communication, provide culturally relevant health information, and improve migrants’ access to healthcare services. Recent studies have highlighted the potential benefits and challenges associated with implementing technology and telemedicine to support culturally competent care.

One significant advantage of telemedicine is its ability to overcome geographical and logistical barriers that often hinder migrants’ access to healthcare. Al-Worafi (2024) discusses how telemedicine can empower migrants by providing timely access to healthcare services, regardless of their location. This study emphasizes the importance of culturally tailored telemedicine platforms that consider the specific needs and preferences of migrant populations. These platforms can include language translation services and culturally relevant health education materials, thereby enhancing the overall quality of care (Al-Worafi 2024).

Telemedicine can facilitate better communication between healthcare providers and migrant patients. By using video consultations, providers can offer more personalized care and build stronger patient–provider relationships, which are essential for effective healthcare delivery. The integration of interpreters and cultural mediators into telemedicine sessions can further enhance communication and ensure that cultural nuances are addressed appropriately. For instance, a scoping review by Sawadogo et al. (2023) identified telehealth consultations and mobile applications for translation as significant facilitators for improving communication between patients and healthcare providers. These tools help bridge language barriers and provide culturally relevant care, thereby enhancing the overall patient experience (Sawadogo et al. 2023).

In addition to telemedicine, other technological solutions, such as mobile health (mHealth) applications, can play a crucial role in supporting culturally competent care. These applications can offer health information in multiple languages, track health metrics, and provide reminders for medication and appointments, all tailored to the cultural context of users. For example, Liem et al. (2021) found that mHealth applications designed for refugees significantly improved their health outcomes by providing accessible and culturally relevant health information. These applications have helped bridge the gap between healthcare providers and refugee populations, fostering a more inclusive healthcare environment (Liem et al. 2021).

However, the implementation of technology and telemedicine also presents challenges that need to be addressed to ensure their effectiveness. One major challenge is the digital divide phenomenon, which can limit access to telemedicine services for migrants who may not have reliable internet access or the necessary digital literacy skills. To overcome this, healthcare organizations must invest in digital infrastructure and provide tailored training programs that focus on enhancing digital literacy among migrant populations. Saeed and Masters (2021) highlight the digital divide phenomenon faced by underserved communities, emphasizing the need for targeted interventions to improve internet access and digital skills in these populations (Saeed and Masters 2021; National Academies of Sciences, Engineering, and Medicine 2022).

Ensuring data privacy and security is paramount when using technology in general but even more when delivering healthcare services. Migrants may have concerns about the confidentiality of their health information, especially if they are undocumented or have experienced trauma related to surveillance. Healthcare providers must implement robust data protection measures and communicate these protection measures clearly to build trust with migrant patients. A study by Hall and McGraw (2014) discusses the importance of data privacy in telemedicine, noting that clear communication about data protection policies is essential for maintaining patient trust and engagement (Hall and McGraw 2014; Pool et al. 2022).

In conclusion, the use of technology and telemedicine holds great promise for enhancing cultural competence in healthcare delivery to migrants. By overcoming geographical barriers, facilitating better communication, and providing culturally relevant health information, these tools can significantly improve health outcomes for migrant populations. However, addressing challenges such as the digital divide and ensuring data privacy is essential for the successful implementation of these technologies. Future research and practice should focus on developing and refining technological solutions that are inclusive, accessible, and culturally sensitive to meet the diverse needs of migrant communities.

7. Future Directions and Research Gaps

Future research and practice must focus on addressing several critical gaps to enhance the delivery of culturally competent care to migrants by healthcare personnel. There is a need for longitudinal studies that evaluate the long-term effectiveness of cultural competence training programs and their impact on health outcomes among migrant populations. Metrics and methodologies to assess improved health outcomes should include both qualitative and quantitative measures, such as patient satisfaction surveys, health status indicators, and utilization rates of healthcare services. Moreover, when tools to assess cultural competence exist, they should be standardized and modified to fit the application parameters.

Additionally, research should explore the integration of advanced technologies, such as artificial intelligence (AI) and machine learning (ML), to personalize care and improve communication between healthcare providers and migrant patients. AI and ML can analyze large datasets to identify patterns and predict healthcare needs, enabling more tailored and effective interventions. Studies could investigate how these technologies can be leveraged to enhance cultural competence, such as through real-time language translation, cultural context analysis, and personalized health education materials. These innovations can enhance the accuracy and effectiveness of telemedicine services.

Further studies are also required to develop and validate culturally sensitive assessment tools that can accurately capture the health needs and preferences of diverse migrant groups.

