# Association between the frequency of treating foreign patients and the cultural competency of Japanese healthcare professionals: a mixed-method study

## TL;DR

This study finds that treating foreign patients is linked to higher motivation and skills but lower attitudes among Japanese healthcare professionals due to systemic issues.

## Contribution

The study identifies specific components of cultural competence affected by treating foreign patients, revealing nuanced associations not previously emphasized.

## Key findings

- J-HCPs who treat foreign patients several times a week have lower attitude scores but higher skill scores.
- Qualitative insights suggest that stress and lack of institutional support lower attitudes among J-HCPs.
- Training and interpretation services could improve cultural competence in healthcare.

## Abstract

Previous studies have emphasized that interactions with foreign patients were associated with high cultural competence among Japanese healthcare professionals (J-HCPs), with little focus on the individual components of cultural competence. This study examines how frequencies of treating foreign patients are associated with the components of cultural competence among J-HCPs, using a mixed-method design.

Quantitative data were collected from 1089 J-HCPs via internet survey assessing cultural competence using the Cross-Cultural Competence Instrument for Healthcare Professionals (J-CCCHP), containing subscales, motivation/curiosity, emotion/empathy, attitude, and skill. Associations were stratified by the participation in trainings for treating foreign patients. Qualitative data were further collected from 16 key-informant interviews recruited by snowball sampling.

J-HCPs who treated foreign patients several times a week (n = 203, 18.6%) scored a lower attitude score (coefficient = − 0.67, 95% Confidence Interval [CI] − 1.28, − 0.06), and a higher skill score (coefficient = 1.36, 95% CI 0.43, 2.29) compared to those who treated almost none. Those who treated foreign patients several times a year scored higher in motivation/curiosity, additionally. Qualitative studies explained that rewarding experiences and gaining extensive knowledge in treating foreign patients enhanced J-HCPs’ motivation/curiosity and skill. Stress due to extra workload, language barriers and cultural differences, insufficient resources and the lack of institutional support might lower the attitude of J-HCPs.

Treating foreign patients is associated with high motivation and skill but low attitude scores among J-HCPs, due to systemic challenges. Providing reliable interpretation services, offering practical cultural competence training, and strengthening institutional support may help reduce these challenges.

The online version contains supplementary material available at 10.1186/s41182-025-00844-z.