Understanding the Importance and Future Directions of Cultural Sensitivity in Healthcare: Developing a Culturally sensitive Patient Experience Framework with Emirati Patients as a Case Study

In healthcare, patient feedback is pivotal for enhancing care quality, satisfaction, and trust. Cultural factors, as evidenced in previous studies on Emirati patients, significantly shape these perceptions. This paper underscores the universal need for culturally sensitive patient experience frameworks, using Emirati patients as a case study. Distinctly, it differentiates between the Patient Experience Framework, a blueprint for positive patient experiences, and the Patient Experience Survey, a tool for gauging actual experiences. Given the UAE's healthcare workforce, predominantly non-Emirati, challenges arise in cultural competency. This paper emphasizes the importance of qualitative studies for deeper insights into patient experiences, especially in the Arab-Muslim context. By considering cultural beliefs, traditional medicine, modesty, spirituality, and familial roles, healthcare providers can enhance Arab-Muslim patient experiences in outpatient settings. As the UAE prioritizes healthcare, this study advocates for contextually adapted frameworks, emphasizing the need for further research and training in culturally sensitive care. This collaborative research sets the foundation for future studies on patient experience frameworks in diverse cultural contexts.


Introduction
In healthcare settings, understanding the quality of care from the patient's perspective is crucial to ensure patient-centered, safe, and effective care (Vaz & Araujo, 2022).Patient feedback helps to identify areas that need improvement, drive changes that meet their expectations, and enhance patient satisfaction, health outcomes, and trust in the healthcare system (Ree et al., 2019).Cultural factors also play a critical role in shaping patient perceptions of healthcare services, which providers need to be aware of to provide culturally sensitive care that meets the unique needs of diverse patient populations.Previous studies have shown that cultural factors significantly impact the patient experience for Emirati patients in healthcare settings (Attum et al., 2023;Elbarazi et al., 2017).Therefore, this study aims to establish the importance of developing a culturally sensitive patient experience framework for Emirati patients to improve the overall quality of healthcare services.By reflecting on the role of culture in shaping the experiences of Emirati patients, this study seeks to: • Highlight the necessity of developing a patient experience framework that is not only culturally sensitive but also tailored to the unique needs of Emirati patients, with the goal of elevating the quality of healthcare services.• Examine and document how cultural factors influence the perceptions and experiences of Emirati patients in healthcare settings to understand the nuances of culturally sensitive care.

Understanding the Difference between a Patient Experience Framework and Survey in Healthcare
A patient experience framework and a patient experience survey are two distinct concepts with different purposes in healthcare.The patient experience framework provides the blueprint for creating a positive patient experience, while the patient experience survey is a tool used to gather feedback and measure the actual patient experience.
The Patient experience framework is a comprehensive guide or set of principles that outline the key elements of a positive patient experience.Its purpose is to provide healthcare organizations with a roadmap for designing and improving their patient experience (Staniszewska et al., 2014).The framework typically includes critical areas such as communication, teamwork, safety, and access to care, among others.By outlining the essential components of a positive patient experience, the framework sets the goals and expectations for patient-centered care.
On the other hand, the Patient Experience Survey is a tool used to gather feedback from patients about their experiences with the healthcare system.Its purpose is to measure how well the healthcare organization meets the goals and expectations set by the Patient Experience Framework.The survey can include various questions that seek to understand the patient's experience, including their experience with the healthcare staff, the atmosphere and environment of the healthcare facility, and more.The survey results can be used to inform and improve the Patient Experience Framework (CAHPS Clinician & Group Survey | Agency for Healthcare Research and Quality, n.d.) .
Understanding the difference between the Patient experience framework and the Patient Experience Survey is crucial in delivering high-quality, patient-centred care.While the framework provides the blueprint for creating a positive patient experience, the survey is a tool used to gather feedback and measure the actual patient experience, allowing healthcare organizations to make informed decisions to improve the quality of care continuously they provide (CAHPS Clinician & Group Survey | Agency for Healthcare Research and Quality, n.d.).