The concept of intersectionality is crucial in understanding and addressing the complexities of migrants’ experiences. Future research should investigate how multiple intersecting factors, such as immigration status, race/colorism, ability, gender, and socioeconomic status, impact healthcare access and outcomes. This approach can help identify specific vulnerabilities and needs within migrant populations, allowing for more nuanced and effective healthcare interventions. By recognizing the interconnectedness of these social categories, healthcare providers can better address the unique challenges faced by migrants and work toward reducing health disparities.

Suggestions for healthcare providers include ongoing training in cultural competence, the use of interpreters, and the adoption of patient-centered communication strategies. Educators should integrate cultural competence into medical and nursing curricula to prepare future healthcare professionals. Policymakers must advocate for and implement policies that ensure equitable access to healthcare services for all migrants, regardless of their legal status.

Addressing these research gaps will provide a comprehensive framework for improving healthcare delivery and advocating for equity in health services for migrant populations.

8. Conclusions

This literature review has underscored the crucial importance of delivering culturally competent care to migrant populations by healthcare personnel. Key findings highlight the multifaceted components of cultural competence, including awareness, knowledge, skills, encounters, and desire, all of which are essential for improving healthcare outcomes and patient satisfaction. Effective culturally competent care can bridge communication gaps, build trust, and address the unique health needs of migrants, ultimately leading to reduced health disparities and enhanced quality of care.

The significance of culturally competent care is evident in its impact on delivering better health services, thus resulting in better health outcomes. Studies have shown that culturally sensitive healthcare practices can improve patient engagement, adherence to treatment plans, and overall health status. For migrant populations, who often face significant barriers to accessing healthcare, culturally competent care is not just beneficial but necessary. It promotes equity and inclusivity in healthcare delivery, ensuring that all individuals receive appropriate and effective care regardless of their cultural or linguistic background.

The review also highlights the ongoing challenges in implementing culturally competent care. Systemic and institutional barriers, such as inadequate training, lack of resources, and insufficient policies, impede the effective delivery of culturally sensitive care. Personal biases and communication barriers further complicate interactions between healthcare providers and migrant patients. Addressing these challenges requires comprehensive strategies, including robust education and training programs, supportive organizational policies, and active community engagement.

Innovative approaches, such as the use of technology and telemedicine, show promise in enhancing cultural competence. Telemedicine, mHealth applications, and other technological solutions can facilitate better communication and provide culturally relevant health information, improving access to healthcare services for migrants. However, issues like the digital divide phenomenon and data privacy must be carefully managed to ensure these technologies are effective and trusted by migrant populations.

Future research should focus on evaluating the long-term effectiveness of cultural competence training, developing sophisticated digital tools, and understanding the specific barriers faced by undocumented migrants. By addressing these research gaps, healthcare providers, educators, and policymakers can develop more effective strategies and policies to support culturally competent care.

In conclusion, delivering culturally competent care is essential for providing high-quality health services, improving health outcomes and achieving health equity for migrant populations. Continuous commitment from healthcare personnel, organizations, and policymakers is needed to integrate cultural competence into all aspects of healthcare delivery. This ongoing dedication will ensure that healthcare systems are inclusive, responsive, and capable of meeting the diverse needs of all patients.

Author Contributions

Conceptualization, L.T., A.D. and F.T.; methodology, F.T.; software, L.T.; validation, L.T., E.C.F. and A.P.; formal analysis, L.T.; investigation, L.T.; resources, L.T.; data curation, L.T.; writing—original draft preparation, L.T.; writing—review and editing, L.T., E.C.F., A.P., A.D. and F.T.; visualization, L.T.; supervision, F.T.; project administration, F.T.; funding acquisition, L.T. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created.

Conflicts of Interest

The authors declare no conflicts of interest.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

Agency for Healthcare Research and Quality. Improving Cultural Competence to Reduce Health Disparities; AHRQ Publication No. 16-EHC006-EF Agency for Healthcare Research and Quality (US): Rockville, 2019.

Alizadeh, Somayeh; Chavan, Meena. Cultural competence dimensions and outcomes: A systematic review of the literature. Health & Social Care in the Community; 2016; 24, pp. e117-e130.

Al-Worafi, Yaser Mohammed. Special Population-Related Issues in Developing Countries. Handbook of Medical and Health Sciences in Developing Countries: Education, Practice, and Research; Springer International Publishing: Cham, 2024; pp. 1-21.

American Medical Association. AMA Ed Hub. Retrieved from Cultural Competency 2024; Available online: https://edhub.ama-assn.org/collections/46325/cultural-competency (accessed on 12 January 2024).

