Identifying key elements of cultural competence to incorporate into a New Zealand undergraduate pharmacy curriculum

Trudi Aspden, Rachael Butler, Friederike Heinrich, Matire Harwood, Janie Sheridan


Background: Culturally competent practice is now mandatory for New Zealand (NZ) pharmacists.

Aims: This research sought the opinions of those with expertise in different facets of cultural competence, to inform the content and teaching strategies for this subject within a pharmacy undergraduate programme in NZ.

Methods: An exploratory, qualitative study design analysing the transcriptions of nineteen audio-recorded, semi- structured interviews was used. Prior to the interviews, participants received a copy of the Revised Tool for Assessing Cultural Competence Training (TACCT-R).

Results: Seven main themes were identified: teaching challenges; curriculum content; content positioning; teaching delivery; teaching staff; assessment of student learning; and positioning Māori (the indigenous peoples of NZ) health in cultural competence. Challenges included the topic broadness and sensitivity. With modifications, the TACCT-R was found to have a scope relevant to the NZ pharmacy environment.

Conclusions: The findings reveal similarities with previous research but also tensions including the place of Hauora Māori and cultural experiences. 


Cultural competence, New Zealand, pharmacy, qualitative, TACCT-R

Full Text:



Ajwani, S., Blakely, T., Robson, B., Tobias, M. & Bonne, M. (2003). Decades of Disparity: Ethnic mortality trends in New Zealand 1980-1999. Wellington: Ministry of Health and University of Otago.

Alcoff, L. (1992). The problem of speaking for others. Cultural Critique, 20, 5-32.

Beagan, B.L. (2003). Teaching social and cultural awareness to medical students: "it's all very nice to talk about it in theory, but ultimately it makes no difference". Academic Medicine, 78(6), 605-614.

Betancourt, J.R. & Green, A.R. (2010). Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Academic Medicine: Journal of the Association of American Medical Colleges, 85(4), 583-585. doi: 10.1097/ACM. 0b013e3181d2b2f3

Betancourt, J.R., Green, A.R., Carrillo, J.E. & Ananeh- Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports (Washington, D.C.: 1974), 118(4), 293-302.

Blakely, T., Fawcett, J., Atkinson, J., Tobias, M. & Cheung, J. (2005). Decades of Disparity II: Socioeconomic mortality trends in New Zealand, 1981-1999.

Blakely, T., Tobias, M., Atkinson, J., Yeh, L. & Huang, K. (2007). Tracking Disparity: Trends in ethnic and socioeconomic inequalities in mortality, 1981–2004 Wellington: Ministry of Health.

Chapman, E., Kaatz, A. & Carnes, M. (2013). Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. Journal of General Internal Medicine, 28(11), 1504-1510. doi: 10.1007/ s11606-013-2441-1

Chou, C., Hirschmann, K., Fortin, A. t. & Lichstein, P. (2014). The impact of a faculty learning community on professional and personal development: the facilitator training program of the American Academy on Communication in Healthcare. Academic Medicine, 89(7), 1051-1061.

Chun, M.B.J. (2010). Pitfalls to avoid when introducing a cultural competency training initiative. Medical Education, 44(6), 613-620. doi: 10.1111/j.1365-2923. 2010.03635.x

Cross, T.L., Bazron, B.J. & Isaacs, M.R. (1989). Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who are Severely Emotionally Disturbed (pp. 90): Georgetown University Child Development


Cuellar, L.M. & Fitzsimmons, D.S. (2003). Raising pharmacists' cultural awareness. American Journal of Health-System Pharmacy, 60(3), 285-286.

Dogra, N. (2001). The development and evaluation of a programme to teach cultural diversity to medical undergraduate students. Medical Education, 35(3), 232-241.

Dogra, N., Reitmanova, S. & Carter-Pokras, O. (2009). Twelve tips for teaching diversity and embedding it in the medical curriculum. Medical Teacher, 31(11), 990-993.

Dunning, D., Heath, C. & Suls, J. (2004). Flawed self- assessment: Implications for health, education, and the workplace. Journal Psychological Science in the Public Interest, 5, 69–106.