The importance of a culturally sensitive patient experience framework
A culturally sensitive patient experience framework is essential to provide appropriate healthcare services to patients with distinctive cultural backgrounds.Such an approach involves recognizing each patient's unique needs, preferences, and values and involving them in their care, including religious and spiritual practices (Wilson-Stronks et al., 2010).However, developing a culturally sensitive patient experience framework requires a context-specific and culturally appropriate approach that recognizes the unique needs of diverse patient populations, as patient experience domains vary widely across countries, regions, and settings (Atkinson & Haran, 2005;Bele et al., 2021;Bleich et al., 2009;Gulliford et al., 2002;Satpathy et al., 2022;Sovd et al., 2006).
For Emirati citizens in the UAE, a culturally sensitive patient experience framework should consider their unique cultural context, including different health beliefs, communication styles, and social and religious practices.In addition, healthcare providers must be aware of the potential involvement of older family members and husbands in healthcare decisionmaking for Emirati patients and engage with them as appropriate to empower Emirati women to make informed healthcare decisions (Attum et al., 2023;Elbarazi et al., 2017).Therefore, healthcare providers must respect and accommodate the unique needs, preferences, and values of Emirati patients to design a more personalized and effective care that can lead to improved health outcomes and patient satisfaction.

Challenges and Importance of Developing a Culturally Sensitive Healthcare Workforce in the UAE
Despite the significant number of Emirati patients, the majority of healthcare workers in the UAE are non-Emirati.For example, 10.5 % of the Physicians are Emirati, while almost 90% are non-Emirati.In addition, 0.7% of the nurses are Emirati (Paulo et al., 2019).Like the other GCC countries, the UAE faces challenges due to the lack of Emirati healthcare workers.The challenges include High reliance on expatriate staff, challenges of cultural competency, and High turnover of expatriate health workers (Organization, 2018).Moreover, Emiratis represent around 10 % of the population and are Muslim (United Arab Emirates | Middle East Concern, n.d.).Given that most healthcare workers in the UAE are non-Emirati.Several studies have suggested that Emirati patients were likely to encounter difficulties relating to modesty, gender preference for healthcare professionals, and misconceptions about disease causation in healthcare settings because of their cultural beliefs and practices.Other challenges for Muslims include the complexity of the healthcare system and a deficit of culturally appropriate services (Al-Yateem et al., 2018;Odeh Yosef, 2008;Wehbe-Alamah, 2011).This demonstrates that a guiding framework for non-Emirati healthcare professionals is needed to promote a better patient experience and outcomes.Therefore, it is crucial to understand the dimensions and attributes of the patient experience in the Arab-Muslim context, as the expectations and values of Arab-Muslim patients are substantially distinct from those of non-Muslim patients (Yosef, 2008; Wehbe-Alamah, 2011) A culturally sensitive patient experience framework will help healthcare professionals to individualize care based on the patient's needs.It is essential because ethnic and sociocultural factors impact an individual's decision to seek care and adherence to a care plan (Rassool, 2015).
This underscores the importance of educating and training healthcare practitioners to provide culturally sensitive care and incorporating it into their competency assessment.By doing so, healthcare organizations can guarantee that their staff possesses the necessary knowledge, skills, and attitudes to deliver responsive, respectful care customized to the unique needs of patients with diverse backgrounds, including those with varying beliefs, values, and cultural practices.This can, in turn, enhance patient experience and health outcomes.However, without a framework to guide this process, achieving this objective may be difficult.Therefore, healthcare organizations should develop a comprehensive framework that outlines the essential components of culturally sensitive care and use it to assess the competence of their staff.This will help ensure that healthcare practitioners are adequately equipped to provide high-quality care that meets the diverse needs of their patients.

Developing Culturally Sensitive Patient Experience Frameworks: The Importance of Qualitative Studies
Qualitative research can play a crucial role in providing a deeper understanding of patients' experiences and perspectives, which is essential for developing culturally sensitive patient experience frameworks (Cohen et al., 2007).While quantitative research provides numerical data points, qualitative research helps generate hypotheses, further investigates and understands quantitative data, and provides the context and depth necessary to fully comprehend the patient experience (Tenny et al., 2022) .Qualitative research methods such as in-depth interviews, focus groups, observation, and analysis of written documents can help explore the unique cultural beliefs, values, and attitudes that influence patient behaviour, expectations, and healthcare decision-making (Gooberman-Hill, 2012) .
A qualitative study can be conducted to explore the experiences and perceptions of Arab-Muslim patients receiving healthcare services in the UAE.The study could aim to identify the specific cultural factors that impact their healthcare experiences and how healthcare professionals could provide more culturally sensitive care.This approach can provide a more nuanced understanding of the patient experience and inform the development of a culturally sensitive patient experience framework that is tailored to specific cultures and contexts (What Is Qualitative Research? | Methods & Examples, n.d.).Overall, qualitative studies can provide essential insights into patients' experiences and perspectives, which can inform the development of patient experience frameworks that are culturally sensitive and tailored to meet the unique needs of diverse patient populations.