Andrulis, Dennis P.; Brach, Cindy. Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior; 2007; 31, pp. S122-S133. [DOI: https://dx.doi.org/10.5993/AJHB.31.s1.16] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17931131]

Balcazar, Fabricio; Suarez-Balcazar, Yolanda; Willis, Celestine; Alvarado, Francisco. Cultural competence: A review of conceptual frameworks. Race, Culture and Disability: Rehabilitation Science and Practice; Jones and Bartlett: Sudbury, 2010; pp. 281-305.

Beach, Mary Catherine; Price, Eboni G.; Gary, Tiffany L.; Robinson, Karen A.; Gozu, Aysegul; Palacio, Ana; Smarth, Carole; Jenckes, Mollie W.; Feuerstein, Carolyn; Bass;, Eric B. et al. Cultural competence: A systematic review of health care provider educational interventions. Medical Care; 2005; 43, pp. 356-73. [DOI: https://dx.doi.org/10.1097/01.mlr.0000156861.58905.96] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15778639]

Beach, Mary Catherine; Saha, Somnath; Cooper, Lisa A. The Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality; Commonwealth Fund: New York, 2006; 36.

Berlinger, Nancy; Gusmano, Michael K. Undocumented Patients: Undocumented Immigrants and Access to Health Care. The Hastings Center, Executive Summary.; 2013; Available online: https://ssrn.com/abstract=2321295 (accessed on 1 April 2024).

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, Juan Emilio. Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches; Commonwealth Fund: New York, 2002; Quality of Care for Underserved Populations vol. 576.

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Park, Elyse R. Cultural competence and health care disparities: Key perspectives and trends. Health Affairs; 2005; 24, pp. 499-505. [DOI: https://dx.doi.org/10.1377/hlthaff.24.2.499]

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Ananeh-Firempong, Owusu. Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports; 2003; 118, pp. 293-302. [DOI: https://dx.doi.org/10.1016/S0033-3549(04)50253-4]

Blaise, Sandie. Community-Engagement as an Innovative Way to Revitalize Language Programs. Language Program Vitality in the United States: From Surviving to Thriving in Higher Education; Springer International Publishing: Cham, 2023; pp. 199-202.

Brach, Cindy; Fraserirector, Irene. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review; 2000; 57, pp. 181-217. [DOI: https://dx.doi.org/10.1177/1077558700057001S09]

Brownstein, J. Nell; Chowdhury, Farah M.; Norris, Susan L.; Horsley, Tanya; Jack, Leonard; Zhang, Xuanping; Satterfield, Dawn. Effectiveness of community health workers in the care of people with hypertension. American Journal of Preventive Medicine; 2007; 32, pp. 435-47. [DOI: https://dx.doi.org/10.1016/j.amepre.2007.01.011]

Campinha-Bacote, Josepha. The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing; 2002; 13, pp. 181-84. [DOI: https://dx.doi.org/10.1177/10459602013003003]

Connolly, Máire A.; Gayer, Michelle; Ryan, Michael J.; Salama, Peter; Spiegel, Paul; Heymann, David L. Communicable diseases in complex emergencies: Impact and challenges. The Lancet; 2004; 9449, pp. 1974-83. [DOI: https://dx.doi.org/10.1016/S0140-6736(04)17481-3]

Coumans, Joëlle V. F.; Wark, Stuart. A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country. BMC Public Health; 2024; 24, 199. [DOI: https://dx.doi.org/10.1186/s12889-024-17694-9]

Crawford, Scott B.; Monks, Stormy M.; Wells, Radosveta N. ‘La Oportunidad’–simulation as an opportunity for training language among health care providers. International Journal of Healthcare Simulation; 2023; pp. 1-10. [DOI: https://dx.doi.org/10.54531/jerc4053]

Cross, Terry L. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who are Severely Emotionally Disturbed. 1989; Available online: https://eric.ed.gov/?id=ED330171 (accessed on 1 April 2024).

Cross, Terry. Cultural Competence Continuum. Journal of Child and Youth Care Work; 2020; 24, pp. 83-85. [DOI: https://dx.doi.org/10.5195/jcycw.2012.48]

Dauvrin, Marie; Lorant, Vincent. Leadership and cultural competence of healthcare professionals: A social network analysis. Nursing Research; 2015; 64, pp. 200-10. [DOI: https://dx.doi.org/10.1097/NNR.0000000000000092] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25871625]

Dewez, Julia Olufemi. Enhancing Access to Mental Health Care for Refugees and Asylum Seekers through the Intercultural Competence of Volunteers. 2023; Available online: https://thesis.eur.nl/pub/62540/Thesis_HEPL_Dewez_JO_571602.pdf (accessed on 24 January 2024).