Engebretson, J., Mahoney, J. & Carlson, E.D. (2008). Cultural Competence in the Era of Evidence-Based Practice. Journal of Professional Nursing, 24(3), 172-178.

Grote, E. (2008). Principles and Practices of Cultural Competency: A Review of the Literature. Canberra: Indigenous Higher Education Advisory Council (IHEAC), Australian Government, Department of Education Employment and Workplace Relations.

Hawala-Druy, S. & Hill, M. (2012). Interdisciplinary: Cultural competency and culturally congruent education for millennials in health professions. Nurse Education Today, 32, 772-778.

Health Practitioners Competence Assurance Act. (2003). No. 48 (18th September, 2003).

Hsieh, J.-G., Hsu, M. & Wang, Y.-W. (2016). An anthropological approach to teach and evaluate cultural competence in medical students – the application of mini-ethnography in medical history taking. Medical Education Online, 21. doi:


Illing, J. (2007). A systematic review of the literature on the effectiveness of self-assessment in clinical education. Newcastle upon Tyne, UK: Institute of Health and Society BEME Self-Assessment Topic Review Group. .

Jeffreys, M.R. & Dogan, E. (2012). Evaluating the influence of cultural competence education on students' transcultural self-efficiacy training The Journal of Physician Assistant Education, 22(4), 38-43.

Jensen, R. (2005). The Fears of White People The Heart of Whiteness: Confronting Race, Racism and White Privilege. Oregon: City Lights Books.

Jungnickel, P., Kelley, K., Hammer, D., Haines, S. & Marlowe, K. (2009). Addressing competencies for the future in the professional curriculum. American Journal of Pharmaceutical Education, 73(8), Article 156.

Kai, J., Bridgewater, R. & Spencer, J. (2001). "Just think of TB and Asians,", that's all I ever hear': Medical learners' views about training to work in an ethnically diverse society. Medical Education, 35(3), 250-256.

Kamaka, M.L. (2010). Designing a cultural competency curriculum: asking the stakeholders. [Research Support, Non-U.S. Gov't]. Hawaii Medical Journal, 69(6 Suppl. 3), 31-34.

Kelly, P. (2011). Exploring the theoretical framework of cultural competency training. The Journal of Physician Assistant Education, 22(4), 38-43.

Kleinman, A., Eisenberg, L. & Good, B. (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251 - 258.

Kratzke, C. & Bertolo, M. (2013). Enhancing students' cultural competence using cross-cultural experiential learning. Journal of Cultural Diversity, 20(3), 107-111.

Kumagai, A.K. & Lypson, M. L. (2009). Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education. Academic Medicine, 84(6), 782-787. doi: 710.1097/ACM.1090b1013e3181a42398.

Leninger, M. (1988). Leninger's theory of nursing: cultural care diversity and universality. Nursing Science Quarterly, 1(2), 152-159.

Lie, D. A., Boker, J., Crandall, S., DeGannes, C. N., Elliott, D., Henderson, P., Kodjo, C. & Seng, L. (2008). Revising the Tool for Assessing Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert consensus. Medical Education Online, 13(11), 1-9.

Medical Council of New Zealand. (2006). Statement on cultural competence. Wellington: New Zealand Medical Council.

Ministry for Culture and Heritage. (2012). New Zealand History. (2012). ‘Read the Treaty’, New Zealand History - Nga korero a ipurangi o Aotearoa (online). Available at nz/politics/treaty/read-the- treaty/english-text. Accessed 17th January, 2017.

Muzumdar, J.M., Holiday-Goodman, M., Black, C. & Powers, M. (2010). Cultural Competence Knowledge and Confidence After Classroom Activities. American Journal of Pharmaceutical Education, 74(8), 8.

New Zealand Ministry of Justice. (2015). The Treaty of Waitangi (online). Available at: http:// waitangi-tribunal/treaty- of-waitangi. Accessed 8th May, 2015.

Nursing Council of New Zealand. (2011). Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice.

