# The Challenges of Multiculturalism in Belgian Emergency Services: An Exploration of Emergency Physicians’ Experiences, Attitudes and Intercultural Competence

## TL;DR

This study explores how cultural diversity affects emergency care in Belgium, focusing on communication barriers and physicians' intercultural competence when treating migrant patients.

## Contribution

The paper provides the first exploration of culture-specific challenges faced by emergency physicians in Belgium and evaluates their intercultural competence and attitudes.

## Key findings

- 60% of physicians reported communication barriers when treating migrant patients.
- Most physicians highlighted the lack of 24/7 translation services, minority language documentation, and universal pictograms.
- Self-reported intercultural competence did not correlate with attitudes toward cultural adaptation or patient backgrounds.

## Abstract

The increasing cultural diversity in Belgium necessitates an understanding of the challenges faced by emergency physicians in treating migrant patients. Cultural differences influence how patients experience and communicate their symptoms while migration often alters individuals' ways of being and relating to others. Despite the critical importance of these issues, no prior studies to the best of our knowledge have examined the culture-specific challenges faced by emergency physicians in Belgium. This exploratory study aims to address this gap by investigating these challenges and evaluating physicians' levels of cultural sensitivity and self-reported intercultural competence.

An online survey was conducted between September and December 2023 with 50 emergency physicians (62% female, 36% male, Mage​ = 39.88) from Brussels and Walloon regions in Belgium. Our analyses demonstrated that physicians expressed strong interest in treating migrant patients, yet 60% reported experiencing communication barriers. A majority pointed to the absence of 24/7 translation services (98%), minority language documentation (82%), and universal pictograms (90%) to facilitate communication. Furthermore, intercultural competence was positively associated with age and higher among physicians in urban areas. However, older physicians were more likely to view cultural adaptation as the responsibility of patients, whereas younger physicians emphasized the importance of understanding patients' sociocultural backgrounds and migration histories. Notably, self-reported intercultural competence did not correlate with attitudes on cultural adaptation or the importance assigned to patients’ backgrounds.

These findings highlight systemic barriers to equitable care and reveal inconsistencies in physicians’ beliefs about cultural adaptation. The absence of correlations between intercultural competence and cultural sensitivity measures underscores the limitations of self-reported assessments. Addressing these challenges requires structural interventions, such as multilingual documentation, universal pictograms, and translation services, to support physicians and improve patient outcomes. As such, the study provides initial insights into the Belgian context and calls for further exploration of organizational and cultural changes to foster inclusive emergency care.