Indian Journal of Oral Health and Research

: 2020  |  Volume : 6  |  Issue : 1  |  Page : 12--15

Assessment of cross-cultural competency among dental interns: An exploratory study

Thounaojam Leimaton, Simarpreet Singh, Manu Batra, Deeksha Gijwani, Sakshi Shukla, Parul Mangal 
 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

Correspondence Address:
Dr. Thounaojam Leimaton
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan


Aims: The study aims to quantity the variation in dental interns' self perceived levels toward cultural competence. Settings and Design: A cross-sectional study was conducted among 84 dental interns from dental college during December 2019. Subjects and Methods: 84 dental interns were participated from college during the month of December for this study. Data were collected through interview using pretested and prevalidated form, consisting of demographic variables such as age, gender, and community with cross-cultural care survey that concerning about the ability to deliver diverse patient's care. Statistical Analysis Used: The statistical analysis was done using SPSS software, and mean, standard deviation, paired t-test and Analysis of Variance (ANOVA) test were applied for the analysis of the data, and the level of significance was set at P < 0.05. Results: It showed that males had significantly higher mean ± SD knowledge (3.29 ± 0.60), skill (3.55 ± 0.52), and attitude (3.32 ± 0.51) scores, respectively, as compared to females; however, while comparing the various domains on the basis of religion factor, the difference was not found statistically significant. Conclusions: The current study suggests that cultural competence knowledge, skill, and attitude of the study participants were inadequate. Hence, there is a need to conduct training programs for interns to enlighten them on the sensitive issue of cross-cultural competency in oral health services.

How to cite this article:
Leimaton T, Singh S, Batra M, Gijwani D, Shukla S, Mangal P. Assessment of cross-cultural competency among dental interns: An exploratory study.Indian J Oral Health Res 2020;6:12-15

How to cite this URL:
Leimaton T, Singh S, Batra M, Gijwani D, Shukla S, Mangal P. Assessment of cross-cultural competency among dental interns: An exploratory study. Indian J Oral Health Res [serial online] 2020 [cited 2023 Oct 4 ];6:12-15
Available from:

Full Text


India is one of the vast countries with amazing features and diversity in terms of its topographical, language, religious, and social-cultural features.[1] As the patients become progressively diverse, medical field becomes progressively complex, so medical education has need to cultivate new approaches for future physicians to address these encounters. It is high time to enlighten the knowledge of healthcare providers' ability to deal with different culture patients. This has been focused on those who suffered worse health outcomes in healthcare by the recognition of minorities group and other vulnerable populations among diverse patients.

Changing demographics demand that dentists must be organized to treat a different patient population. Increase in race, ethnic, and cultural diversity makes evident that the requirement of cultural competence is to call for action in the healthcare segment.

The word cultural competence was first coined by Terry L. Cross and colleagues in 1989.[2] Cultural competence is the ability to interact effectively with people from diverse cultures.[3] This ability depends on the information of other cultural observes, awareness of one's own ethnic worldview, and tolerant approaches toward cultural differences and skills.[3] Developing cultural competence results in an ability to work with varying cultural beliefs and schedules and to communicate and comprehend with people across cultures.[3] In healthcare, the goal is to offer optimal care to patients and to decrease health disparities irrespective of their race, gender, ethnic background, cultural beliefs, etc.

The quality of care, patient safety, patient resources, and their oral health may be compromised because of failure to improve cultural competency of oral healthcare providers.[4] To provide health care, an educational movement “cross-cultural care” has emerged which comprises skilled and knowledgeable authorities that can effectively care for diverse populations.[5]

Knowledge of cultural competence must be retained by the oral healthcare providers to tend to the diverse population, in a culturally and linguistically suitable manner. The present research was ended to quantify the variation in interns' self-perceived levels toward cultural competence.

 Subjects and Methods

The present study was conducted among the dental interns from Dental Institute, Sri Ganganagar, Rajasthan, during December 2019. Ethical approval was obtained to conduct a study from the ethical committee of the institution. Inclusion criteria were those who agreed to give the written consent to participate in the study. Participants who had not submitted written consent and was absent on the day of the study were excluded. Hence, the final sample size of 84 students was obtained as 12 participants did not give written consent and the response rate was of 88%.

Data were collected through face-to-face interview using pretested and prevalidated form, consisting of demographic variables with the cross-cultural care survey (CCCS),[6] concerning about the skill, knowledge, and attitude for delivering care of diverse patients. This survey is intended to help health workers better comprehend people's health beliefs and expectations about the therapeutic process. Eight-four participants completed 18 close-ended questionnaires of CCCS, related to their general perspectives on culturally competent care, their own levels of cultural competence, and their experiences working with multicultural patients in the workplace. The cross-cultural knowledge, skill, and attitude show preparedness for the communication, treatment, and empathy with regard to different culture and religious beliefs.[7]

Knowledge domain indicating perception of preparedness to diverse patients care was recorded with response choices: 1 for “very unprepared;” 2, “somewhat unprepared;” 3, “somewhat prepared;” 4, “well prepared;” and 5, “very well prepared.” Skill domain includes score by 1 for “not at all skillful” to 5 for “very skillful”. For the attitude domain, items were scored using a 4-point Likert-liked scale ranging from 1 “not at all important” to 4 “very important.”[8] Higher score indicates higher culturally competent.

Data were analyzed with SPSS Statistics Windows, version 21.0 (IBM Corp., Armonk, NY, USA). The statistical analysis was determined by mean, standard deviation (SD), analysis of variance test, and paired t-test, and the level of significance was set at P < 0.05.