Diamond, Lisa C.; Wilson-Stronks, Amy; Jacobs, Elizabeth A. Do hospitals measure up to the national culturally and linguistically appropriate services standards?. Medical Care; 2010; 48, pp. 1080-87. [DOI: https://dx.doi.org/10.1097/MLR.0b013e3181f380bc] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21063229]

DiClemente, Ralph J.; Wingood, Gina M.; Harrington, Kathy F.; Lang, Delia L.; Davies, Susan L.; Hook, Edward W.; Oh, M. Kim; Crosby, Richard A.; Hertzberg, Vicki Stover; Gordon;, Angelita B. et al. Efficacy of an HIV prevention intervention for African American adolescent girls: A randomized controlled trial. JAMA; 2004; 292, pp. 171-79. [DOI: https://dx.doi.org/10.1001/jama.292.2.171]

Drefahl, Sven; Wallace, Matthew; Mussino, Eleonora; Aradhya, Siddartha; Kolk, Martin; Brandén, Maria; Malmberg, Bo; Andersson, Gunnar. A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden. Nature Communications; 2020; 11, 5097. [DOI: https://dx.doi.org/10.1038/s41467-020-18926-3]

Drewniak, Daniel; Krones, Tanja; Wild, Verina. Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. International Journal of Nursing Studies; 2017; 70, pp. 89-98. [DOI: https://dx.doi.org/10.1016/j.ijnurstu.2017.02.015]

Ferrari, Rossella. Writing narrative style literature reviews. Medical Writing; 2015; 24, pp. 230-35. [DOI: https://dx.doi.org/10.1179/2047480615Z.000000000329]

Flores, Glenn. Language barriers to health care in the United States. The New England Journal of Medicine; 2006; 355, pp. 229-31. [DOI: https://dx.doi.org/10.1056/NEJMp058316]

Foronda, Cynthia; Baptiste, Diana-Lyn; Reinholdt, Maren M; Ousman, Kevin. Cultural humility: A concept analysis. Journal of Transcultural Nursing; 2016; 27, pp. 210-17. [DOI: https://dx.doi.org/10.1177/1043659615592677]

Fouskas, Theodoros. Repercussions of precarious employment on migrants’ perceptions of healthcare in Greece. International Journal of Human Rights in Healthcare; 2018; 11, pp. 298-311. [DOI: https://dx.doi.org/10.1108/IJHRH-01-2018-0010]

Fouskas, Theodoros; Koulierakis, George; Mine, Fotini-Maria; Theofilopoulos, Athanasios; Konstantopoulou, Sofia; Ortega-de-Mora, Fabiola; Georgiadis, Dimitrios; Pantazi, Georgia. Racial and Ethnic Inequalities, Health Disparities and Racism in Times of COVID-19 Pandemic Populism in the EU: Unveiling Anti-Migrant Attitudes, Precarious Living Conditions and Barriers to Integration in Greece. Societies; 2022; 12, 189. [DOI: https://dx.doi.org/10.3390/soc12060189]

Gathen, Jan Marius. User participation through interest organisations: A qualitative study of representation, strategies and impact for people in vulnerable life situations. VID Vitenskapelige Høgskole-Avhandlinger; VID Specialized University: Oslo, 2023.

Giger, Joyce Newman; Davidhizar, Ruth. The Giger and Davidhizar transcultural assessment model. Journal of Transcultural Nursing; 2002; 13, pp. 185-88. [DOI: https://dx.doi.org/10.1177/10459602013003004] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12113147]

Hall, Joseph L.; McGraw, Deven. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affairs; 2014; 33, pp. 216-21. [DOI: https://dx.doi.org/10.1377/hlthaff.2013.0997]

Hemmati, Reza; Imani, Almaskhan. A Sociological Analysis of the Quality of Life of Afghan Immigrants Living in Isfahan. Strategic Research on Social Problems in Iran; 2023; 12, pp. 81-100.

Horvat, Lidia; Horey, Dell; Romios, Panayiota; Kis-Rigo, John. Cultural competence education for health professionals. Cochrane Database of Systematic Reviews; 2014; 2014, CD009405. [DOI: https://dx.doi.org/10.1002/14651858.CD009405.pub2]

International Organization for Migration. World Migration Report 2020. Retrieved 12 June 2024 2020; Available online: https://publications.iom.int/system/files/pdf/wmr_2020.pdf (accessed on 15 March 2024).

International Organization for Migration. World Migration Report 2024. Retrieved 12 June 2024 2024; Available online: https://worldmigrationreport.iom.int/msite/wmr-2024-interactive/ (accessed on 1 March 2024).