Cultural Considerations for Arab-Muslim Patients in Outpatient Settings
Considering cultural beliefs, the supernatural, traditional medicine, modesty, spirituality, and familial roles when providing care is essential for healthcare providers to effectively communicate with Arab-Muslim patients and improve their experience in an outpatient setting.Healthcare providers who do not consider the cultural beliefs of Arab-Muslim patients may experience communication difficulties with them.Arab-Muslims hold strong beliefs about health, illness, and healing, which may differ from Western medical perspectives (Swihart et al., 2022).Ignoring these beliefs can result in misunderstandings and mistrust between the healthcare provider and patient, leading to a negative patient experience.Additionally, Arab-Muslims often believe in the evil eye and jinn, which may affect their health outcomes (Lovering et al., 2015).Healthcare providers who are unaware of these beliefs may not be able to provide culturally sensitive care, which can impact the patient experience negatively.
Traditional medicine is also widely used in the Arab-Muslim community, and healthcare providers who do not acknowledge this practice may fail to provide holistic and comprehensive care to their patients (Lovering et al., 2015).Moreover, some Arab-Muslim patients may be hesitant to disclose their use of traditional medicine to healthcare providers due to fears of judgment or stigma, leading to inadequate care and a negative patient experience.Furthermore, Arab-Muslim patients highly value modesty and dignity, and healthcare providers who do not respect these values may create a negative patient experience.Providers should establish trust and rapport with their patients and ensure that they provide a comfortable environment that is conducive to modesty and dignity (Lovering et al., 2015).Arab-Muslim patients may also require friendly environments for spiritual practices, such as prayer, which are an essential aspect of their faith (What Role Should Religion and Spirituality Play in Patient Care? | American Medical Association, n.d.).Healthcare providers who do not provide a conducive environment for these practices may make their patients feel uncomfortable and unsupported.Finally, healthcare providers who do not consider age, relationships, and health status when communicating with Arab-Muslim patients may face communication barriers (Swihart et al., 2022) .Arab-Muslim families tend to value the input of elderly family members and may assign decision-making authority to family members or guardians in cases where the patient is unable to make decisions for themselves.
In The paper argues that there is a need to educate and train healthcare practitioners to provide culturally sensitive care and incorporate it into their competency assessment.By doing so, healthcare organizations can ensure that their staff possesses the necessary knowledge, skills, and attitudes to deliver care that is responsive, respectful, and customized to the unique needs of patients with diverse backgrounds, including those with varying beliefs, values, and cultural practices.The paper's findings pave the way for future research on the validity and reliability of patient experience domains and items used in current patient experience Frameworks.The study adds to the existing body of knowledge on the need for culturally sensitive domains and attributes of the patient experience.In conclusion, the study highlights the significance of patient experience in the UAE healthcare system and the need for further research to improve patient care quality.

Future Directions in Developing Culturally Sensitive Patient Experience Frameworks in the UAE The
conclusion, healthcare providers who do not consider the cultural beliefs, practices, and values of Arab-Muslim patients can create barriers to effective communication and a negative patient experience.It is essential to provide culturally sensitive care to Arab-Muslim patients, which involves understanding their unique perspectives, values, and beliefs.By doing so, healthcare providers can improve patient outcomes and foster trust and rapport with their patients healthcare system in the UAE is crucial to the government's agenda, with significant funding allocated to provide quality medical services (Healthcare Budget -The Official Portal of the UAE Government, n.d.).Over the past five decades, the UAE has built a robust healthcare system through various initiatives, such as the Centennial 2071 project, aimed at placing the UAE as the best country in the world by 2071 (UAE Centennial Plan 2071, n.d.).In parts of the UAE healthcare system, financial funding for hospitals is directly linked to patient experience measures, leading hospital administrators to focus on identifying patient experience domains to improve metrics.This study emphasizes the need for a more contextually adapted patient experience framework that addresses the UAE's unique cultural and societal context.Due to a lack of research into culturally sensitive domains and attributes of patient experience in Arab countries, especially the UAE, this paper argues for further research to identify the most critical domains and attributes for patients.It also highlights the importance of culturally sensitive patient experience measures to improve patient care quality.