[Table 1] shows the demographic characteristics for the internship undergraduate students who participated in this study. The study sample comprised males (45.2%) and females (54.8%). Based on their communities, the number of the participants were from Hindu (56%), followed by Sikh (25%), Christian (7.1%), Muslim (4.8%), Donyi Polo (4.8%) and Buddhist (2.4%) for this study.{Table 1}

[Table 2] shows the comparison of mean scores of knowledge, skill, and attitude based on their gender. The mean ± SD knowledge was found higher in male (3.29 ± 0.60). The mean ± SD skill was found higher in male (3.55 ± 0.52) than in female. The mean ± SD attitude was found higher in male (3.32 ± 0.51). Hence, the results were found to be statistically significant.{Table 2}

[Table 3] presents the comparisons of mean scores of knowledge, skill, and attitude based on their religious beliefs. The mean ± SD skill was more higher seen in Buddhist sect (3.76 ± 0.47). The mean ± SD knowledge was more seen higher in Sikh sect (3.40 ± 0.57). The mean ± SD attitude was more seen higher in Muslim sect (3.63 ± 0.25). The results were found to be non-statistically significant.{Table 3}


Cross-cultural educational initiatives for professionals were become common across various sectors including health care. At an individual level, it could be observed that capability to recognize and challenge one's cultural traditions and principles.[9] At present, it has slowly gained attention in the healthcare segment and have appeared as one of the key approaches to address the disparities in healthcare. Hence, the present study was conducted to understand the perspectives of intern students among diverse patients, using the validated CCCS.

As the present study has been conducted in Sri Ganganagar city of India, the majority of the participants were from Hindu and Sikh communities.

In the current study, the comparison was done between the knowledge, skill, and attitude scores among dental interns based on their gender. Male had higher knowledge, skill, and attitude than female. Similar study done by Lopez et al.[10] showed similar kind of results, where males self-reported better perceived preparedness than females, particularly in cross-cultural needs and skills.

Although participants from the Sikh, Buddhist, and Muslim communities showed higher scores as far as knowledge, skill, and attitude were concerned, the results were not statistically significant. All communities had comparable mean scores for knowledge, skill, and attitude toward cultural competence care.

Dental colleges must strive to prepare their students in these areas. Oral healthcare providers must be culturally competent to treat advice and interconnect with diverse patients.[11] Dental students must have knowledge regarding the quality of healthcare toward diverse patients with different cultures, beliefs, and customs.

In healthcare, cultural competence was a necessary method and idea to design, deliver, and the policies, programs, and actions in public health system. The decision to embrace the developed guidelines is left to the discretion of the practitioner as no framework has been projected by the government in this regard. India is still in procedure of implementing it, though other countries have verified the cultural competence as an effective method to decrease the healthcare disparities.[12] Cultural competence will develop the symbol of high-quality public health systems, programs, and research, with increasing diversity of population globally.[13]

Our study had several limitations that include the study was conducted at a single academic institution although incoming students were from a wide variety of social and different backgrounds from various parts of India, and also, there might have been played a role of biased on the respondents of the participants. A better understanding and interpretation of cross cultural competence can be obtained from longitudinal studies in the future.


Developing strong working relationships with diverse communities will provide the ability to increase cultural involvement experiences to improve cultural competence of students. Participants are accompanied with being less prepared for various features of cross-cultural care. This underscore highlights the need to conduct training programs for interns to enlighten them on the sensitive issue of cross-cultural competency in oral health services and systems. Our determination to measure students' self-assessment regarding on their diverse patients care is an early footstep for upcoming research.


We would like to thank to the Surendera Groups of Institution for their support and all the interns who have participated in the study, without whose cooperation this research work would not have been successful.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1What is the Diversity of India? Available from: [Last accessed on 2019 Oct 19].
2Cross TL, Bazron BJ, Dennis KW, Isaacs MR. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Vol. 1. Washington: Georgetown University Child Development Center, CASSP Technical Assistance Center; 1989. p. 1-96.
3Alpert RT. Cultural Diversity in the Workplace. Available from: [Last accessed on 2019 Oct 18].
4Newcomb TL, Sokolik TL. Cultural competence: How to incorporate different cultural beliefs and practices into the dental hygiene process of care. Dimens 2012;10:58-61.
5Betancourt JR. Cultural competence – Marginal or mainstream movement? N Engl J Med 2004;351:953-5.
6Weissman JS, Betancourt EG, Campbell ER. Resident physicians' preparedness to provide cross-cultural care. JAMA. 2005; 294:1058-67.
7Park ER. Measuring residents' perceived preparedness and skillfulness to deliver cross-cultural care. J Gen Intern Med 24:1053-56.
8Park, Chun MB J et al. Using the Cross-Cultural Care Survey to Assess Cultural Competency in Graduate Medical Education. JGME. 2010;2:96-01.
9Flores G. Culture and the patient physician relationship: Achieving cultural competency in health care. J Pediatr 2000;136:14 23.
10Lopez et al. Resident Physicians' Self Perceptions of Preparedness to Deliver Cross-Cultural Care. J Gen Intern Med. 2008;23:1953-48.
11Betancourt JR, Green AR, Carrillo JE. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports. 2016;118:293-02.
12Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Serv Res 2014;14:99.
13Kumar R, Bhattacharya S, Sharma N, Thiyagarajan A. Cultural competence in family practice and primary care setting. J Family Med Prim Care 2019;8:1-4.