Journalistic cultural competence for health journalists: A systematic review and overview of reviews using concept analysis

Data collection

This data collection was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Moher et al. 2015). As shown in Figure 1, we complied with all steps of our selection process with these guidelines and included a completed flowchart as recommended by PRISMA. Given the limited research on cultural competence in the context of journalism, our data collection strategy involves gathering relevant academic literature on both cultural competence without disciplinary limitation and journalistic competence within the field of journalism. We focused on collecting and analysing works that are representative of how scholars use and understand these concepts.

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Figure 1.

PRISMA flowchart for systematic review.

Given that numerous studies on cultural competence have been published since its introduction by the Georgetown University Child Development Centre in the United States in 1989 (Mao and Ahmed, 2017), this study aims to keep the number of included articles manageable. To do so, we conducted a overviews of reviews by selecting only systematic review articles on cultural competence from the past three years between 2022 and October 2024 (the census date of this study), to analyse the current use of the concept. We chose systematic review articles to review because they provide a comprehensive overview and rigorous assessment of relevant studies in cultural competence (Sriganesh et al., 2016). Furthermore, due to the limited literature on journalistic competence, this study expanded the search timeframe from the past 3 years to the past decade, covering articles on journalistic competence published between 2014 and October 2024.

Scopus was chosen for its extensive coverage of social sciences compared to other databases (Norris and Oppenheim, 2007). Additionally, Scopus provides greater coverage of health journalism research literature, as suggested by a bibliometric analysis (Feng, 2024). Ultimately, a total of 56 systematic reviews on cultural competence, published between 2022 and October 2024 (the census date of this study), were identified through Scopus, using Boolean operators ‘cultural competence’ as the keyword and ‘systematic review’ in the article title.

For the systematic review on journalistic competence, a total of 35 journal articles published between 2014 and October 2024 were identified in Scopus using the Boolean operators ‘journalistic’ or ‘journalism’ and ‘competenc’ in the keywords. After screening the full texts, two articles were excluded because they were not written in English, and four were excluded for falling outside the scope of journalism studies. Only one article (Garyantes and Murphy, 2019) specialised in the domain of health journalism, while most articles have focused on journalistic competence in the wider general context of journalism practice. As a result, this produced a dataset encompassing a total of 85 articles for the concept analysis. These peer-reviewed journal articles, published in English, present a comprehensive overview and rigorous assessment of relevant studies related to cultural competence and journalistic competence. Supplemental Appendices 1 and 2 outline the details.

Concept analysis

Concept analysis is helpful in promoting the consistent use of a concept, ensuring that everyone in this conversation is clear about the definition, without using different terms with the same or relative meaning (Jabareen, 2008; Walker and Avant, 1995). We adopted the analytical framework proposed by Walker and Avant (1995) and Jabareen (2008) by followng the steps below.

Define journalistic cultural competence by analysing the use of ‘competence’, ‘culture’ and ‘journalism’ in the selected literature.

We then highlighted and extracted key phrases related to the concepts, looking at them closely, and grouping them into themes. We also noted similar terms and related ideas. One reviewer handled the data collection and analysis, and two others checked the process and results to minimise bias. Based on the findings, we came up with a definition that articulates key features, what comes before and what results from the concept.

Defining ‘journalistic cultural competence’

To provide a coherent definition of journalistic cultural competence for health journalism, we examined how ‘competence’, ‘culture’, or ‘cultural’, and ‘journalism’, or ‘journalistic’ are conceptualised in the selected literature on cultural competence and journalistic competence. Our analysis shows that the literature lacks a clearly defined concept of cultural competence for journalists, including health journalists, and that cultural competence itself remains inconsistently defined in the studies on journalism education and practice. For instance, ‘diversity competence’ was incorporated as an independent item into the Accrediting Council on Education in Journalism and Mass Communications (ACEJMC) assessment of the United States in 2009 (Christ and Henderson, 2014; Henderson and Christ, 2014). It is defined as the requirement for a qualified journalism graduate to ‘demonstrate an understanding of the diversity of peoples and cultures and of the significance and impact of mass communications in a global society’ (Christ and Henderson, 2014, p. 305). Christ and Henderson (2014, p. 305) argue that the ambiguous wording of terms like ‘diversity of peoples/cultures’, ‘significance/impact’ and ‘global society’ necessitates clearer definitions.

Moreover, the definition and application of cultural competence should align with the specific demands of professional roles in journalism, rather than relying on established frameworks borrowed from other professions. For instance, Garyantes and Murphy (2019) examined the cultural competence of health coverage in US newspapers, directly applying the concept of cultural competence from clinical settings to health journalism. They attempted to integrate cultural competence into news production, but their approach has not been consistently developed in subsequent studies.

