Malta : an ever-shifting cultural kaleidoscope : exploring cultural competence in doctors working in primary health care

Abstract

The increasing cultural diversity within populations presents healthcare systems with the challenge of delivering culturally sensitive care. Although cultural competence is widely recognised as essential, its consistent integration into practice remains limited. This study assessed the cultural competence of family medicine specialists in Malta’s Primary Health Care system, across both public and private sectors, by examining individual competencies and organisational strategies promoted by healthcare leaders. Guided by a pragmatic philosophy and an abductive research strategy, the study employed a concurrent mixed-methods design. Quantitative data were collected using the validated Healthcare Provider Cultural Competence Instrument (HPCCI) via an online survey sent to all eligible family medicine specialists. A total of 41 responses were received from 240 invited MMCFD members, yielding a response rate of 17.1%. Qualitative insights were drawn from seven semi-structured interviews with healthcare leaders and policy-makers from various roles within Primary Health Care. Findings revealed a gap between cultural awareness and its application. While most respondents acknowledged its importance, only 12.2% had received formal training. Younger and less experienced doctors scored higher in awareness and self-assessment, and willingness to engage in training was linked to more culturally responsive behaviours. Although the response rate was low, the findings align with existing literature, supporting their validity. Thematic analysis identified four core themes − Beyond the Textbook, Beyond Barriers, Beyond the White Coat, and Beyond the Present − highlighting conceptual inconsistencies, systemic barriers, emotional strain, and strong support for formal training. The study emphasises the need for longitudinal training, integration of culturally responsive practices into clinical routines, and policy reform to strengthen cultural competence in Malta’s evolving healthcare landscape.