Jacobs, Elizabeth A.; Shepard, Donald S. MPP Suaya, Jose A.; Stone, Esta-Lee. Overcoming language barriers in health care: Costs and benefits of interpreter services. American Journal of Public Health; 2004; 94, pp. 866-69. [DOI: https://dx.doi.org/10.2105/AJPH.94.5.866] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15117713]

Jiang, Luohua; Manson, Spero M.; Beals, Janette; Henderson, William G.; Huang, Haixiao; Acton, Kelly J.; Roubideaux, Yvette; Project, Special Diabetes Program for Indians Diabetes Prevention Demonstration. Translating the diabetes prevention program into American Indian and Alaska native communities: Results from the special diabetes program for Indians diabetes prevention demonstration project. Diabetes Care; 2013; 36, pp. 2027-34. [DOI: https://dx.doi.org/10.2337/dc12-1250]

Jongen, Crystal; McCalman, Janya; Bainbridge, Roxanne; Clifford, Anton. Cultural Competence in Health: A Review of the Evidence; Springer: Singapore, 2018.

Joseph, Tiffany D. Falling through the coverage cracks: How documentation status minimizes immigrants’ access to health care. Journal of Health Politics, Policy and Law; 2017; 42, pp. 961-84. [DOI: https://dx.doi.org/10.1215/03616878-3940495]

Kaihlanen, Anu-Marja; Hietapakka, Laura; Heponiemi, Tarja. Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing; 2019; 18, pp. 1-9. [DOI: https://dx.doi.org/10.1186/s12912-019-0363-x]

Kankaanpää, Saija Liisa; Lehti, Venla; Solin, Pia; Salama, Essi. Fostering trust and understanding in social and healthcare services with migrant-origin parents: Qualitative focus-group interviews of foreign-born mothers living in Finland. European Child & Adolescent Psychiatry; 2024; 33, pp. 1827-36. [DOI: https://dx.doi.org/10.1007/s00787-023-02288-4]

Karman, Abd; Sova, Maya; Hafizi, Muhammad Riza; Silvanita, Ktut; Mukti, Muhi; Lestari, Indah; Mahmudi; Munawir. Strategies for Self-Development among Indonesian Migrant Workers in Malaysia in the Digital Era: A Community Engagement Initiative. International Journal of Community Care of Humanity (IJCCH); 2023; 1, pp. 48-55.

Khuri, Jacob; Wang, Youfa; Holden, Kendall; Mbogori, Teresia; Fly, Alyce; Mueller, Sarah; Kandiah, Jayanhi; Zhang, Mengxi. Dietary intake and nutritional status among refugees in host countries: A systematic review. Advances in Nutrition; 2022; 13, pp. 1846-65. [DOI: https://dx.doi.org/10.1093/advances/nmac051] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35561746]

Kirmayer, Laurence J. Rethinking cultural competence. Transcultural Psychiatry; 2012; 49, pp. 149-64. [DOI: https://dx.doi.org/10.1177/1363461512444673]

Kirmayer, Laurence J.; Narasiah, Lavanya; Munoz, Marie; Rashid, Meb; Ryder, Andrew G; Guzder, Jaswant; Hassan, Ghayda; Rousseau, Cécile; Pottie, Kevin Canadian Collaboration for Immigrant and Refugee Health (CCIRH). Common mental health problems in immigrants and refugees: General approach in primary care. CMAJ; 2011; 183, pp. E959-E967. [DOI: https://dx.doi.org/10.1503/cmaj.090292] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20603342]

Kompothanasi, Eleni; Charos, Dimitrios; Vivilaki, Victoria. Experience with the midwifery-led continuity care model among female migrants, refugees and asylum seekers in the context of the ORAMMA project. Eleutho; 2022; 21, 1. [DOI: https://dx.doi.org/10.18332/eleutho/158049]

Kroll, Jerome; Yusuf, Ahmed Ismail; Fujiwara, Koji. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Social Psychiatry and Psychiatric Epidemiology; 2011; 46, pp. 481-93. [DOI: https://dx.doi.org/10.1007/s00127-010-0216-0]

Lai, Dylan. Access to High-Quality Healthcare in the United States for Chinese-American Immigrants. Retrieved from Brown Undergraduate Journal of Public Health.; 2023; Available online: https://sites.brown.edu/publichealthjournal/2023/11/29/access-to-high-quality-healthcare-in-the-united-states-for-chinese-american-immigrants/ (accessed on 15 March 2024).

Lanari, Donatella; Bussini, Odoardo. Health Inequalities among Elderly Immigrants in Europe. Communi-Care for Migrants and Ethnic Minorities; 2023; Available online: https://hdl.handle.net/11391/923308 (accessed on 1 April 2024).