Based on our review, we draw from the established concepts of cultural and journalistic competence to propose a definition of journalistic cultural competence, marking an initial attempt to initiate this conversation in journalism studies. Starting with an analysis of how ‘competence’ is conceptualised in the selected articles, we found that the term is used to describe a set of specific competencies required for a profession, which Estella (2021a) refers to as a ‘domain of competencies’ (p. 195) or ‘meta-competencies’ (p. 196). Accordingly, in the journalism context, competence refers to the quality or ability to support the acquisition and application of specific competencies, such as self-awareness of personal strengths and weaknesses relevant to the role of a news reporter, as well as the ability to write a news article. Similarly, Guo and Volz (2021) suggest that the concept of competence is understood as a professional competence model comprising a set of fundamental components that underpin professional values and practices in journalism.

In addition, understanding ‘competence’ within cultural competence requires its contextualisation to meet the specific demands of various professional practices. Our review of selected literature on cultural competence shows that cultural competence manifests in distinct ways across different professions, such as therapists (Kayrouz et al., 2024), social workers (Williams and Lee, 2024), pharmacists (Sawalha et al., 2023), nurses (Correa-Betancour et al., 2024), dentists (Álvarez-Cruces et al., 2024) and genetic counsellors (Shete et al., 2024).

However, we found that no work has been done to analyse the cultural competence required to become a qualified journalist. To address this gap, we can begin by examining the requirements of the journalism profession, moving towards an analysis of what ‘journalism’ or ‘journalistic’ means through the lens of journalistic competence. Our review shows that journalism is seen as a profession with clear professional boundaries. In this sense, journalistic competence is used to determine whether an individual is qualified to work as a journalist or whether a student meets the requirements to graduate and obtain a journalism degree (e.g. Bobkowski and Rosenthal, 2022; Christ and Henderson, 2014; Estella, 2021a, 2021b; Guo and Volz, 2021). Certain types of journalistic practices require more specialised knowledge or experience in a particular subject area than that of a general news reporter, such as entrepreneurial journalism (Caplan et al., 2020) and health journalism (Garyantes and Murphy, 2019). Applied to this understanding of journalism as a profession, we can suggest that journalistic cultural competence should be further integrated into the established framework for evaluating journalistic competence.

Finally, with culture at the centre of the concept of journalistic cultural competence, it is essential to examine how it has been defined in the literature on the cultural competence of other professionals to address the gap in journalism studies. Our review reveals that ‘culture’ in cultural competence encompasses a broad range of factors, including race, ethnicity, socioeconomic status, religion, age, gender, sexuality, ability status, immigration status, health beliefs, etc. (Medina et al., 2022). Specifically, the literature identifies several approaches to clarifying the concept of culture. For instance, culture is often understood as cultural identity (Chu et al., 2022) or as the cultural background of individuals, referring to an individual's sense of affiliation and belonging to a sociocultural group.

Furthermore, another approach reframes cultural competence to reflect social constructivist perspectives, moving away from an essentialist paradigm of culture that emphasises stereotypical cultural norms and overlooks intracultural diversity (Höhne et al., 2022). For instance, culture is described as a system in which individuals are both acted upon and act as agents within power structures (e.g. Freire et al., 2023; Walshe et al., 2022). This system involves an interconnected relationship between peoples (such as population dynamics, social groups and social relations), places (such as institutional influences and ecological dynamics), and practices (such as community engagement). Freire et al. (2023) argues that this conceptualisation allows researchers to analyse how different cultural groups experience various forms of oppression within a given society.

Additionally, a cognitive conceptualisation of culture focuses on knowledge about cultural differences at the individual, familial and community levels (Jarrar et al., 2024). For instance, Walkowska et al. (2023) view culture as a set of elements, including beliefs, values, behaviours, and norms, that define these identities and groups, shaped by dynamic, intergenerational, social, historical and political factors. Lie Ken Jie et al. (2022) further emphasise that these cultural elements can be shared, learned and passed on among individuals or specific groups as symbolic artefacts.

In summary, the concept of cultural competence for journalists, including health journalists, is not clearly defined in the current academic literature and remains inconsistently addressed within journalism education and practice. This is supported by our analysis of how the terms ‘competence’, ‘journalism’ and ‘culture’ are defined in the selected literature. We, thereby, propose that journalistic cultural competence for health journalists refers to a professional competence model that encompasses specific competencies – such as news gathering and reporting – required for qualified health journalists to effectively report on health issues, while taking into account the evolving and diverse range of relevant cultural factors. This initial attempt to define journalistic cultural competence, though not yet well-established, serves as a foundation for further empirical studies on journalistic cultural competence within specific cultural contexts.

