Cultural competence training for health care professionals
Cultural competence training for health care professionals focuses on skills and knowledge that value diversity, understand and respond to cultural differences, and increase awareness of providers’ and care organizations’ cultural norms. Trainings can provide facts about patient cultures or include more complex interventions such as intercultural communication skills training, exploration of potential barriers to care, and institution of policies that are sensitive to the needs of patients from culturally and linguistically diverse (CALD) backgrounds1, 2.
Cultural competency includes cultural awareness (awareness of patients and one’s own background), cultural knowledge (integrate health beliefs and values), cultural skills (identify care needs and adapt them to the context), cultural encounters (involve students and health professionals in inter-cultural immersions to prevent stereotypes), and cultural desire (respect differences and reinforce similarities)3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased cultural understanding and skills
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased patient satisfaction
Improved health outcomes
What does the research say about effectiveness?
There is strong evidence that cultural competence training for health care professionals improves providers’ knowledge, understanding, and skills for treating patients from culturally, linguistically, and socio-economically diverse backgrounds1, 4, 5, 6, 7, 8, 9, 10, 11, 12. Additional evidence is needed to determine effects on patient care and health outcomes2, 4, 5, 6, 8, 13, 14.
Cultural competence training can be customized according to the type of health care provider and the population receiving care6. Programs for health care providers still in training, such as pediatric residents10 and pharmacy students, have been shown to increase cultural knowledge and skills15 and, overall, cultural competence education through both training and continuing education can increase nurses’ levels of cultural competence5. Cultural competency programs implemented within an organization, when tailored to staff roles and organizational context, can also increase cultural understanding and skills6, 11, 12. For example, Caring for Women Veterans, a cultural competence training program for Veterans Affairs (VA) health care providers, improved providers’ gender sensitivity and knowledge and increased training uptake more when delivered to in-person groups compared to a standard web-based training12. Cultural competence training can improve patient satisfaction1, 6, 7, 8, 16. In some circumstances, patients whose providers completed training report better opinions of their clinicians or participate longer in mental health counseling than patients whose providers did not participate in trainings2.
Experts recommend that to normalize culturally competent integrated care, training needs to be supported at multiple levels, from local hospital, clinic, and health system leadership to local, state, and federal government agencies17. Experts also suggest that cultural competency training begin in medical and nursing schools and continue throughout professional practice, such as through continuing education credits3, 4, 5, 8, 17, 18, 19. Ensuring this training is standard practice, particularly for safety net providers, may reduce health disparities17. Experts recommend that when preparing cultural competence trainings organizations consider their strengths and weaknesses, the needs of their patients, and then implement systemic changes to accommodate patients’ cultures6. Cultural competence training can be customized to meet the needs of specific groups known to experience disparities in health care, such as female veterans12, children with chronic respiratory conditions and their families10, Hispanic elders and their caregivers, and minoritized patients with diabetes8.
Experts suggest that systemic cross-cultural approaches can foster cultural safety and help providers recognize their own racism, power imbalances, and cultural biases20. However, evidence on trainings for LGBTQ+ populations is mixed13, and while some studies suggest positive impacts21, some early efforts led to increased stigma against these populations13. Connecting cultural competency to professional values rather than legal or organizational requirements, nurturing a safe and respectful learning environment, cultivating cultural humility, and avoiding stereotypes throughout trainings are also recommended8. Experts suggest that trainings on the beliefs or practices of culturally and linguistically diverse (CALD) patients emphasize that variation exists within groups and that providers should treat patients as individuals and avoid generalizations3, 22.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Cultural competence training for health care professionals has the potential to decrease disparities in quality of care and health outcomes for patients from diverse racialized minorities, those for whom English is not their first language, and those from socio-economically disadvantaged communities4, 8, 17, 22. Evidence to date has been focused on impacts on provider knowledge and skills, and additional evidence is needed to determine if these interventions can change patient outcomes, particularly in the long-term2, 4, 5, 6, 8, 13, 14.
Experts recommend that cultural competence training account for the ways intersectional identities (overlapping identities such as race and ethnicity, gender, sexuality, socioeconomic status, level of ability, etc.) impact patients and their needs37, such as programs specifically addressing the needs of sexual and gender minorities (SGM) who are Black38. While a small study suggests that simulated role-plays in nursing classes may improve students’ knowledge and comfort with caring for transgender patients21, some early research suggests that cultural competency trainings for providers treating LGBTQ+ patients increased negative perceptions and stigma toward this population13. Given the potential for unintended consequences, program designers must be alert for flaws within potential interventions that may reinforce stereotypes when creating training programs13, 22.
