JMIR Publications

ABSTRACT

Background:

Cultural competence is an essential dimension of contemporary healthcare delivery, particularly in diverse, multicultural societies. South Africa, with its rich linguistic and cultural plurality, presents a unique context in which culturally responsive care is critical for equitable health outcomes. Despite growing international attention to cultural competence in health professions education, little research has explored this domain within optometry education in sub-Saharan Africa.

Objective:

This study aimed to assess the self-reported levels of cultural competence — specifically preparedness, skilfulness, and educational exposure — among third- and fourth-year optometry students at a South African university.

Methods:

A descriptive, cross-sectional survey design was employed. An adapted version of the Harvard Cross-Cultural Care Survey (CCCS) was distributed via Google Forms to 91 eligible students, yielding 68 responses (response rate: 74.7%). Quantitative data were analysed using descriptive statistics and exploratory factor analysis (SPSS v29). Qualitative responses were analysed thematically using Braun and Clarke's reflexive thematic analysis framework.

Results:

Participants reported higher preparedness for caring for immigrant patients (69.2%) and LGBTIQA+ individuals (66.2%) than for patients with religious beliefs affecting treatment (only 29.5% prepared) or health beliefs at odds with Western medicine (30.9% prepared). In terms of skills, students felt most capable in assessing illness understanding (85.3% skilled) and identifying English literacy (82.4% skilled), but reported deficits in counselling patients about traditional/alternative medicine use (32.4% unskilled) and identifying religious beliefs affecting care (27.9% unskilled). Experiential learning, particularly community outreach and the Phelophepa Health Train, was identified as the most impactful preparation for cross-cultural care. Qualitative themes included: exposure to diverse patient populations; communication across cultures; developing cultural awareness and empathy; awareness of health inequities; informal/social learning; and gaps in structured training.

Conclusions:

The optometry students demonstrate moderate cultural competence, with meaningful strengths in communication and rapport-building, alongside notable gaps in engaging with religious beliefs, traditional medicine, and systemic health inequities. These findings align with international literature and underscore the need for structured, curriculum-embedded cultural competence training. We recommend integration of formal training modules, reflective practice frameworks, faculty development, and expanded equitable access to diverse clinical placements.