Related and contrary concepts

Identifying both related and contrary concepts in our analysis can enhance the consistency and accuracy in applying the primary concept (Walker and Avant, 1995). Here, relevant concepts are those that closely resemble the one being studied, but reveal subtle differences upon closer examination, while contrary concepts are terms that directly contrast with the primary concept (Walker and Avant, 1995). Our review of recent cultural competence literature indicates that, even in fields with a long history of cultural competence research, many related concepts have been used interchangeably to address the evolving ideas of culture and diversity within the health-related domain. As noted by several scholars (e.g. Chowdhury et al., 2022; Hardy et al., 2023; Higgins et al., 2023; Jarrar et al., 2024, both culture and competence are multidimensional concepts. This has led to the interchangeable use of terms, such as cultural competence, cultural safety, cultural humility and intercultural competence, among others, due to the absence of consistent and clear definitions. Some of these concepts, such as cultural safety and cultural humility, were developed as critiques of cultural competence and aim to advance the concept from different perspectives (Höhne et al., 2022).

To enhance the consistency and accuracy in applying the concept of cultural competence within the field of health journalism, we identified related concepts from recent cultural competence literature. These include cultural safety, cultural humility (e.g. Höhne et al., 2022; Lambor et al., 2024) cultural sensitivity (e.g. Anakwenze, 2022) cultural adaptation (e.g. Anakwenze, 2022; Day et al., 2023) and intercultural competence (e.g. Huish et al., 2023). Within the literature on journalistic competence, some relevant concepts also emerge, including intercultural competence (e.g. Mykytenko et al., 2022), and sociolinguistic competence, which Bagheri Nevisi and Mousakazemi (2020) define as the knowledge of culturally appropriate forms of communication. The related concepts are discussed below in Table 1.

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Table 1.

The related concepts of cultural competence from reviewed literature.

Concept	Definition	How it relates to cultural competence	How it relates to other related concepts
Culturally sensitivity	It refers to the extent to which cultural distinctions, including ethnocultural characteristics, experiences, norms, values, behavioural patterns and beliefs, are understood, appreciated and integrated into a given social system (Okoniewski et al., 2022). On individual level, cultural sensitivity entails being aware of the cultural information and schemas clients hold and incorporating this knowledge into one's actions and thought processes when interacting with clients (Freire et al., 2023)	According to Freire et al. (2023), cultural competence, as an expansion of cultural sensitivity, includes not only awareness but also the application of cultural knowledge when working with diverse clients. Jarrar et al. (2024) suggest that cultural sensitivity may be either synonymous with cultural competence or functioning as a key component of becoming culturally competent or as a specific action or skill. It provides individuals with the opportunity to demonstrate their cultural sensitivity while progressing towards cultural competence	‘Culturally sensitive’ is used inclusively, encompassing related terminology such as ‘culturally appropriate’, ‘culturally relevant’, ‘culturally suitable’ and ‘culturally compelling’ (Anakwenze, 2022)
Cultural adaption	It involves modifying healthcare treatments or interventions to make them compatible with a client's cultural patterns, meanings and values (Day et al., 2023)	This concept is often paired with cultural sensitivity as an approach to achieving cultural competence (Anakwenze, 2022; Day et al., 2023)	This practice is developed based on the idea of cultural sensitivity which enhances the acceptability and impact of healthcare interventions by increasing their cultural relevance (Day et al., 2023)
Cultural safety	Cultural safety addresses structural and interpersonal power imbalances that shape discriminatory practices, such as institutionalised racism (Nouvini et al., 2022)	It emerged as a critique of cultural competence, arguing that the latter fails to account for the socio-political and institutional mechanisms that contribute to healthcare disparities (Höhne et al., 2022)	Practicing cultural safety requires ongoing self-reflection and the ability to challenge conventional thinking, which also contributes to the development of cultural humility (Höhne et al., 2022)
Cultural humility	Cultural humility, is not seen as an endpoint but rather as an ongoing process of self-reflection and self-critique. It is not seen as a final goal but as an ongoing process of self-reflection and self-critique, which fosters an appreciation for the cultural priorities and practices of others and raises awareness of the power imbalances that exist between healthcare professionals and patients, particularly those from diverse backgrounds (Höhne et al., 2022)	Cultural humility, alongside cultural safety, emerged as a response to critiques of cultural competence (Höhne et al., 2022). The ongoing debate over whether cultural competence or cultural safety/humility should be prioritised by health professionals when working with culturally diverse populations (Yu et al., 2023a, 2023b). The concept of cultural competence has evolved to incorporate the values and principles emphasised by cultural safety and cultural humility (Yu et al., 2023a, 2023b)	Furthermore, due to inconsistencies in these concepts, alternative ways of understanding exist. For instance, Freire et al. (2023) argue that cultural humility advances the concepts of both cultural competence and sensitivity by emphasising the importance of critical self-examination, openness to new cultural knowledge and a lifelong commitment to learning from others. These elements build on key competencies of cultural competence, while also highlighting the continuous, reflective practice central to cultural humility
Intercultural competence	It refers to the ability to communicate effectively across individuals from various cultures, particularly between diverse communities and healthcare professionals, which requires public health professionals to possess the necessary intercultural knowledge, skills and attitudes (Huish et al., 2023)	As noted by Álvarez-Cruces et al. (2024), while it is often used a synonym for cultural competence in healthcare settings, the term intercultural competence is more commonly applied in the fields of philosophy, anthropology and sociology. Cultural competence encourages communicators to acquire cultural knowledge, such as alternative perspectives on subjects like illness and wellbeing in various cultures (Jongen et al., 2018). In contrast, intercultural competence primarily focuses on the communicator's understanding of communication processes, underscoring the importance of communication styles and facework in diverse cultural contexts (e.g. Dai and Chen, 2014; Dalib et al., 2017; Liu et al., 2015). In journalism studies, Mykytenko et al. (2022) consider intercultural competence as synonymous and interconnected with what we refer to as cultural competence. They conceptualise intercultural competence for journalists across four dimensions: knowledge, skills, attitude and awareness, which may overlap with the definition of cultural competence	Overlapping with cultural humility, intercultural competence also places greater emphasis on self-reflection (Zotzmann, 2015)

