ISSN 2806-5638

South American Research Journal, 3(1), 71-90

https://www.sa-rj.net/index.php/sarj/article/view/104

https://doi.org/10.5281/zenodo.23737909 71

The incorporation of interculturality

in the training of health professionals:

a systematic review

La incorporación de la interculturalidad

en la formación de profesionales del área

de la salud: una revisión sistemática

Freddy Patricio Cabrera-Ortiz¹

² , Mauricio

Esteban Reyes-Guaranda²

³ , Christhye Ionne

Briones-Arias⁴ , Nube Janeth Clavijo-Morocho¹

Intercultural Studies Research Group (GEI), Univer-

sity of Cuenca, Ecuador.

Educational Policy Research Group (GIPE), Univer-

sity of Cuenca, Ecuador.

Feminism, Human Rights, and Technology Research

Group, University of Cuenca, Ecuador.

University of Cuenca, Ecuador.

Corresponding author: mauricio.reyes@ucuenca.edu.ec

Received: July 7, 2026 – Accepted: October 7, 2026 –

Published: October 29, 2026.

ABSTRACT

The training of health professionals has developed

under the predominance of a biomedical rationality

that tends to exclude traditional, indigenous, and

community-based medical knowledge, despite the

growing cultural diversity of Latin American soci-

eties. This systematic review aimed to analyze the

available empirical evidence on the incorporation

of interculturality into the curricula of university

health science programs, in order to identify the

main strengths, weaknesses, and training gaps re-

ported in the literature, as well as the pedagogical

and curricular strategies proposed to strengthen and

implement it. Following the PRISMA 2020 state-

ment and the eligibility criteria of the PICO model,

a search was conducted in Scopus, Dialnet,

Redalyc, LILACS, and SciELO, yielding a final

sample of 27 studies reporting primary empirical

data, published between 2020 and 2025. The re-

sults, organized through a narrative synthesis into

four thematic categories, showed that intercultural-

ity has been incorporated predominantly in a de-

clarative manner into institutional normative

frameworks, but in most cases has not translated

into an effective transformation of curricular con-

tent. Transversal and sustained training experi-

ences were also identified, along with moderate

levels of intercultural competence and sensitivity

among students and faculty, and persistent struc-

tural barriers to care for indigenous, migrant, and

Afro-descendant populations. The review con-

cludes that a critical and effective curricular trans-

formation toward interculturality requires strate-

gies that go beyond the declarative incorporation of

isolated content, moving instead toward cross-cut-

ting curricular structures developed in direct dia-

logue with communities.

Keywords: interculturality, higher education,

health sciences, curriculum, systematic review.

RESUMEN

La formación de profesionales de la salud se ha

desarrollado bajo el predominio de una racionalidad

biomédica que tiende a excluir los saberes médicos

tradicionales, indígenas y comunitarios, pese a la

creciente diversidad cultural de las sociedades lati-

noamericanas. El objetivo de esta revisión sistemá-

tica fue analizar la evidencia empírica disponible so-

bre la incorporación de la interculturalidad en el cu-

rrículo de carreras universitarias del área de la salud,

para identificar las principales fortalezas, debilida-

des y vacíos formativos reportados en la literatura,

así como las estrategias pedagógicas y curriculares

propuestas para su fortalecimiento. Siguiendo la de-

claración PRISMA 2020 y los criterios de elegibili-

dad del modelo PICO, se realizó una búsqueda en

Scopus, Dialnet, Redalyc, LILACS y SciELO, que

arrojó 27 estudios con datos empíricos primarios,

publicados entre 2020 y 2025. Los resultados, orga-

nizados mediante síntesis narrativa en cuatro cate-

gorías temáticas, evidenciaron que la interculturali-

dad ha sido incorporada de manera predominante-

mente declarativa en los marcos normativos institu-

cionales, sin traducirse, en la mayoría de los casos,

en una transformación efectiva de los contenidos cu-

rriculares; asimismo, se identificaron experiencias

formativas transversales y sostenidas en el tiempo,

niveles moderados de competencia y sensibilidad in-

tercultural en estudiantes y docentes, sin embargo,

barreras estructurales persistentes en la atención a

poblaciones indígenas, migrantes y afrodescendien-

tes. Se concluye que la transformación curricular ha-

cia una interculturalidad crítica y efectiva requiere

estrategias que trasciendan la incorporación

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declarativa de contenidos puntuales, y se orienten

hacia dispositivos curriculares transversales cons-

truidos en diálogo directo con las comunidades.

Palabras clave: interculturalidad, educación supe-

rior, ciencias de la salud, currículo, revisión sistemá-

tica.

INTRODUCTION

The training of health science professionals in

Latin America has developed under the predomi-

nance of a biomedical rationality that tends to

fragment the human being into systems amenable

to technical intervention, relegating the cultural,

spiritual, and community dimensions of health and

illness (Menéndez, 2024). Historically, this model

has operated as a mechanism of subordination of

traditional and indigenous medical knowledge,

whose epistemic validity is denied because it does

not conform to the criteria of Western science.

