Cultural Humility Practices in Occupational Therapy Services: A Scoping Review

Method

This article presents a substudy of a larger scoping review conducted of the existing health services literature on cultural humility (Singh et al., 2022). The protocol for the larger review has been published to ensure our review methodology was transparent. However, given the extent of the literature found in our database search and the opportunity to look more closely at occupational therapy practice, we report on the extent and nature of published literature on cultural humility in rehabilitation services as a separate study. Deviations from the protocol (Singh et al., 2022) that are specific to this substudy are outlined. The results of the larger scoping review will be published elsewhere. We present a brief overview of our methods, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines (Tricco et al., 2018).

Results

Duplicates were first removed. Next, we used a stepped screening approach in which articles were initially excluded if they did not specifically include the term cultural humility, with 1,123 studies advancing to title and abstract screening and 855 studies graduating to full-text review. During the full-text review stage, we further assessed articles for inclusion on the basis of their relevance to rehabilitation because we noticed a significant number of relevant articles at this stage. Studies that did not have a primary objective of defining, discussing, debating, or testing the concept of cultural humility in the context of rehabilitation services were excluded. Two additional studies were identified through the supplemental searching techniques (i.e., hand searching, forward and backward citation searching; see Figure 1 for the PRISMA flow diagram). In total, 11 studies were analyzed and included in this scoping review (see Appendix D in the Supplemental Material for study details).

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Figure 1.

Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram for new systematic reviews that included searches of databases and registers only.

Recommendations Related to the Practice of Cultural Humility as Defined by the CPPF

We identified recommendations for both societal and practice contexts, as well as frames of reference within the practice of cultural humility, following the CPPF structure (see Figure 2; Fazio et al., 2008). Supporting data and examples are listed in Table 2. Through the mapping process, we found that the majority of studies discussed cultural humility practices relating to the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF. Expanding beyond the client–therapist dynamic, practice recommendations in the studies emphasized therapists’ societal understanding of cultural humility. This includes acquiring knowledge of current practices and issues and maintaining critical reflexivity. As described in the included studies, the practice context involved both the therapist’s and the client’s personal and environmental factors.

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Figure 2.

Findings related to the Canadian Practice Process Framework structure.

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Table 2.

Findings Related to Cultural Humility Practices Identified in the Included Studies Mapped to Occupational Therapy Practice Using the CPPF