Patients from culturally and linguistically diverse (CALD) populations have significant health disparities and higher rates of chronic diseases than non-minoritized patients and are less likely to use or have access to care18, 39. As societies become more diverse, cultural competence training is an important component of efforts to decrease health disparities4, 8, 17, particularly for training safety net providers in resource poor populations17, but cultural competence training alone cannot overcome health inequities brought about by poverty and racial discrimination6.
What is the relevant historical background?
Culturally competent care, also known as culturally adapted care, emerged in the 1980s as a way to improve health care accessibility, acknowledging that differences in culture and language between patients and health care providers could be barriers to quality care6, 22. Originally focused on immigrants, care and training expanded to include most other minority groups, especially patients most impacted by racial disparities when accessing health care22. A range of models and frameworks followed, most incorporating different knowledge, attitudes, and skills, moving from interpersonal interactions to organizational and systemic cultural competency6, 22.
Racism and structural inequalities may have a greater negative effect on health disparities than cultural differences6. Systemic racism contributes to under-resourced health care facilities, inequitable policies, and disparities in access to care40. A substantial portion of health care infrastructure in the U.S. was built prior to the Civil Rights era, prioritizing access to the majority population in power at the time (white patients) and primarily staffed by white, middle-class male clinicians which further institutionalized discrimination against people of color by limiting access and quality of care22.
Equity Considerations
- What groups in your community have difficulty accessing care due to cultural or language barriers, and could benefit from health care providers receiving cultural competence training?
- If you are already providing cultural competence training, how can it be expanded to include other minoritized groups, such as patients from sexual and gender minorities (SGM), with disabilities, or from Indigenous populations?
- Who can you partner with to adapt and expand cultural competence training based on community needs?
Implementation Examples
The federal Office of Minority Health offers cultural competence training resources and publishes the National Culturally and Linguistically Appropriate Services (CLAS) standards23. CLAS serves as a blueprint for health care organizations, providers, and individuals who provide culturally adapted care, including cultural competence training24. As of 2023, ten states (Arizona, California, Connecticut, Illinois, Indiana, Nevada, New Jersey, New Mexico, Oregon, and Washington) have enacted state-level CLAS legislation requiring cultural competence training for health care providers, while 26 states have proposed CLAS legislation, including further expansions in California, Connecticut, Indiana, New Jersey, Oregon, and Washington25.
For example, New Jersey requires cultural competence training for medical and dental school graduation and continuing medical education (CME) for physicians, dentists26, and podiatrists8. Drexel University’s College of Medicine recommends free, online cultural competency courses and fee-based courses that meet the New Jersey requirement for six CME credit hours27.
American medical schools have cultural competence accreditation requirements8. The Association of American Medical Colleges (AAMC) and its hundreds of member institutions (American and Canadian medical schools, academic health systems and teaching hospitals, Veterans Affairs medical centers, and academic societies) are committed to preparing an inclusive and culturally competent health care workforce that provides culturally responsive, quality care for a multicultural society28, 29. The AAMC’s Tool for Assessing Cultural Competence Training (TACCT) can be used by medical schools to evaluate all aspects of their curriculum for gaps and redundancies and act as a blueprint to assess existing cultural competence content and integrate any necessary additional content using available resources29.
Many nursing programs have similar requirements to medical schools in terms of cultural competency, across levels of nursing education (registered nurse, bachelors, masters, and doctoral nursing degrees)30, 31, 32. For example, the curriculum of Nevada State University’s School of Nursing focuses on caring and competence as a way to improve health, safety, and cultural awareness for all patients33, 34.
The Curricula Enhancement Module Series, a program of the National Center for Cultural Competence at Georgetown University Medical Center, is a resource for faculty training health care providers to offer culturally competent care and features multimedia resources, along with instructional and self-discovery strategies35.
Think Cultural Health, a program of the U.S. Department of Health and Human Services, offers four free, online continuing education training courses for health care administrators and providers, behavioral health professionals, community health workers (CHW), maternal health providers, nurses, oral health professionals, physicians, nurse practitioners, and physician assistants to improve cultural competency, along with Spanish-language versions and a program specific to disaster and emergency management36.
Implementation Resources
‡ Resources with a focus on equity.
US DHHS-Think cultural health - U.S. Department of Health and Human Services (U.S. DHHS). Think cultural health.
