Culturally Competent Patient Engagement: From Theory to Practice

Nadia Malliou, President of Pain Alliance Europe and ISPEP Patient Organisation Bursary Awardee

Introduction

Patient engagement is essential for quality healthcare, yet engagement efforts often fall short for culturally diverse populations. Patient engagement leaders play a pivotal role in shaping healthcare systems that are inclusive, equitable, and responsive to diverse populations. As such, factors including migration trends, demographic shifts, and evolving patient expectations require leaders to champion culturally competent engagement strategies. This is crucial to ensure equitable access, foster trust, and improve outcomes for all patients. By embedding equity and cultural awareness into organisational priorities, leaders can better ensure that engagement efforts resonate with and have a positive impact across more communities.

This blog post explores frameworks for equitable involvement, highlights successful initiatives, and outlines actionable steps for patient engagement professionals to help close the gaps opened by homogenous engagement.

Diversity, Equity, Inclusion (DEI) in healthcare: why does it matter?

When living with a chronic disease and/or chronic pain, participating in patient communities and networking with patients from every corner of the world, it quickly becomes evident that we all come from different backgrounds, races, ethnicities, languages, and cultures. We also vary in gender, sexual orientation, socioeconomic status, disability status, preferences, lifestyles, aspirations, hopes and dreams, and more. Each group may face unique health challenges and may have different beliefs, communication styles (both verbal and non-verbal), or ways of perceiving experiences such as pain, chronic illness, disability, or fatigue.

If DEI is not taken into account and these factors are overlooked, patients are at risk of serious communication failures, diagnostic and treatment errors, and even fatal mistakes. These may be due to cultural misunderstandings or barriers to care such as language differences, fear of discrimination, or general distrust in ‘the system’. Commitment to DEI principles benefits all involved – better outcomes for patients, and better success for healthcare professionals, patient engagement specialists, and more. 

Current frameworks

Culturally competent engagement strategies are built on frameworks that recognise and are open to the intersectionality of culture, identity, and health¹. Numerous well-regarded frameworks are available:

1. The Cultural Competence Continuum², for example, posits that cultural competence is an ongoing process, moving from cultural destructiveness to cultural proficiency. This model encourages continuous staff development and system-wide assessments, which leaders can embed into long-term organisational strategy. 

   
   

2. The Equity-Oriented Healthcare Framework³ highlights key dimensions: trauma- and violence-informed care, culturally safe care, and harm reduction. This model integrates cultural humility, acknowledging systemic barriers and power imbalances that affect patient engagement. Leaders can address this by ensuring policies, processes, and patient communications and engagement are optimised with these concepts in mind.

   
   

3. The Health Equity Implementation Framework⁴ guides organisations and healthcare professionals in implementing interventions that reduce disparities. Leaders can use this model to align in a variety of contexts, ensuring equity is integrated into decision-making processes.

   
   

These frameworks underscore that culturally competent leadership is not about one-off initiatives, but about sustained, structural transformation. 

Image source here.

Examples of successful initiatives

Many healthcare organisations and professionals worldwide have demonstrated the value of inclusive patient/community engagement. Here are a few notable examples:

• The "Ask Me 3" Health Literacy Initiative, a simple but powerful approach encouraging patients to ask: "What is my main problem? What do I need to do? Why is it important for me to do this?". This has demonstrated success in empowering diverse patients to engage actively in their care, improving adherence and understanding⁵.

  
  

• The NHS “Working in partnership with people and communities: Statutory guidance” mandates that healthcare providers identify and meet the communication needs of patients with disabilities or language differences. This initiative has significantly improved patients’ experiences of care and reduced missed appointments. It is aimed at all UK HCPs involved in ambulatory and community-based healthcare to ensure inequalities are addressed and reduced⁶.

  
  

• The case study from Egality Health on developing tailored patient materials to improve recruitment of African, Caribbean, and South Asian communities in breast cancer clinical trials⁷.

  
  

• Multiple case studies on health equity in paediatric drug development outlined by Folayan and colleagues across the US, UK, and the African continent⁸.