Lebrón, Alana M.; Torres, Ivy R.; Kline, Nolan; Lopez, William D.; Trinidad Young, Maria-Elena D. E.; Novak, Nicole. Immigration and immigrant policies, health, and health equity in the United States. The Milbank Quarterly; 101 (Suppl. S1), pp. 119-52.2023.

Leininger, Madeleine. Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing; 2002; 13, pp. 189-92. [DOI: https://dx.doi.org/10.1177/10459602013003005]

Lie, Désirée A.; Lee-Rey, Elizabeth MPH Gomez, Art; Bereknyei, Sylvia; Braddock, Clarence H. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. Journal of General Internal Medicine; 2011; 26, pp. 317-25. [DOI: https://dx.doi.org/10.1007/s11606-010-1529-0]

Liem, Andrian; Natari, Rifani B.; Jimmy; Hall, Brian J. Digital health applications in mental health care for immigrants and refugees: A rapid review. Telemedicine and e-Health; 2021; 27, pp. 3-16. [DOI: https://dx.doi.org/10.1089/tmj.2020.0012]

Martinez, Omar; Wu, Elwin; Sandfort, Theo; Dodge, Brian; Carballo-Dieguez, Alex; Pinto, Rogeiro; Rhodes, Scott D.; Moya, Eva; Chavez-Baray, Silvia. Evaluating the impact of immigration policies on health status among undocumented immigrants: A systematic review. Journal of Immigrant and Minority Health; 2015; 17, pp. 947-70. [DOI: https://dx.doi.org/10.1007/s10903-013-9968-4]

Mayell, Stephanie; McLaughlin, Janet. Migrating to Work at what Cost?: The Cumulative Health Consequences of Contemporary Labour Migration. Handbook of Migration and Health; Thomas, Felicity. Edward Elgar Publishing: Cheltenham, 2016; pp. 230-52.

Mudi, Rassendyll Ngu. Developing Countries Immigrants’ Perceptions of Physiotherapy. 2023; Available online: https://www.theseus.fi/handle/10024/812168 (accessed on 20 February 2024).

Nashwan, Abdulqadir J. Culturally competent care across borders: Implementing culturally responsive teaching for nurses in diverse workforces. International Journal of Nursing Sciences; 2024; 11, 155. [DOI: https://dx.doi.org/10.1016/j.ijnss.2023.09.001] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38352286]

National Academies of Sciences, Engineering, and Medicine. Trends in Telehealth and Its Implications for Health Disparities. NAIC. 2022; Available online: https://content.naic.org/sites/default/files/national_meeting/Trends%20in%20Telehealth.pdf (accessed on 1 April 2024).

Nyikavaranda, Patrick; Pantelic, Marija; Jones, Christina J.; Paudyal, Priyamvada; Tunks, Alice; Llewellyn, Carrie D. Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: A “feminisms” systematic review. International Journal for Equity in Health; 2023; 22, 196. [DOI: https://dx.doi.org/10.1186/s12939-023-01990-8] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37752502]

Papadopoulos, Irena. The Papadopoulos, Tilki and Taylor model of developing cultural competence. Transcultural Health and Social Care: Development of Culturally Competent Practitioners; Churchill Livingstone Elsevier: London, 2006; pp. 7-24.

Paré, Guy; Kitsiou, Spyros. Methods for literature reviews. Handbook of eHealth Evaluation: An Evidence-Based Approach; University of Victoria: Victoria, 2017.

Perla, Loredana; Gallelli, Rosa; Palermo, Rosa; Amati, Ilenia. AHEAD: A Project to Fight Discrimination and Hate Speech. Living and Leading in the Next Era: Connecting Teaching, Research, Citizenship and Equity. 2023; Available online: https://www.researchgate.net/profile/Mats_Vernholz/publication/378803324_Academic_self-concept_of_pre-service_technology_teachers_for_vocational_education_in_Germany_according_to_the_TPACK-Model/links/65eaadad9ab2af0ef8959e81/Academic-self-concept-of-pre- (accessed on 21 February 2024).

Pool, Javad; Akhlaghpour, Saeed; Fatehi, Farhad; Gray, Leonard C. Data privacy concerns and use of telehealth in the aged care context: An integrative review and research agenda. International Journal of Medical Informatics; 2022; 160, 104707. [DOI: https://dx.doi.org/10.1016/j.ijmedinf.2022.104707] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35131698]

Prosen, Mirko. Developing cross-cultural competences: For ensuring health and healthcare equality and equity. Obzornik Zdravstvene Nege; 2018; 52, pp. 76-80. [DOI: https://dx.doi.org/10.14528/snr.2018.52.2.262]

Purnell, Larry D. The Purnell model for cultural competence. Intervention in Mental Health-Substance Use; CRC Press: Boca Raton, 2016; pp. 57-78.