O'Connell, M., Korner, E., Rickles, N. & Sias, J. (2007). ACCP white paper. Cultural competence in health care and its implications for pharmacy part 1: Overview of key concepts in multicultural healthcare. Pharmacotherapy, 27(7), 1062-1079.

O'Connell, M., Rickles, N., Sias, J. & Korner, E. (2009). ACCP white paper. Cultural competence in health care and its implications for pharmacy part 2: Emphasis on pharmacy systems and practice. Pharmacotherapy, 29(2), 14e-34e.

Pharmacy Council of New Zealand. (2011). Statement on Cultural Competence: Pharmacy Council of New Zealand.

Pharmacy Council of New Zealand. (2015). Competence standards for the pharmacy profession (online). Available at: download.php id=504. Accessed 17th January, 2017.

Poirier, T.I., Butler, L.M., Devraj, R., Gupchup, G.V., Santanello, C. & Lynch, J.C. (2009). A cultural competency course for pharmacy students. American Journal of Pharmaceutical Education, 73(5), 7.

Qureshi, A., Collazos, F., Ramos, M. & Casas, M. (2008). Cultural competency training in psychiatry. [Research Support, Non-U.S. Gov't]. European Psychiatry: the Journal of the Association of European Psychiatrists, 23 (Suppl. 1), 49-58.

Schön, D.A. (1983). The reflective practitioner: How professionals think in action. London: Maurice Temple Smith Ltd.

Sharma, N., Lalinde, P.S. & Brosco, J.P. (2006). What do residents learn by meeting with families of children with disabilities?: A qualitative analysis of an experiential learning module. Pediatric Rehabilitation, 9(3), 185-189. doi: 10.1080/13638490600570606

Tashiro, J., Shimpuku, Y., Naruse, K., Maftuhah & Matsutani, M. (2013). Concept analysis of reflection in nursing professional development. Japan Journal of Nursing Science, 10(2), 170-179. doi: 10.1111/j. 1742-7924. 2012.00222.x

The Association of American Medical Colleges. (2005). Tool for assessing cultural competence training (TACCT) (online). Available at: tacct/. Accessed 17th January, 2017.

Thomas, D.R. (2006). A General Inductive Approach for Analyzing Qualitative Evaluation Data. American Journal of Evaluation, 27(2), 237-246. doi: 10.1177/109821400 5283748

Thomason, A.R., Elmore, L.K., Naro, P.B. & Huddleston, T.W. (2013). Pharmacy students’ attitudes toward the underserved population: The role of experiential education. Currents in Pharmacy Teaching and Learning, 5(5), 444-449. doi: 10.1016/j.cptl.2013.06.002

Tsingos, C., Bosnic-Anticevich, S. & Smith, L. (2014). Reflective Practice and Its Implications for Pharmacy Education. American Journal of Pharmaceutical Education, 78(1), 18. doi: 10.5688/ajpe78118

University of Auckland. (2009). Te Ara - Graduate Profile in Hauora Māori for undergraduate programmes of the Faculty of Medical and Health Sciences (online). Available at: https://www.fmhs. fmhs/faculty/tkhm/docs/Te-Ara.pdf. Accessed 17th January, 2017.

Vanlaere, L., Coucke, T. & Gastmans, C. (2010). Experiential learning of empathy in a care-ethics lab. Nursing Ethics, 17(3), 325-336. doi: 10.1177/096973301 0361440

Vyas, D. & Caligiuri, F.J. (2010). Reinforcing cultural competency concepts during introductory pharmacy practice experiences. American Journal of Pharmaceutical Education, 74(7), 129.

Wear, D. (2003). Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education. Academic Medicine, 78(6), 549-554.

Wormald, B.W., Schoeman, S., Somasunderam, A. & Penn, M. (2009). Assessment drives learning: An unavoidable truth? Anatomical Sciences Education, 2, 199–204. doi:10.1002/ase.102

Zweber, A. (2002). Cultural Competence in Pharmacy Practice. American Journal of Pharmaceutical Education, 66, 172-176.


  • There are currently no refbacks.
article/comments.tpl article/footer.tpl