CPPF Components and Description	Findings
Societal context (n = 11; 100%): Broader societal context (i.e., cultural, institutional, physical, and social environment that individuals are situated within), outside of the client–therapist relationship	Understanding culture and cultural humility: ▪ Cultural difference is a relationship between the therapist’s and client’s equally valid worldviews (Beagan & Chacala, 2012). ▪ Rather than valuing neutrality with cultural competence, cultural humility and critical reflexivity value negotiation in the context of social power relations to “celebrate and embrace diversity as an asset” (Beagan & Chacala, 2012, p. 150). ▪ Culture shapes one’s beliefs and practices about disease, perception of symptoms, care that is pursued, and response to treatment (Leslie et al., 2021). ▪ Cultural humility is a desire to engage and seek justice with each person by their desires and needs identified through client-centered care (Aldrich et al., 2017). ▪ Cultural humility cannot be taught using didactic methods but is a practice skill (Agner, 2020). Current understanding, practice, and issues: ▪ Canadian view of best practice is a product of a specific, culturally embedded world review (Cleaver et al., 2016). ▪ Lack of cultural knowledge contributes to challenges in finding common ground (Bostick et al., 2021). ▪ Illness is a cultural and psychological construct influencing one’s perception and experience of health and disease (Leslie et al., 2021). New ways of thinking and practice: ▪ Self-reflection and recognition of how biases are aligned with dominant cultural narratives (Agner, 2020; Bangs et al., 2022; Beamish et al., 2024). ▪ Cultural training to gain knowledge of cultural traditions and norms, engaging in a lifelong process of learning and self-reflection, not presuming cultural preferences, awareness of culture’s influence on individuals, respecting individual differences within groups, and recognizing bias (Leslie et al., 2021). ▪ Increase training, cultural liaisons from local communities, specialist goals of care, language interpreters, improved workplace diversity, and community-level advocacy (Barnes et al., 2020). ▪ Leave behind the mastery-oriented concept of cultural competence and embrace cultural humility and how our actions contribute to health disparities and power imbalances (Cleaver et al., 2016). ▪ Understand one’s own cultural identities and inherent biases and how they affect clinical practice (Leslie et al., 2021). ▪ Embrace cultural humility to improve clinical communication, and advocate for roles within interdisciplinary teams (Barnes et al., 2020). ▪ Recognize the vision, objectives, and mandates of the profession (Barnes et al., 2020). ▪ Understand oneself first and form diverse perspectives to build trustworthy relationships with others; value diverse perspectives to appreciate the full picture of each individual (Hall & Johnson, 2020). ▪ Introspection leads to negative emotions, internal conflicts, or dilemmas that should be addressed and embraced (Agner, 2020). ▪ Be a lifelong learner with no fixed endpoint (Agner, 2020). ▪ Journaling-based cultural humility to increase awareness of and perspective on learning instead of knowing (Agner, 2020).
Practice context (n  = 10; 90.9%): Occupational therapist’s and client’s personal (e.g., health, age, gender, ethnicity, personal nature and temporal aspects, knowledge, skills, abilities, perspectives) and environmental (e.g., physical, social, cultural, institutional) contexts	Therapist: ▪ Engaging in ongoing, reflective practice through a cultural humility lens can lead to useful insights and actions (Agner, 2020; Bangs et al., 2022; Beamish et al., 2024; Cleaver et al., 2016). ▪ Reflect on biases, values, and cultural assumptions; be willing to relinquish the role of the expert to the client to create an environment that is open, respectful, and acknowledging of health care disparities (Bostick et al., 2021). Less of “them vs. us” and more of what matters most to the client, becoming egoless, thinking of yourself as less and others as more (Hall & Johnson, 2020; Leslie et al., 2021). ▪ Remove the clinician as the authority and instead place them as an attentive supporter (Barnes et al., 2020). Relationship: ▪ Make attention to power central to explorations of culture and diversity (Beagan & Chacala, 2012). ▪ Offer expertise while acknowledging potential biases and empowering clients to make clinically informed decisions (Leslie et al., 2021). ▪ Establish clear boundaries between clinical knowledge and client autonomy (Leslie et al., 2021). ▪ Recognize that age, education, gender identity, and degree of acculturation can affect client–clinician communication (Leslie et al., 2021). ▪ Recognize that clinician and client perspectives are culturally rooted; operate within institutions and systems with subcultures that shape views and opportunities that may or may not promote health (Agner, 2020). ▪ Only clients can determine whether therapists are delivering culturally safe services; cultural humility can enhance the possibility that practices are safe (Hammell, 2013). ▪ Redress power imbalances in client–therapist relationships; cultural differences lie within the client–therapist relationship (Hammell, 2013).
Action Point 1—Enter and initiate (n = 2; 18.2%): Receive referral and identify client–stakeholder; begin first point of contact and establish therapeutic relationship with client; obtain informed consent by providing client enough information to make an informed decision	Review client’s history: ▪ Focus on preferred pronouns, gender, identity, social factors, religion, education level, primary language spoken, and caregiver support (Barnes et al., 2020). ▪ Do not make assumptions based on client’s demographic information (Barnes et al., 2020). Communication: ▪ Mitigate communication barriers (e.g., augmentative and alternative communication, amplification devices, interpreter or translator, literacy skills; Barnes et al., 2020). ▪ Engage in a shared decision-making process to obtain consent (e.g., nature of the treatment, costs, benefits, alternatives; Leslie et al., 2021).