Furthermore, contrary concepts to cultural competence include othering, labelling and cultural blindness. Othering refers to a top-down approach that involves transferring predetermined cultural information one-way, focusing on stereotypes and portraying specific communities as distinct or ‘other’. This approach reinforces feelings of separation and inequality towards those considered different (Lie Ken Jie et al., 2022). Labelling refers to the practice of stereotyping certain cultural groups as ‘deviant’, which hinders effective healthcare promotion and management. This practice perpetuates the notion that minority groups are problematic because they do not conform to dominant white, middle-class norms (Lie Ken Jie et al., 2022). Cultural blindness involves the assumption that all individuals are alike and that what works for one cultural group should work equally well for another (Higgins et al., 2023). Though these concepts were highlighted in the cultural competence literature we selected, which comes from the healthcare discipline, they are relevant to health journalism and can help researchers and reporters conceptualise health-related issues. For instance, mainstream news outlets in the United States have been acknowledged for creating obesity stereotypes within the Black community as a form of othering (Garyantes and Murphy, 2019).

In addition, our review of recent literature on journalistic competence suggests that while journalistic excellence may closely align with the concept of journalistic competence, it carries distinct meanings (e.g. Estella, 2021a). As a recognition of quality journalism, Estella (2021a) argues that journalistic excellence requires journalistic competence to achieve, while both are open to criticism or judgement from external parties, rather than solely within professional circles. For instance, Estella (2021a, p. 179) uses the term ‘journalistic excellence narratives’ to describe the standard of news quality set by online right-wing populists, who, espousing traditional or conservative values believed to be under threat by minority groups, redefine journalistic excellence and the required competence in their own ways to delegitimise professional journalism practices.

In summary, the analysis of concepts related to and contrasting with cultural competence in journalism reveals an inconsistent and ambiguous use of the term in existing literature. Based on this finding, we suggest that the development of journalistic cultural competence should consider the evolving understanding of cultural competence from other fields. While terms such as cultural safety, cultural humility, cultural sensitivity, cultural adaptation and intercultural competence are often used interchangeably with cultural competence, each offers unique perspectives and approaches that highlight the multidimensional nature of culture and competence. For researchers and reporters in the field of health journalism, our findings suggest that a coherent use of the term ‘cultural competence’ is needed. From this article, we suggest that the term ‘journalistic cultural competence’ would help stakeholders involved in the field of health journalism communicate more clearly when discussing health issues that may otherwise be labelled differently.

Component attributes

To analyse the factors or indicators used to examine cultural competence, it is important to explore its component attributes. For instance, Garyantes and Murphy (2019) identified cultural knowledge, cultural awareness and cultural skills as the component attributes in their study on cultural competence in health journalism. Based on our review on cultural competence literature, we identified most studies have used the Campinha-Bacote (2003, 2008) model for cultural competence, which includes cultural knowledge, cultural awareness, cultural desire, cultural encounter and cultural skills (e.g. Bishop et al., 2022; Jarrar et al., 2024; Pokharel et al., 2023). Our findings align with previous systematic reviews (Alizadeh and Chavan, 2016; Henderson et al., 2018; Tao et al., 2022). The components from Campinha-Bacote (2003; 2008) model are listed below:

Cultural knowledge refers to seeking and obtaining knowledge of cultural and ethnic groups (Lie Ken Jie et al., 2022).

In summary, the Campinha-Bacote (2003, 2008) model has been widely used in cultural competence studies but has not been fully explored in journalism, including health journalism, leaving this as an area for further research. While the application of the Campinha-Bacote model to journalism may require more investigation, it provides a framework for a more systematic examination of cultural competence.