AAMC-TACCT - Association of American Medical Colleges (AAMC). Tool for assessing cultural competence training (TACCT).
NJ Health-CC resources - State of New Jersey Department of Health (NJ Health), Minority and Multicultural Health. Cultural competency resources.
WiCPHET-Cultural awareness‡ - Wisconsin Center for Public Health Education and Training (WiCPHET). (n.d.). Cultural awareness series. Accessed September 7, 2025.
Footnotes
* Journal subscription may be required for access.
1 Govere 2016 - Govere L, Govere EM. How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews on Evidence-Based Nursing. 2016;13(6):402-410.
2 Cochrane-Horvat 2014 - Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals: Review. Cochrane Database of Systematic Reviews. 2014;(5):CD009405.
3 Gradellini 2021 - Gradellini, C., Gómez-Cantarino, S., Dominguez-Isabel, P., Molina-Gallego, B., Mecugni, D., & Ugarte-Gurrutxaga, M. I. (2021). Cultural competence and cultural sensitivity education in university nursing courses. A scoping review. Frontiers in Psychology, 12, 682920.
4 Chae 2020 - Chae, D., Kim, J., Kim, S., Lee, J., & Park, S. (2020). Effectiveness of cultural competence educational interventions on health professionals and patient outcomes: A systematic review. Japan Journal of Nursing Science, 17(3), e12326.
5 Osmancevic 2025 - Osmancevic, S., Steiner, L. M., Großschädl, F., Lohrmann, C., & Schoberer, D. (2025). The effectiveness of cultural competence interventions in nursing: A systematic review and meta-analysis. International Journal of Nursing Studies, 167, 105079.
6 Truong 2014 - Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research. 2014;14(1):99.
7 Renzaho 2013 - Renzaho AMN, Romios P, Crock C, Sønderlund AL. The effectiveness of cultural competence programs in ethnic minority patient-centered health care — a systematic review of the literature. International Journal for Quality in Health Care. 2013;25(3):261–269.
8 Like 2011 - Like RC. Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions. 2011;31(3):196-206.
9 Patel 2019 - Patel MR, Song PXK, Bruzzese JM, et al. Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial. Journal of Asthma. 2019;56(3):273-284.
10 Horky 2017 - Horky S, Andreola J, Black E, Lossius M. Evaluation of a cross cultural curriculum: Changing knowledge, attitudes and skills in pediatric residents. Maternal and Child Health Journal. 2017;21(7):1537-1543.
11 Cruz-Oliver 2017 - Cruz-Oliver DM, Malmstrom TK, Roegner M, Yeo G. Evaluation of a video-based seminar to raise health care professionals’ awareness of culturally sensitive end-of-life care. Journal of Pain and Symptom Management. 2017;54(4):546-554.
12 Fox 2016 - Fox AB, Hamilton AB, Frayne SM, et al. Effectiveness of an evidence-based quality improvement approach to cultural competence training: The Veterans Affairs’ “Caring for Women Veterans” program. Journal of Continuing Education in the Health Professions. 2016;36(2):96-103.
13 Butler 2016 - Butler M. Improving cultural competence to reduce health disparities for priority populations. Effective Health Care Program. 2016;(170):1-19.
14 Shepherd 2019 - Shepherd SM. Cultural awareness workshops: Limitations and practical consequences. BMC Medical Education. 2019;19(1):1-10.
15 Arif 2019 - Arif, S., Wang, S., Lakada, I. Y., & Lee, J. Y. (2019). An elective course to train student pharmacists to provide culturally sensitive health care. American Journal of Pharmaceutical Education, 83(8), 7027.
16 Clifford 2015 - Clifford A, McCalman J, Bainbridge R, Tsey K. Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: A systematic review. International Journal for Quality in Health Care. 2015;27(2):89-98.
17 McGregor 2019 - McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & Disease. 2019;29:359-364.
18 Joo 2021 - Joo, J. Y., & Liu, M. F. (2021). Culturally tailored interventions for ethnic minorities: A scoping review. Nursing Open, 8(5), 2078–2090.
19 Young 2016a - Young S, Guo KL. Cultural diversity training: The necessity of cultural competence for health care providers and in nursing practice. Health Care Manager. 2016;35(2):94-102.
20 Shepherd 2019a - Shepherd SM, Willis-Esqueda C, Newton D, Sivasubramaniam D, Paradies Y. The challenge of cultural competence in the workplace: Perspectives of healthcare providers. BMC Health Services Research. 2019;19(1):1-11.