Action Point 2—Set the stage (n  = 4; 36.4%): Discuss client’s occupational history and life course narrative; determine occupational issues and goals; engage in rapport building with client; discuss rules, expectations, roles, and responsibilities	Involving family: ▪ Interview both client and family members to understand how the client’s cultural background influences their values, beliefs, health behaviors, and goals. Explore internal and external factors influencing client and caregiver behavior (e.g., historical, geographical, social, political, generational, and gender factors; Bangs et al., 2022; Leslie et al., 2021). ▪ Ask for client’s and family’s preferences for clinical decisions instead of assuming cultural values and overgeneralizing experiences (Hall & Johnson, 2020; Leslie et al., 2021). ▪ Explore goals before discussing intervention; allow client and family the opportunity to digest information and ask their own questions (Hall & Johnson, 2020; Leslie et al., 2021). ▪ Involve caregivers and inform them of the client’s care (Hall & Johnson, 2020). Communication: ▪ Engage in truth telling (e.g., disclosure of terminal prognosis) using SPIKES (setting, perception, invitation, knowledge, emotions, summary) to evoke the client’s understanding of the situation and demonstrate unconditional positive regard and affirmation of the person’s cultural perspective (Barnes et al., 2020). ▪ Use the acronym PREPARE (preparing for adequate time and privacy, relating to the person with compassion and empathy, eliciting client preferences, providing information tailored to client needs, fostering realistic hope, encouraging questions, documenting results in the client’s medical record; Barnes et al., 2020). Attitude: ▪ Acknowledge cultural differences and be open to discussion about cultural beliefs; explore how culture and ethical beliefs may be influencing the client’s decision making and actions (Hall & Johnson, 2020). ▪ Show client and family your desire to know, understand, and value their viewpoints for use in care planning (Hall & Johnson, 2020). ▪ Be comfortable with discussing conflict and tension; understand how culture and ethics influence the situation (Hall & Johnson, 2020).
Action Point 3—Assess and evaluate (n = 6; 54.5%): In-depth assessment of person, environment, and occupation factors affecting the client’s occupational issues and goals; share potential recommendations; determine whether further intervention is required	Assessment techniques: ▪ Approach the client with dialogical approaches, open-ended questions about goals, and questions illustrating how systemic pressures affect the client (Agner, 2020; Hall & Johnson, 2020). ▪ Assess pain using intensity, function, and work (Bostick et al., 2021). ▪ Use active listening and the principle of “ask, don’t tell” (Bangs et al., 2022; Leslie et al., 2021). ▪ Ask for specific information to understand the client’s concerns, ask one question at a time, mirror the client’s body language, take minimal notes to maintain a conversational tone, and go slowly (Hall & Johnson, 2020). ▪ Use motivational interviewing, dialogue that is client centered and explores behavior change (Barnes et al., 2020). Attitude: ▪ Understand that there is no universal language to communicate pain and that pain metaphors and descriptors can have different meanings depending on culture and experience (Bostick et al., 2021).
Action Point 4—Agree on objectives and plan: (n = 4/11; 36.4%): Develop occupational goals, objectives, and plan collaboratively with client and stakeholders	Clinical reasoning: ▪ Create alternative courses of action that are mutually beneficial and nonpaternalistic, consider others’ rationale for conducting treatment, and engage in cultural humility to reveal considerations and opportunities that are not apparent (Cleaver et al., 2016). ▪ Incorporate first-person perspectives to develop meaningful and client-centered interventions (Bostick et al., 2021). ▪ Consider nurturing and passive treatment rather than promoting independence and autonomy (Bostick et al., 2021). Decision-making: ▪ Engage in shared decision-making in a sociocultural context and with a polyocular view (acknowledging and valuing all members of a group; Hall & Johnson, 2020; Leslie et al., 2021). ▪ Find a middle ground and compromise with the client and family during the decision-making process (Hall & Johnson, 2020). ▪ Prioritize the client’s and family’s goals and promote shared decision-making with client-centered care (Hall & Johnson, 2020; Leslie et al., 2021). Involving family: ▪ Explain medical problems in client-friendly language to enable understanding of the rationale for and duration of treatment and increase client and family buy-in for treatment (Leslie et al., 2021). ▪ Involve family members in goal setting, decision-making, and caregiver training to promote treatment adherence (Leslie et al., 2021).
Action Point 5—Implement the plan (n = 3; 27.3%): Develop occupational care plan collaboratively with client, stakeholders, or both	Incorporating culture: ▪ Integrate traditional ideas about wellness to increase the likelihood that clients will engage in interventions (Bangs et al., 2022; Bostick et al., 2021). ▪ Address cultural and linguistic impediments to communication, and incorporate relevant cultural values and beliefs into intervention (Bostick et al., 2021). ▪ Recognize psychosocial and cultural factors affecting participation in treatment (Leslie et al., 2021). Involving family: ▪ Train caregivers to promote treatment adherence (Leslie et al., 2021).
Action Point 6—Monitor and modify (n = 1; 9.1%): Ongoing evaluation to determine whether plan is meeting objectives, making modifications as needed	▪ Check in often, reassess, and make changes to plan as needed (Leslie et al., 2021).
Action Point 7—Evaluate outcome: Evaluate whether occupational goals were met and identify further goals, objectives, or plans as needed	No data pertaining to this stage were identified in the included articles.
Action Point 8—Conclude and exit: Conclude the therapeutic relationship; refer client to other resources; discuss reentry	No data pertaining to this stage were identified in the included articles.
Frames of reference (n = 3; 27.3%): Theories, models, constructs, concepts, and practice lenses guiding the understanding of occupational challenges and clinical decision-making	▪ Cultural processes influence views on illness and health (Leslie et al., 2021). ▪ Culture as an important concept within models of occupation (Hammell, 2013). ▪ Cultural humility in theoretical development to facilitate inclusivity and reduce ethnocentrism (Hammell, 2013). ▪ Challenge dominant models that depict cultural environments as external to and divisible from the person (Hammell, 2013). Discuss occupational therapy using a justice lens, considering cultural humility (Aldrich et al., 2017).

