Developing Cultural Competence in Physical Therapy Practice

Journal of Physical Therapy Education, Fall 2006 by Leavitt, Ronnie

Developing Cultural Competence in Physical Therapy Practice. Black Lattanzi J, Purnell L, eds. Philadelphia, Pa, FA Davis, 2006, softcover, 417 pp, $36.95.

Developing Cultural Competence in Physical Therapy Practice is a book specifically written for physical therapists (PTs) and physical therapist assistants (PTAs). It explores specifics about particular cultural groups using the Purnell Model for Cultural Competence. Reflective exercises, vignettes, and case studies are used throughout the book. All of the contributing authors are physical therapists, except for Purnell, who has a nursing background.

The first of 5 sections (Chapters 1 and 2) introduces the study of culture and the Purnell Model of Cultural Competence, which is used throughout the text as an organizing framework. The Purnell Model is a circle, with the outermost rim representing global society, a second rim representing community, a third representing family, and the innermost rim representing the individual. The center of the innermost circle is divided into 12 pie-shaped wedges, depicting cultural domains and their concepts. The 12 specific categories are: overview/heritage, communication, family roles and organization, workforce issues, biomedical ecology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, health care practices, and health care practitioners. The dark center of the circle represents unknown phenomena.

The second section (Chapters 3-9), is authored by the 2 editors and addresses self-exploration of culture. Each chapter asks the reader to explore for themselves, 1 of the 12 aforementioned categories in the Purnell Model. I believe, as do the editors, that this section is the most important for reflection by PTs and PTAs. Understanding oneself and one's culture and how this affects the practitioner-patient relationship is the first and most important step in developing cultural competence.

The third and fourth sections provide information for specific cultural groups that PTs encounter, based on ethnicity or unique characteristics. Ethnic groups (Chapters 10-15) specifically addressed in these sections include the African American/Black cultures, Chinese culture, Latino/Hispanic cultures, American Indian cultures, Middle Eastern cultures, and Jewish culture. Cultures of particular population groups who are likely to need physical therapy (Chapters 16-20) include individuals with disabilities, veteran and military groups, people who are poor or homeless, and pediatrie and geriatric populations. Personally, I do not believe the Purnell Model is always appropriate as an organizing framework. However, in Chapters 10-15, the Purnell Model ensures that all of the aforementioned cultural domains are covered for each ethnic group. Thus, each chapter is thorough. On the other hand, there are instances throughout Chapters 16-20, which focus on specific physical therapy population groups, where I believe the use of this model does not foster the most articulate, logical, well-organized information.

The fifth section (Chapters 21-22) focuses on strategies and resources for physical therapy students, educators, and practitioners, both within the US and internationally.

The strength of this book lies in its effort to urge the reader to explore personal beliefs and behaviors. The authors have done a superb job integrating reflective exercises, case studies, figures, tables, pictures, and vignettes into this text. References are timely. I highly recommend this book as a resource for any present or future physical therapy practitioner, educator, researcher, or administrator who is serious about working toward cultural proficiency. I highly recommend this book as a text for physical therapist and physical therapist assistant students.

Ronnie Leavitt, PT, PhD

Associate Clinical Professor

School of Allied Health

University of Connecticut

Storrs, CT