Association between the frequency of treating foreign patients and the cultural competency of Japanese healthcare professionals: a mixed-method study

Background Previous studies have emphasized that interactions with foreign patients were associated with high cultural competence among Japanese healthcare professionals (J-HCPs), with little focus on the individual components of cultural competence. This study examines how frequencies of treating foreign patients are associated with the components of cultural competence among J-HCPs, using a mixed-method design. Methods Quantitative data were collected from 1089 J-HCPs via internet survey assessing cultural competence using the Cross-Cultural Competence Instrument for Healthcare Professionals (J-CCCHP), containing subscales, motivation/curiosity, emotion/empathy, attitude, and skill. Associations were stratified by the participation in trainings for treating foreign patients. Qualitative data were further collected from 16 key-informant interviews recruited by snowball sampling. Results J-HCPs who treated foreign patients several times a week (n = 203, 18.6%) scored a lower attitude score (coefficient = − 0.67, 95% Confidence Interval [CI] − 1.28, − 0.06), and a higher skill score (coefficient = 1.36, 95% CI 0.43, 2.29) compared to those who treated almost none. Those who treated foreign patients several times a year scored higher in motivation/curiosity, additionally. Qualitative studies explained that rewarding experiences and gaining extensive knowledge in treating foreign patients enhanced J-HCPs’ motivation/curiosity and skill. Stress due to extra workload, language barriers and cultural differences, insufficient resources and the lack of institutional support might lower the attitude of J-HCPs. Conclusions Treating foreign patients is associated with high motivation and skill but low attitude scores among J-HCPs, due to systemic challenges. Providing reliable interpretation services, offering practical cultural competence training, and strengthening institutional support may help reduce these challenges.