Note. CPPF = Canadian Practice Process Framework.

Practice recommendations pertaining to CPPF that were less represented in the studies included Action Point 1 (enter and initiate; n = 2; 18.2%), Action Point 2 (set the stage; n = 4; 36.4%), Action Point 5 (implement the plan; n = 3; 27.3%), Action Point 6 (monitor and modify; n = 1; 9.1%), and frames of reference (n = 3; 27.3%), each of which was discussed in fewer than 40% of the included studies. CPPF Action Points 3 (assess and evaluate; n = 6; 54.5%) and 4 (agree on objectives and plan; n = 4; 36.4%) were discussed moderately, with more than 40% of studies providing cultural humility practice recommendations for these action points.

In cultural humility’s practical application, therapists, as noted in the studies, entered and initiated by reviewing the client’s history, avoiding assumptions, and ensuring effective communication for shared decision-making and obtaining consent (Barnes et al., 2020; Leslie et al., 2021). The studies described the practice of cultural humility in Action Point 2 (set the stage) as effective communication; the therapist’s attitude when interacting with clients; and involving the family when discussing the client’s cultural background, goals, and preferences for making clinical decisions and involvement in the client’s care (Bangs et al., 2022; Hall & Johnson, 2020; Leslie et al., 2021). For CPPF Action Points 3 (assess and evaluate) and 4 (agree on objectives and plan), the studies described the practice of cultural humility as a collaboration between the client and therapist to determine the client’s goals and interventions on the basis of in-depth assessments of the client (i.e., person, environment, occupation; Townsend & Polatajko, 2013) and person-centered communication during assessments (e.g., asking open-ended questions, addressing how systemic pressure affects the client, and active listening). Some studies (Agner, 2020; Bangs et al., 2022; Bostick et al., 2021; Hall & Johnson, 2020; Leslie et al., 2021) emphasized the importance of therapists adopting sensitive attitudes. Some studies described the practice of cultural humility in Action Point 4 as related to clinical reasoning and decision-making (e.g., creating nonpaternalistic solutions that may not be apparent by engaging in cultural humility, considering nurturing and passive treatment rather than prioritizing independence and autonomy, coming to a compromise with the client and family when making decisions; Bostick et al., 2021; Cleaver et al., 2016; Hall & Johnson, 2020; Leslie et al., 2021). In addition, the practice of cultural humility described in the studies acknowledged the importance of involving the family in the decision-making process and promotion of treatment adherence (Leslie et al., 2021).

For Action Point 5 (implement the plan), studies described the practice of cultural humility as involving family and incorporating cultural factors into the intervention, such as integrating the client’s cultural values, beliefs, and traditional ideas about wellness and addressing barriers to communication, all of which can affect participation and engagement (Bangs et al., 2022; Bostick et al., 2021).

One study (Bostick et al., 2021) described the practice of cultural humility in Action Point 6 (monitor and modify) as checking in often on the client’s progress, reassessing, and making changes to the intervention as needed. No data from the included studies pertained to Action Points 7 (evaluate outcome) and 8 (conclude and exit).

