Cultural Competence Among Optometry Students at a South African University: Cross-Sectional Survey Study (Preprint)

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BACKGROUND Cultural competence is an essential dimension of contemporary health care 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 self-reported levels of cultural competence, specifically preparedness, skillfulness, and educational exposure, among third- and fourth-year optometry students at a South African university. METHODS A descriptive, cross-sectional survey design was used. An adapted version of the Harvard Cross-Cultural Care Survey was distributed via Google Forms to 91 eligible students, yielding 68 (74.7%) responses. Quantitative data were analyzed using descriptive statistics in SPSS (version 29). Qualitative responses were analyzed using conventional content analysis. RESULTS Participants reported high preparedness for caring for immigrant patients (47/68, 69.1%) and lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTIQA+) patients (45/68, 66.2%), but low preparedness for patients with religious beliefs affecting treatment (only 20/68, 29.4% prepared) or health beliefs at odds with Western medicine (21/68, 30.9% prepared). Regarding skills, students felt most capable of assessing illness understanding (58/68, 85.3% skilled) and identifying English literacy (56/68, 82.4% skilled) but reported deficits in counseling patients about traditional and alternative medicine use (45/68, 66.2% lacking adequate skill) and identifying religious beliefs affecting care (42/68, 61.8% lacking adequate skill). Experiential learning, particularly community outreach and the Phelophepa Healthcare Train, was identified as the most impactful preparation for cross-cultural care. Content analysis identified 6 categories related to cross-cultural learning experiences: exposure to diverse patient populations, communication across cultures, developing cultural awareness and empathy, awareness of health inequities, informal and social learning, and gaps in structured training. CONCLUSIONS The optometry students demonstrated 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 the integration of formal training modules, reflective practice frameworks, faculty development, and expanded equitable access to diverse clinical placements.

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