A grounded theory investigation of diversity and multiculturalism in the physical therapy profession

Journal of Physical Therapy Education, Spring 2003 by Kachingwe, Aimie Fitzgerald

Background and Purpose. Although the goals of increasing practitioner diversity and incorporating multiculturalism into professional education cunicula are increasingly being professed, it appears that physical therapy education programs are failing to achieve both objectives. The overall purposes of this qualitative investigation were: (1) to use multiple perspectives to define the terms diversity and multiculturalism, (2) to investigate the importance of diversity and multiculturalism in the physical therapy profession, (3) to gain knowledge that can be utilized by physical therapy educators to more effectively address diversity and multiculturalism, and (4) to develop a model suggesting how diversity and multiculturalism can be attained in physical therapy education. In this article, only purposes 2 and 3 will be addressed. Subjects. Twenty-eight physical therapists participated in this study. Methods. Data were collected using a semistructured interview format centered on the conceptual categories of diversity and multiculturalism. Data analysis utilized grounded theory methodology applying simultaneous data collection, coding, and analysis through constant comparison. Results. Results revealed the theory of interculturalization: a paradigm evidenced by the ensemble of diversity, multiculturalism, and conviction. The inexorable link among these 3 components was evidenced by 4 themes: (1) incidental learning, (2) understanding of physiological differences, (3) understanding of cultural differences and similarities, and (4) fostering an inclusive environment. Discussion and Conclusion. Due to the inexorable link among diversity, multiculturalism, and conviction, striving to attain diversity or multiculturalism in the abstract, or without conviction, may prove futile.

Key Words: Conviction, Diversity, Interculturalization, Multiculturalism, Physical therapy education

INTRODUCTION

As our nation becomes increasingly diverse, the physical therapy profession is being called upon to graduate more students from underrepresented ethnic groups and to ensure that all students entering the profession are culturally proficient to work ethically and efficiently with diverse patients. Despite this directive, most physical therapy education programs struggle to effectively increase physical therapy student diversity and struggle over the ethical consequences of race-sensitive practices in admissions. There is also an ignorance of the ethical ramifications if the physical therapy profession continues to teach from a Eurocentric perspective ignoring the centrality of culture in patient care. If physical therapy programs do give credence to the importance of multiculturalism, there remains a lack of guidance on how to infuse cultural components into the educational curricula.

Although the goals of increasing diversity and incorporating multiculturalism are increasingly being professed in the physical therapy educational arena and by the American Physical Therapy Association (APTA),1 it appears that programs are falling short of achieving both objectives. The overall purposes of this qualitative investigation were: (1) to use multiple perspectives to define the terms diversity and multiculturalism, (2) to investigate the importance of diversity and multiculturalism in the physical therapy profession, (3) to gain knowledge that can be utilized by physical therapy educators to more effectively address diversity and multiculturalism, and (4) to develop a model suggesting how diversity and multiculturalism can be attained in physical therapy education programs. In this article, only purposes 2 and 3 will be addressed.

REVIEW OF THE LITERATURE

There are numerous publications in the health care professions advocating the importance of increasing practitioner diversity In the workforce and having multiculturalism In the curricula. In regard to diversity, an analysis of the literature reveals 3 main arguments as to why it is beneficial to the health care professions to have increased ethnic representation. The first argument is that professions should reflect national racial/ethnic demographics. It has been well documented that there are dramatic demographic changes occurring within the United States.2 Tills trend is projected to continue, with the Census Bureau predicting that by 2045, the number of whites of non-Hispanic origin will continue to decrease to 54.5%.3 Naturally, these demographic changes will be reflected in the health care professional's patient population. Many have suggested that the healdi care workforce should match the ethnic and cultural profiles of the population it serves, and the call to increase the number of ethnic underreprcsented students has been well documented.4-17

The second rationale for increasing the diversity of health care practitioners is based on die argument that culturally matching practitioners and patients results in better treatment outcomes.5,7 Despite this speculation, there have been few studies documenting this phenomenon to date. CooperPatrick et al18 found that African-American patients reported significantly fewer participatory visits (likelihood of physician to involve patient in treatment decisions) with white physicians man white patients reported with white physicians, despite the fact that there was no significant difference between African-American and white physicians with respect to overall patient ratings of their participatory decision-making style. This finding suggests that when physicians share the same ethnic or racial affiliation as their patients, they may use more participatory communication with their patients or the patients may perceive the communication to be more participatory.