Frames of reference related to the practice of cultural humility that were discussed in the included studies included considering culture within models of occupation, cultural processes and the influence they have on illness and health, challenging dominant models that depict cultural environments as external to and divisible from the person, and discussing occupational therapy using a justice lens (Aldrich et al., 2017; Hammell, 2013; Leslie et al., 2021).

Discussion

This scoping review aimed to provide a comprehensive synthesis of the peer-reviewed rehabilitation services literature on the practice of cultural humility and to align these findings to occupational therapy practice using the CPPF. In total, the review included 11 articles. We identified several elements that inform the definition of cultural humility in the context of rehabilitation services. Moreover, we identified only six of the eight action points, societal and practice contexts, and frames of reference components of the CPPF. In light of our findings, it is evident that integrating cultural humility into CPPF Action Points 7 and 8 is crucial to assessing and concluding therapeutic relationships in a culturally relevant manner. Interestingly, Element 5, which addresses broader systemic and structural injustices, was less frequently discussed in the articles. This finding highlights a potential limitation in the practical application of the framework, in which individual-level interactions are prioritized over confronting systemic issues. This observation aligns with our broader critique of the framework, suggesting that although individual self-reflection is crucial, it cannot be fully effective without addressing the structural forces that shape inequities in health care. By considering and incorporating cultural humility, occupational therapists can ensure that outcomes are evaluated and therapeutic relationships are concluded in a manner that respects and embraces the diversity of clients’ cultural backgrounds and experiences.

In our examination, we found that discussions of cultural humility predominantly focused on elements such as self-awareness, supportive interaction, and self-reflection. Conversely, less attention was given to aspects such as lifelong learning, commitment, recognizing and addressing power dynamics, and openness. Our review suggests that cultural humility entails recognizing one’s privilege, knowledge, and advantages as a professional while also acknowledging the influence of personal history and societal values on one’s perspectives. Cultural humility emphasizes self-awareness (Barnes et al., 2020; Beagan & Chacala, 2012; Beamish et al., 2024; Hammell, 2013), openness to diverse perspectives, and the acknowledgment of not being all-knowing (Aldrich et al., 2017; Cleaver et al., 2016; Hammell, 2013; Leslie et al., 2021). Many studies in the health care literature, including those beyond the scope of rehabilitation, corroborate our finding that cultural humility encompasses both an awareness of cultural differences and a recognition of the limits of one’s understanding of another culture (Agner, 2020; Ahmed et al., 2018; Campinha-Bacote, 2019; Hilty et al., 2021; Hook et al., 2013). Because cultural humility is being adopted by several health disciplines, short-term, immediate recommendations may involve allowing for time in scheduling to allow the clinician to partake in active listening that prioritizes clients’ stories and concerns, fostering a culture that values linguistic and cultural diversity through use of interpreters (Butow et al., 2011), and mandating the development of culturally tailored care plans that respect clients’ values and identities (Torres-Ruiz et al., 2018). These recommendations point to the necessity for system-level changes that would yield benefits not only for occupational therapists but also for other rehabilitation professionals. We also recognize that our study findings could contribute to a continuum of education on cultural humility for occupational therapy students and practitioners. The conclusions drawn from our study may inform educational approaches aimed at integrating cultural humility into clinical practice.

As conceptualized by Tervalon and Murray-García (1998), cultural humility has evolved significantly in its application to occupational therapy practice. Although their core principles of self-reflection, addressing power imbalances, and lifelong learning remain relevant, the occupational therapy context necessitates some adaptations (Anderson, 2022). Recent scholarship has expanded on these ideas, emphasizing the need for occupational therapists to critically examine their own cultural assumptions and biases within the specific framework of occupation-based practice (Agner, 2020). Furthermore, the field has moved beyond simply acknowledging power differentials to actively working to dismantle them through client-centered goal setting and intervention planning (Greene-Moton & Minkler, 2020). Current understandings of cultural humility in occupational therapy also place greater emphasis on the therapist’s role in advocating for systemic change to address health disparities, going beyond the individual patient–provider interaction that Tervalon and Murray-García (1998) initially focused on (Lekas et al., 2020). This evolution reflects occupational therapy’s holistic view of health and well-being, as well as its commitment to social justice and equity in health care delivery.

