Advancing the practice of cultural safety in physiotherapy: a scoping review.

Abstract

This scoping review synthesizes literature on cultural safety in physiotherapy, identifying recommended practices at individual, organizational and systemic levels. It also evaluates the extent of engagement with Indigenous Peoples to advance this work. Following up-to-date methodological guidance and reported according to PRISMA-ScR standards, a comprehensive search was conducted in September 2024 across MEDLINE, Embase, CINAHL and PsycINFO databases with no date restrictions. Grey literature, including regulatory guidelines, was also reviewed. Data were analyzed using a mixed deductive-inductive approach and a conceptual framework created comprising six cultural safety principles: (1) sharing power, (2) supporting cultural identity, (3) practicing critical reflexivity, (4) communicating safely, (5) supporting Indigenous leadership, and (6) building partnerships. These were examined using a socio-ecological lens across individual, organizational, and systemic levels. Among 39 documents reviewed, 72% addressed individual-level practices, 62% organizational and 44% systemic. Additionally, 41% involved Indigenous authorship or collaboration. Findings synthesize various practices aligned with cultural safety principles and identify emerging themes, including valuing time, creating space, and regulating cultural safety. This review highlights the need to shift from individual to broader organizational and systemic change. It offers a foundation for advancing cultural safety within physiotherapy practice.