Barriers to Practising Cultural Humility During Health Service Delivery: A Qualitative Study of Nigerian Providers

Abstract

Cultural humility, an approach to care that is rooted in self-reflexivity, regard for patients’ lay expertise, and openness to sharing power with patients, is pivotal in delivering health services to people with diverse sociocultural characteristics. Without cultural humility in clinical encounters between health care providers and patients, illnesses may be treated, but the patients are poorly understood. This work investigates the barriers to practising cultural humility among healthcare workers in Nigeria, a culturally diverse country. A qualitative online survey collected data from 52 health professionals between May and July 2024. Participants were recruited across primary, secondary and tertiary health facilities, as well as across the six geopolitical zones in Nigeria, to enable the transferability of findings. Purposive sampling was employed for selection. Thematic analysis was performed on the data, and member checks were used to ensure rigour and trustworthiness. The barriers are categorised into human resources for health, patient, and leadership and governance levels. The obstacles within human resources for health include the lack of training on cultural humility, shortage of health workers, low motivation among service providers resulting from poor remuneration, and limited cultural and religious diversity among providers, as well as among leadership actors in the health system. The patient-level hindrances encompass patients’ limited English proficiency and reluctance to engage in open dialogue about their cultural backgrounds and health care preferences during clinical encounters with health professionals. Finally, the barrier at the leadership and governance tier stems from hierarchical organisational culture. These findings not only underscore the urgency of reform but also provide a roadmap for fostering a culturally sensitive health system.