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Kristine Houde


When we’re prescribing therapeutic exercises to our patients, are we modifying our approach to better address determinants of health, cultural diversity, and beliefs that shape our patients’ attitudes towards health and exercise?

The big idea

On March 9th, the Rideau Canal Skateway in Ottawa closed for the season. Some were sad that they could no longer enjoy a good skate on the canal, but I inwardly rejoiced since this meant that spring is on its way.

Another sign of spring is the flurry of university and college acceptance letters being mailed to hopeful high school students like my 17-year-old niece. While I’m happy that my niece has been accepted by her top choices, the thought of her moving to the big city on her own has me a bit worried. I know she’ll do fine once she gets over her initial culture shock and adapts to university life (a process of cultural adaptation also known as the ‘W’ curve), but the reality is that not everyone adjusts so easily or quickly to new environments.

cul·ture shock (noun):
The feeling of disorientation experienced by someone who is suddenly subjected to an unfamiliar culture, way of life, or set of attitudes.

My take on things …

Culture shock is not a phenomenon unique to international travelers. As the definition above illustrates, culture shock can strike individuals during any major life transition, for example, moving to a new province, transitioning from independent to assisted living, or dealing with sudden disability.

Our patients who are new to Canada not only have to brave the elements. They must also deal with other stressors such as language barriers, financial strains, lack of social supports or affordable housing, and decreased access to health services. These factors (along with others), collectively known as the determinants of health, can greatly influence our health and wellbeing.

Figure 1. from Centre for Disease Control

Scientists estimate that 25% of our overall health is dictated by genes, biology, and health behaviours, while the other 75% is influenced by social determinants including social and physical environments, and health services. Figure 1 from the CDC represents rough estimates of how much each of the five main determinant categories (Figure 2) contributes to the health of a population.


Figure 2. from Dahlgren & Whitehead (1991)

While some might argue that developed countries offer more opportunities and access to resources than developing nations, health disparities still exist for many individuals in Canada. As health professionals focused on providing patient-centred care, we should strive for health equity and cultural sensitivity in all our interactions.

For physiotherapists wishing to explore the topics of cultural sensitivity and intercultural communication, here are five resources to assist with self-reflection, evaluation and skills development:

  • College of Nurses of Ontario – Practice Guideline: Culturally Sensitive Care (Opens as PDF)
    This practice guideline outlines assumptions, breaks down elements of providing culturally sensitive care and provides an assessment and approach to providing care
  • American Congress of OBGYNs – Cultural Sensitivity and Awareness in the Delivery of Health Care
    The cases outlined in the document are intended to highlight the importance of cultural sensitivity in clinical practice. Although these examples represent dramatic situations, these examples can serve as useful teaching tools for those in practice.

The first step in developing a culturally sensitive approach to treatment as physiotherapists is that we must examine and recognize our own biases and cultural beliefs, and how these influence our behaviours and decisions. To develop a patient-centred approach to care that is culturally-sensitive, we must understand both the cultural beliefs and the current life situations of our patients. If this done, the result will be improved communication, cooperation, trust, and patient satisfaction, leading to better outcomes for all.

Dig Deeper

If you’d like to explore the topic of cultural sensitivity in other areas of practice, I’ve pulled together some additional resources that demonstrate how culture can impact health outcomes:

And if you’re looking to expand your knowledge and training on the topic of cultural sensitivity, don’t forget to check with your local public health unit, library, community health centre, or cultural centre. Many of them provide resources and assistance – often free of charge – to help you better serve your patients.


What changes have you made to your individual practice or clinic tools and resources to address culturally specific needs of your patients?

Have you ever experienced culture shock? How has this helped you communicate and relate better to your patients?

Share your thoughts with CPA and with me using the comments box below, or via the CPA Facebook page or on Twitter (hashtag #cpa30reps)

About Kristine Houde

Kristine Houde is Health Promotion Manager at the University of Ottawa Health Services. She has worked as a physiotherapist clinician in a variety of clinical settings, and as project manager for CPA and the CPA Private Practice Division. In addition to health and wellness, her interests include EMR adoption and use, physiotherapy business benchmarking, and e-Health.

You can reach her on FacebookLinkedIn and Twitter.