Our review revealed a significant gap in the identification of cultural humility practices aligning with the CPPF Action Points 7 (evaluate outcomes) and 8 (conclude and exit). Integrating cultural humility within these action points is key to assessing and concluding therapeutic relationships in a culturally relevant manner. As research has ascertained, cultural factors can significantly influence how people perceive and measure success (Chipulu et al., 2014), and, without a culturally humble approach, there is a risk of misinterpreting or undervaluing the outcomes from the client’s perspective (Choe et al., 2023; Sandage et al., 2016). Moreover, cultural factors can influence how individuals approach, perceive, and expect the conclusion of therapeutic interventions (Comas-Díaz, 2006). A culturally humble approach ensures that the decision-making process respects and integrates diverse cultural perspectives, fostering a more respectful and effective conclusion to the therapeutic relationship. By considering and incorporating cultural humility, occupational therapists can ensure that outcomes are evaluated and therapeutic relationships are concluded in a manner that respects and embraces the diversity of clients’ cultural backgrounds and experiences.

In recognizing the limitations of assuming that individual actions alone, such as incorporating cultural humility, can fully address systemic barriers in health care systems, it is imperative to acknowledge and address broader institutional policies, funding structures, and societal factors that contribute to disparities in health care access and delivery. Although cultural humility may support more effective therapeutic relationships and improve outcomes on an individual level, it is imperative to recognize that it alone is not a sufficient response to address ingrained sociocultural structures of inequity (Alegría et al., 2010). These structures encompass systemic biases, discriminatory policies, unequal access to resources, and historical injustices that disproportionately affect marginalized communities (Alegría et al., 2010; Egede et al., 2024). Although cultural humility can facilitate more equitable interactions in therapeutic settings, it does not address the root causes of these structural inequities. Instead, policy should, for example, promote equity in health care access, such as expanding Medicaid coverage (Artiga et al., 2015), implementing antidiscrimination laws, and ensuring culturally competent care standards (Anderson et al., 2003).

Although improvement in cultural humility may be a difficult concept to measure through empirical means (Foronda et al., 2018), researchers have suggested that the process of developing cultural humility can be characterized by a transformation in attitudes, beliefs, and behaviors (Patallo, 2019). In the context of rehabilitation practice, a pragmatic approach to evaluating the ongoing development of cultural humility could involve mixed-methods research designs that combine qualitative approaches, such as in-depth interviews and participant observations, with quantitative self-assessment tools, such as the Cultural Humility Scale (Gonzalez et al., 2021) or the Intercultural Development Inventory (Hammer et al., 2003). Longitudinal studies that track changes in cultural humility can provide a nuanced understanding of its developmental trajectory across providers’ careers (Choe et al., 2023). In the context of occupational therapy, the use of standardized measures for cultural humility can serve as a valuable tool to assess the adoption of cultural humility practices. However, it is essential to emphasize that for this approach to be effective, occupational therapists must thoroughly comprehend the concept and be genuinely committed to its significance (Piernik-Yoder & Beck, 2012).

In keeping with the CPPF, we found that the available literature was most abundant in the context of recommendations regarding the societal and practice contexts of the CPPF, rather than a single stage of the process. This emphasis underscores the intricate nature of cultural humility’s integration and the challenge of isolating discrete recommendations tailored to distinct therapeutic stages (Tervalon & Murray-García, 1998). The ethos of cultural humility asserts a continuous learning trajectory that permeates every facet of therapeutic engagement—before, during, and after the therapeutic process (Tervalon & Murray-García, 1998). As such, each therapeutic stage requires attention to culture, because cultural humility’s essence lies in its perpetual relevance across all action points of therapeutic processes. Although the CPPF presents a valuable foundation for comprehending how cultural humility is currently operationalized in existing occupational therapy practice frameworks, it might be helpful to support its integration in other practice models commonly used by occupational therapists worldwide.

