A Scoping Review of the Empirical Evidence on Cultural Competence in Service Provision: The Intersection of Clients and Providers

Background and Purpose: Despite educational standards and ethical requirements concerning cultural competency (CSWE, 2015; NASW, 2008), the literature on racial and ethnic minority client outcomes suggests gaps in the translation to practice. For example, in a comprehensive overview of the issues faced by African Americans in mental health services, Briggs, Briggs, Miller, and Paulson (2011) found that institutional inequalities and cultural insensitivities result in underutilization of services. Few efforts have been made to synthesize the outcomes as well as the theoretical and methodological quality of the current body of empirical knowledge related to multicultural social service provision. The purpose of this scoping review was to critically evaluate the current research on multicultural practice of both minority clients and social work providers across multiple settings.

Methods: A scoping review method was utilized because it allows for addressing a broad topic based on the analyses of studies that use a variety of designs and without restrictions based on quality indicators (Levac, Colquhoun, & O’Brien, 2010). The scoping review covered the 2007-2016 ten-year period. A total of 23 studies met the inclusion criteria for clients and 26 studies for providers. The qualifying studies used qualitative (23), quantitative (23), and mixed-methods (3) designs, and had sample sizes ranging from 8 to 5,002. All studies were assessed for theoretical approach, research design, and outcomes.

Results: Our review of client studies revealed four major themes: (1) numerous barriers when accessing social services, (2) concerns with the shortage of providers who represented their communities, resulting in communication barriers, (3) experiences with bias and microaggressions by helping professionals, and (4) a relationship between perceived provider cultural sensitivity and satisfaction with services, perceived treatment helpfulness, and treatment outcomes. Four major themes emerged from our review of provider studies: (1) variations in levels of cultural competence, (2) tensions and biases in multicultural practice often related to privilege and power dynamics, (3) a lack of self-awareness related to personal cultural beliefs and values in client assessments and interventions, and (4) employer lack of recognition regarding the importance of cultural competence.

The second part of our analysis addressed theoretical and methodological approaches. The studies we reviewed generally relied on descriptive research designs. Specifically, all quantitative studies were cross-sectional. In addition, they relied entirely on self-reports, which can be particularly prone to social desirability bias on the topic of racial and cultural diversity (Larson & Bradshaw, 2017). Qualitative studies generally lacked clear theoretical grounding and specificity about the data analysis process.  

Conclusions and Implications: The results of this scoping review suggest that providers’ cultural competence is a critical component of racial and ethnic minority client satisfaction. Yet, providers were frequently biased and guided by their own cultural beliefs, which affected their ability to deliver culturally competent services. Although indicative, the findings should be interpreted cautiously due to the limitations in the research design of the studies. The application of more complex methodological approaches (e.g., quasi-experimental design) and a stronger theoretical basis will allow for a deeper understanding of this critical aspect of practice.