Puthoopparambil, Soorej Jose; Phelan, Mary; MacFarlane, Anne. Migrant health and language barriers: Uncovering macro level influences on the implementation of trained interpreters in healthcare settings. Health Policy; 2021; 125, pp. 1085-91. [DOI: https://dx.doi.org/10.1016/j.healthpol.2021.05.018]

Saeed, Sy Atezaz; Masters, Ross MacRae. Disparities in health care and the digital divide. Current Psychiatry Reports; 2021; 23, pp. 1-6. [DOI: https://dx.doi.org/10.1007/s11920-021-01274-4]

Saha, Somnath; Beach, Mary Catherine; Cooper, Lisa A. Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association; 2008; 100, pp. 1275-85. [DOI: https://dx.doi.org/10.1016/S0027-9684(15)31505-4]

Sassen, Saskia. A Massive Loss of Habitat: New Drivers for Migration. Sociology of Development; 2016; 2, pp. 204-33. [DOI: https://dx.doi.org/10.1525/sod.2016.2.2.204]

Sawadogo, Pengdewendé Maurice; Sia, Drissa; Onadja, Yentéma; Beogo, Idrissa; Sangli, Gabriel; Sawadogo, Nathalie; Gnambani, Assé; Bassinga, Gaëtan; Robins, Stephanie; Nguemeleu, Eric Tchouaket. Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review. PLoS ONE; 2023; 18, e0291486. [DOI: https://dx.doi.org/10.1371/journal.pone.0291486]

Scales, Sarah Elizabeth; Park, Jee Won; Nixon, Rebecca; Guha-Sapir, Debarati; Horney, Jennifer A. Disease burden among refugees in camps on mainland Greece, 2016–2017: A retrospective cross-sectional study. BMC Public Health; 2023; 23, 1715. [DOI: https://dx.doi.org/10.1186/s12889-023-16472-3] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37667247]

Schloemer, Tamara; Hecht, Henriette; Horstman, Klasien. Participatory transferability analysis of vaccination interventions with underserved communities. European Journal of Public Health; ckad160-485.33 (Suppl. S2), 2023.

Schwei, Rebecca; Pozo, Sam Del; Agger-Gupta, Niels; Bagchi, Wilma Alvarado-Little Ann; Chen, Alice Hm; Diamond, Lisa; Gany, Francesca; Wong, Doreena; Jacobs, Elizabeth A. Changes in research on language barriers in health care since 2003: A cross-sectional review study. International Journal of Nursing Studies; 2016; 54, pp. 36-44. [DOI: https://dx.doi.org/10.1016/j.ijnurstu.2015.03.001] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25816944]

Shabnam, Jahan. Palliative Care for Non-Western Migrants in Denmark: Towards a Supportive Intervention. Retrieved from Elsevier Pure 2023; Available online: https://findresearchersdu.elsevierpure.com/files/238253256/PhD_thesis_JahanS.pdf (accessed on 17 April 2024).

Shahin, Wejdan; Stupans, Ieva; Kennedy, Gerard. Health beliefs and chronic illnesses of refugees: A systematic review. Ethnicity & Health; 2021; 26, pp. 756-68.

Sharifi, Najmeh; Adib-Hajbaghery, Mohsen; Najafi, Maryam. Cultural competence in nursing: A concept analysis. International Journal of Nursing Studies; 2019; 99, 103386. [DOI: https://dx.doi.org/10.1016/j.ijnurstu.2019.103386]

Sherif, Bafreen; Awaisu, Ahmed; Kheir, Nadir. Refugee healthcare needs and barriers to accessing healthcare services in New Zealand: A qualitative phenomenological approach. BMC Health Services Research; 2022; 22, 1310. [DOI: https://dx.doi.org/10.1186/s12913-022-08560-8]

Spinner, Jovonni R.; Haynes, Eboni; Nunez, Cariny; Baskerville, Shakia; Bravo, Katherine; Araojo, Radm Richardae. Enhancing FDA’s Reach to Minorities and Under-Represented Groups through Training: Developing Culturally Competent Health Education Materials. Journal of Primary Care & Community Health; 2021; 12, 21501327211003688.