The intercultural caring abductive model emphasizes community and family involvement and describes caring and culture across three dimensions: ontology, phenomenon, and care activities (Wikberg & Eriksson, 2008). Similar to relational definitions of cultural humility, the model emphasizes that caring occurs within the clinician–client relationship, influenced by both parties’ cultural backgrounds and the client’s family (Haora, 2020; Listerfelt et al., 2019; Wikberg & Eriksson, 2008). This alignment suggests that occupational therapists could draw from the model’s perspective to effectively craft interventions that align with clients’ experiential understanding of care, ensuring meaningful and culturally relevant engagement. Furthermore, the focus on care activities highlights the concrete actions that facilitate care delivery (Wikberg & Eriksson, 2008). Recent studies have highlighted the importance of family-centered care and inclusive care in the context of cultural humility (Lechner et al., 2024; Parente et al., 2023). Therapists can draw parallels between this dimension and the inclusive approach of family-centered care, acknowledging the impact of cultural beliefs and expectations on care interpretation while also recognizing variations in power dynamics. Data from our review focusing on family involvement addressed multiple action points of the CPPF, including Action Points 2 (set the stage), 4 (agree on objectives and plan), and 5 (implement the plan). This finding suggests the possibility of incorporating the intercultural caring abductive model and other family-centered occupational therapy models with cultural humility practices into clinical practice to meaningfully involve the family in the therapeutic process. For example, occupational therapists should consider drawing parallels between the inclusive approach of family-centered care and cultural humility, recognizing that the family’s cultural beliefs and expectations significantly influence their interpretation of care activities. Moreover, by recognizing the family’s cultural background, values, and contributions, occupational therapists can create a holistic care plan that extends beyond the individual client to encompass the broader support network.

Strengths and Limitations

This study involved a rigorous search of the literature for relevant studies, including having a medical librarian search several databases. The large research team involved in conducting this study had a diverse range of experiences, cultures, ethnicities, ages, and educational backgrounds. Thus, the analysis and findings of this scoping review were enriched through rigorous peer review and conversations among the research team.

Rather than aiming to search and analyze all health literature, we focused on rehabilitation practice settings. One limitation of our study is the narrow focus on core rehabilitation services, namely occupational therapy, physical therapy, and speech-language pathology, which may have excluded valuable insights from related but noncore rehabilitation services. Another limitation of this study is the potential lack of generalizability of our findings to the broader field of occupational therapy because of the inclusion of articles from other rehabilitation services.

During coding, interpretation issues were resolved in regular team meetings, preventing the exclusion of relevant studies. Studies equating cultural humility with competence were excluded to maintain the study’s cultural humility focus. There is a possibility that pertinent studies were missed because our research team determined whether articles were focused on cultural humility, potentially leading to the exclusion of relevant research.

Data that did not align with the CPPF were not coded for inclusion in the analysis. However, we recognize the importance of thoroughly examining all data and will conduct further analysis to explore any insights that may inform the refinement of the CPPF or suggest areas for future study. Future research should consider evaluating different frameworks and models to assess their applicability in capturing the full scope of cultural humility in rehabilitation practice. Future research should also involve a more detailed exploration of how cultural humility can be incorporated into Action Steps 7 and 8. Although the CPPF was selected for its relevance to rehabilitation practice settings, some literature may have been better captured by alternative frameworks that may offer a more comprehensive understanding of cultural humility. Specifically, the lack of literature related to CPPF Action Steps 7 and 8 suggests that these steps may not fully align with or address the complexities of cultural humility as discussed in the broader literature. This could indicate a need to explore other models that might provide a more nuanced view and better capture the diverse aspects of cultural humility. Another area of future research is to examine studies related to cultural humility education. Early in the screening process, the research team identified an overwhelming number of articles that exceeded the scope of analysis for a single article; thus, we decided to focus this substudy solely on rehabilitation service practice-related articles. It is important to capture not only how cultural humility is practiced but also how it is integrated into the education of the next generation of therapists.

Implications for Occupational Therapy Practice

The findings of this review highlight the importance of integrating cultural humility into occupational therapy practice to enhance client-centered care and align with professional standards, particularly through the lens of the CPPF. The review has the following implications for occupational therapy practice:

▪ By emphasizing self-awareness, supportive interactions, and reflective practice, occupational therapists can foster respectful and collaborative therapeutic relationships. This includes acknowledging and addressing power imbalances, incorporating clients’ cultural values and beliefs into care plans, and adopting lifelong learning approaches to better understand cultural diversity.

Conclusion

This scoping review aligns cultural humility practice recommendations with an established occupational therapy framework, offering valuable guidance for occupational therapy clinicians and researchers. Cultural humility should permeate occupational therapy practice, enhancing service quality, cross-cultural interactions, and client outcomes through shared research and knowledge development.

Supplemental Material