These examples illustrate the variety of benefits of inclusive initiatives, such as enhanced patient activation, system performance, and research success.

What can PEPs do next?

Patient engagement professionals can take specific actions to enhance their cultural competency and translate it into tangible action:

• Leverage resources such as training programs and toolkits (e.g., the NIHR Culturally Competent Research Framework Toolkit⁹ and the National LGBTQIA+ Health Education Center¹⁰) and establish a culture of ongoing learning in partnership with community organisations.

  
  

• Conduct cultural assessments and gap analyses to better characterise patient population demographics and set measurable goals for improving equity and inclusion. Engage community representatives to understand expectations, preferences, and challenges.

  
  

• Apply findings to study design and activities from the start: whether it’s refining inclusion criteria or co-producing lay summaries, there are bound to be numerous opportunities to improve research conduct.

  
  

• Enable inclusive shared decision-making by offering multilingual resources and professional interpreter services. Use plain language, culturally relevant concepts, and visual aids to bridge communication gaps. Empower patients by offering choices that respect cultural preferences. Use decision aids designed for diverse populations to increase comprehension and involvement¹¹.

Image source here.

Conclusion

For patient engagement leaders, culturally competent strategies are essential for sustainable, equitable healthcare. Frameworks provide structural guidance, while real-world initiatives demonstrate impact. By taking actionable steps such as conducting cultural assessments and enhancing study designs, divisions can be bridged and trust can be built. The journey toward culturally competent – and ideally, culturally humble – care is continuous, and begins with a commitment to equity, respect, and genuine patient partnership.

References

1. Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: a model of care. J Transcult Nurs. 2002;13(3):181–201. Available from: https://doi.org/10.1177/10459602013003003

2. Cross T. Cultural competence continuum. J Child Youth Care Work. 2020;24:83-5. Available from: https://doi.org/10.5195/jcycw.2012.48

3. Ford-Gilboe M, Wathen CN, Varcoe C, Herbert C, Jackson BE, Lavoie JG, et al. How equity-oriented health care affects health: key mechanisms and implications for primary health care practice and policy. Milbank Q. 2018;96(4):635–71. Available from: https://doi.org/10.1111/1468-0009.12349

4. Woodward EN, et al. The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment. Implement Sci. 2019;14(1):26. Available from: https://doi.org/10.1186/s13012-019-0861-y

5. Institute for Healthcare Improvement. Ask Me 3: good questions for your good health [Internet]. Boston: Institute for Healthcare Improvement; 2025. Available from: https://www.ihi.org/resources/tools/ask-me-3-good-questions-your-good-health

6. NHS England. Working in partnership with people and communities: statutory guidance [Internet]. London: NHS England; 2023. Available from: https://www.england.nhs.uk/long-read/working-in-partnership-with-people-and-communities-statutory-guidance/#who-is-this-guidance-for

7. Egality Health. Clinical trial communications for a leading cancer charity and top 10 global pharmaceutical company [Internet]. London: Egality Health; [date unknown]. Available from: https://egality.health/casestudies/clinical-trial-communications-for-a-leading-cancer-charity-and-top-10-global-pharmaceutical-company

8. Folayan MO, Conway M, Russo C, Diniz N, Jafta LP, Sam-Agudu NA, et al. Health equity in pediatric drug development: translating aspiration into operation. Ther Innov Regul Sci. 2022;56(6):992-1002. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9122543/#Sec4

9. NIHR Newcastle Patient Safety Research Collaboration and Connected Voice Haref. Culturally competent research framework [Internet]. Newcastle: NIHR; 2025. Available from: https://psrc-ncl.nihr.ac.uk/2025/10/21/culturally-competent-research-framework-toolkit/

10. National LGBTQIA+ Health Education Center. Health education center [Internet]. Boston: The Fenway Institute; 2025. Available from: https://www.lgbtqiahealtheducation.org/

11. Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891. Available from: https://doi.org/10.1136/bmj.j4891