Exploring the knowledge, attitudes, skills and training (KAST) needs of psychologists working with ethnic minority communities

As global populations become more diverse, the delivery of culturally competent care is increasingly recognised as a clinical and ethical necessity. However, despite growing attention to this area, cultural competence is still frequently conceptualised as an individual clinician attribute, rather than a dynamic and systemic process. This thesis aimed to critically examine the knowledge, attitudes, skills and training needs of psychologists working with ethnic minority communities and in doing so, reframe cultural competence as a shared organisational responsibility. To achieve this, a two-phase exploratory study was conducted. Study 1, a systematic review of cultural competence interventions for healthcare providers synthesised findings using the Knowledge, Attitudes, Skills and Training (KAST) needs framework. Findings from the 23 included studies demonstrated that most interventions focused on immediate post-intervention improvements, typically showing increases in knowledge, attitudes and skills. Fewer studies examined long-term gains and those that did, found these were difficult to sustain, particularly in the absence of organisational support. Training needs reflected a call for interventions adapted to people’s current level of cultural competence. Participants also emphasised that training should extend to all staff within organisations, including administrative personnel. Integration into workplace systems was consistently identified as an ongoing need for culturally competent practice. In Study 2, a qualitative study was conducted through 15 interviews with practising psychologists in Ireland. This study explored clinicians’ lived experiences in working with ethnic minority communities using the KAST framework. Results from this study identified a tension between organisational policies and their limited translation into practice, which clinicians largely perceived as symbolic. Psychologists also identified gaps in preparedness to work with ethnic minorities, describing discomfort in naming cultural differences and the emotional labour involved in conducting this work without meaningful organisational support. Looking to the future, psychologists identified ongoing lived experience input, organisation-wide training, reflective spaces and structural accountability as training needs. In comparing the two studies, a notable insight across both studies was the limited use of structured clinical tools such as the Cultural Formulation Interview and the absence of intersectional approaches. Overall, these findings offer a nuanced and practice-oriented understanding of cultural competence as both an individual and organisational responsibility. This thesis contributes to the field by explicitly introducing training needs as a fourth outcome domain of the KAST framework. In doing so, the framework positions training needs as an organisational outcome rather than an individual responsibility, advocating for a shift from symbolic inclusion to structural accountability. Importantly, the inclusion of training needs also creates space for clinicians’ reflexivity. These insights have implications for training, practice, and policymakers aiming to embed equity in psychological services.