21 Koch 2021a - Koch, A., Ritz, M., Morrow, A., Grier, K., & McMillian-Bohler, J. M. (2021). Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients. Nurse Education in Practice, 54, 103123.
22 Saha 2010 - Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient Centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285.
23 US DHHS OMH-About - U.S. Department of Health and Human Services (U.S. DHHS), Office of Minority Health (OMH). About the Office of Minority Health. Accessed September 4, 2025.
24 US DHHS-OMH-CLAS standards - U.S. Department of Health and Human Services (U.S. DHHS), Office of Minority Health (OMH). (n.d.). Think cultural health: National CLAS Standards. Retrieved July 23, 2025.
25 Network-Hunter 2023 - Hunter, D., Jeden, P., & Campbell Garcia, H. (2023, June 26). National standards for culturally and linguistically appropriate services (CLAS). The Network for Public Health Law. Accessed September 7, 2025.
26 NJ Health-CLAS policy - State of New Jersey Department of Health (NJ Health), Minority and Multicultural Health. Human resources services circular: Cultural competence CLAS policy and practice. 2018.
27 Drexel-CME Cultural competency - Drexel University, College of Medicine. (n.d.). Continuing Medical Education Program: Cultural competency courses. Accessed September 7, 2025.
28 AAMC-About us - Association of American Medical Colleges (AAMC). About us. Accessed September 9, 2025.
29 AAMC-TACCT - Association of American Medical Colleges (AAMC). Tool for assessing cultural competence training (TACCT).
30 Marion 2016 - Marion, L., Douglas, M., Lavin, M., Barr, N., Gazaway, S., Thomas, L., & Bickford, C., (2016, November 18). Implementing the new ANA Standard 8: Culturally congruent practice. OJIN: The Online Journal of Issues in Nursing, 22(1).
31 AACN-CC 2008 - American Association of Colleges of Nursing (AACN). (2008, August). Cultural competency in baccalaureate nursing education. Accessed September 9, 2025.
32 AACN-CC toolkit 2011 - American Association of Colleges of Nursing (AACN). (2011, August). Toolkit for cultural competence in master’s and doctoral nursing education. Accessed September 9, 2025.
33 NS-SON - Nevada State University, School of Nursing (NS-SON). (n.d.). School of Nursing: Overview. Accessed September 7, 2025.
34 NS-Cultural competence - Nevada State University (NS). (2024, July 2). Cultural competence in nursing: A pathway to patient-centered care. Accessed September 7, 2025.
35 NCCC-Curricula Enhancement - National Center for Cultural Competence (NCCC). (n.d.). Curricula Enhancement Module Series. Georgetown University Center for Child and Human Development, Georgetown University Medical Center. Accessed September 7, 2025.
36 US DHHS-TCH Education - U.S. Department of Health and Human Services (U.S. DHHS), Think Cultural Health. (n.d.). Education: free, continuing education E-learning programs designed to provide culturally and linguistically appropriate services (CLAS). Accessed September 7, 2025.
37 Osmosis-Intersectional healthcare - Osmosis from Elsevier. (2025, May 14). What is intersectional healthcare and why is it important? Accessed September 7, 2025.
38 Salerno 2020 - Salerno, J. P., Turpin, R., Howard, D., Dyer, T., Aparicio, E. M., & Boekeloo, B. O. (2020). Health care experiences of Black transgender women and men who have sex with men: A qualitative study. Journal of the Association of Nurses in AIDS Care, 31(4), 466–475.
39 Lambert 2021 - Lambert, S., Schaffler, J. L., Ould Brahim, L., Belzile, E., Laizner, A. M., Folch, N., Rosenberg, E., Maheu, C., Ciofani, L., Dubois, S., Gélinas-Phaneuf, E., Drouin, S., Leung, K., Tremblay, S., Clayberg, K., & Ciampi, A. (2021). The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. Patient Education and Counseling, 104(7), 1608–1635.
40 Spencer 2023 - Spencer, J. C., Kim, J. J., Tiro, J. A., Feldman, S. J., Kobrin, S. C., Skinner, C. S., Wang, L., McCarthy, A. M., Atlas, S. J., Pruitt, S. L., Silver, M. I., & Haas, J. S. (2023). Racial and ethnic disparities in cervical cancer screening from three U.S. healthcare settings. American Journal of Preventive Medicine, 65(4), 667–677.
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