Sukhera, Javeed. Narrative reviews: Flexible, rigorous, and practical. Journal of Graduate Medical Education; 2022; 14, pp. 414-17. [DOI: https://dx.doi.org/10.4300/JGME-D-22-00480.1]

Suphanchaimat, Rapeepong; Kantamaturapoj, Kanang; Putthasri, Weerasak; Prakongsai, Phusit. Challenges in the provision of healthcare services for migrants: A systematic review through providers’ lens. BMC Health Services Research; 2015; 15, pp. 1-14. [DOI: https://dx.doi.org/10.1186/s12913-015-1065-z]

The Joint Commission. The Joint Commision/Health Equity. Retrieved from Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care. A Roadmap for Hospitals. 15 June 2024; Available online: https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/health-equity/aroadmapforhospitalsfinalversion727pdf.pdf (accessed on 29 February 2024).

Tirado, Veronika. Sexual and Reproductive Health and Rights among Newly Arrived Migrants in Sweden: Knowledge Gaps and Healthcare Challenges. Retrieved from Karolinska Institutet Open Archive 2024; Available online: https://dspace.kib.ki.se/xmlui/handle/10616/49030 (accessed on 29 February 2024).

Truong, Mandy; Paradies, Yin; Priest, Naomi. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research; 2014; 14, pp. 1-17. [DOI: https://dx.doi.org/10.1186/1472-6963-14-99]

Tzavella, Foteini; Sakellaridis, Gabriel. Refugee women’s testimonies and human rights in Greece. Archives of Hellenic Medicine; 2020; 37, pp. 10-16.

Tzavella, Foteini; Dreliozi, Angeliki; Prezerakos, Panagiotis. The European refugee crisis in Greece. The challenge of managing the health problems of minors refugees. Archives of Hellenic Medicine; 2020; 37, pp. 28-41.

U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. 2021; Available online: https://www.bls.gov/ooh/healthcare/home.htm (accessed on 19 January 2024).

U.S. Department of Health and Human Services. Think Cultural Health. Retrieved 16 June 2024; Available online: https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf (accessed on 20 January 2024).

Ugas, Mohamed; Mackinnon, Rebecca; Amadasun, Shawn; Escamilla, Zaira; Gill, Bhajan; Guiliani, Meredith; Fazelzad, Rouhi; Martin, Hilary; Samoil, Diana; Papadakos, Janet. Associations of health literacy and health outcomes among populations with limited language proficiency: A scoping review. Journal of Health Care for the Poor and Underserved; 2023; 34, pp. 731-57. [DOI: https://dx.doi.org/10.1353/hpu.2023.0039] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37464529]

United Nations. International Migration. 2023; Available online: https://www.un.org/en/global-issues/migration (accessed on 19 January 2024).

United Nations Department of Economic and Social Affairs. International Migration 2020 Highlights. Retrieved 11 June 2024 2020; Available online: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2020_international_migration_highlights.pdf (accessed on 5 February 2024).

United Nations High Commissioner for Refugees. Global Trends: Forced Displacement in 2020. Retrieved 12 June 2024 2021; Available online: https://www.unhcr.org/statistics/unhcrstats/60b638e37/unhcr-global-trends-2020.html (accessed on 18 January 2024).

Vosko, Leah. Precarious employment: Towards an improved understanding of labour market insecurity. Precarious Employment: Understanding Labour Market Insecurity in Canada; McGill-Queen’s University Press—MQUP: Montreal, 2006; pp. 3-39.

World Health Organization. How Health Systems can Address Health Inequities Linked to Migration and Ethnicity. 2010; Available online: https://iris.who.int/bitstream/handle/10665/345463/9789289002042-eng.pdf (accessed on 8 May 2024).

World Health Organization. Health Workforce. 2020; Available online: https://www.who.int/health-topics/health-workforce#tab=tab_1 (accessed on 13 March 2024).

World Health Organization. Refugee and Migrant Health. 2022; Available online: https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health (accessed on 27 March 2024).

Young, Maria Elena; Tafolla, Sharon; Saadi, Altaf; Sudhinaraset, May; Chen, Lei; Pourat, Nadereh. Beyond “chilling effects”: Latinx and Asian immigrants’ experiences with enforcement and barriers to health care. Medical Care; 2023; 61, pp. 306-13. [DOI: https://dx.doi.org/10.1097/MLR.0000000000001839] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36939228]

Zghal, Afef; El-Masri, Maher; McMurphy, Suzanne; Pfaff, Kathryn. Exploring the impact of health care provider cultural competence on new immigrant health-related quality of life: A cross-sectional study of Canadian newcomers. Journal of Transcultural Nursing; 2021; 32, pp. 508-17. [DOI: https://dx.doi.org/10.1177/1043659620967441]

Zhang, Hui; Nardon, Luciara; Sears, Greg J. Migrant workers in precarious employment. Equality, Diversity and Inclusion: An International Journal; 2022; 41, pp. 254-72. [DOI: https://dx.doi.org/10.1108/EDI-01-2021-0018]