Santos (2010) calls this dynamic "abyssal think-

ing": a line that separates scientific knowledge

from traditional knowledge as incommensurable

universes, leading to an "epistemicide," or the sys-

tematic destruction of cultural knowledge. In re-

sponse, Santos proposes an "ecology of knowl-

edges" that allows for a non-hierarchical intercul-

tural dialogue, recognizing traditional and indige-

nous practices as legitimate interlocutors rather

than as mere folkloric complements to biomedical

knowledge.

Along these lines, Walsh (2023) distinguishes

between functional interculturality, which toler-

ates diversity without modifying existing power

hierarchies, and critical interculturality, which

questions the colonial structures of knowledge and

seeks to "crack" institutions in order to open space

for the genuine recognition of subalternized

knowledges. This distinction is central to health

training, given that a good share of the curricular

initiatives aimed at cultural diversity operate

within the functional register: they incorporate

isolated content without altering the hierarchical

structure that continues to place biomedical

knowledge as the only legitimate authority. This

hegemony also operates in the material sphere, in-

sofar as health systems reserve formal employ-

ment for those trained under the biomedical

model, relegating wise elders and practitioners of

ancestral medicine (a term used here as an

analytical category, without implying that all in-

digenous, peasant, or Afro-descendant communi-

ties use this name for their own knowledge of

care) to a precarious position (Menéndez, 2024).

Against this backdrop, transcultural nursing

theories—taken up here as a common analytical

starting point owing to their pioneering theoretical

development within the health sciences, as justi-

fied in the Methodology section—have proposed

frameworks for thinking about care from a cultur-

ally sensitive perspective. Leininger (1991), the

founder of this current, argued that professional

care must adapt to the worldviews of each com-

munity, distinguishing between the emic

knowledge of communities and universal ethical

principles. Complementarily, Watson (1979)

holds that health personnel must integrate patients'

cultural beliefs as a constitutive, and not acces-

sory, part of care. Both frameworks share the

premise that cultural competence is not a technical

add-on but a condition for the dignity of care in

contexts of diversity.

The translation of these theoretical discus-

sions into the effective training of professionals

has been the subject of systematic reviews in dif-

ferent contexts. Arruzza & Chau (2021), in a scop-

ing review focused on undergraduate health sci-

ence students, found that cultural competence ed-

ucation interventions consistently improve

knowledge acquisition, skills performance, atti-

tudes, and student satisfaction, although they point

to the absence of control groups in most of the

available studies as a fundamental methodological

limitation. Bolarinwa & Nkansah (2025) found

moderate or low levels of cultural competence in

low- and middle-income countries. Gradellini et

al. (2021) concluded that the most effective train-

ing projects combine multiple strategies in a

cross-cutting and sustained manner, in contrast to

isolated initiatives. De-María et al. (2024), in the

European context, found considerable heterogene-

ity in the conceptualization of the construct and a

still limited adoption of these interventions.

In the Latin American context, Álvarez-Cru-

ces et al. (2021) conducted an earlier systematic

review on intercultural competence in the health

sciences, finding a predominance of studies from

the United States and Australia, with training ex-

periences that were mostly extracurricular and

short-term. The authors explicitly warned of the

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scarce representation of Latin American research

in the corpus available up to 2020, a gap that the

present review seeks to help address.

A first group of studies documents the dimen-

sion of teaching and curriculum, that is, how in-

terculturality is manifested—or not—in the study

plans and concrete pedagogical practices of health

training in the region. Villela et al. (2020) showed

that, in Guatemala, the Medicine curriculum does

not explicitly incorporate the intercultural axis

even though institutional regulations declare it.

Martínez Pabón et al. (2022) found that only 3%

of physiotherapy courses and 5% of nursing

courses in Colombia addressed intercultural con-

tent. In response to this gap, Farías-Cancino et al.

(2021) and Beltrán Abad et al. (2020) documented

concrete pedagogical strategies—a participatory

methodology in Chile and an experiential ap-

proach in Cuba—aimed at strengthening intercul-

tural competence from within the curriculum.

A complementary line of studies situates the

discussion at the level of public indigenous health

policies, thus differing from the teaching level ad-

dressed by the previous group. Aguilar Peña et al.

(2020) argued that incorporating the indigenous

model of health into health training requires spe-

cific intercultural training policies. Vieira Weiss

(2023) documented, in Brazil, the persistence of

"ninguendade" as an expression of the structural

non-recognition of native peoples in training pro-

cesses. Urrutia et al. (2022) highlighted, in Chile,

the need for an anthropological perspective that

goes beyond the technical-communicative in the

care of migrants.

Returning to the teaching dimension, Manci-

nelli (2023) showed that sustained collaborative

spaces with Argentine Wichí communities are es-

sential for training that respects indigenous reali-

ties, while Giménez Milán & Acosta Güemes

(2024) reported improvements in students' listen-

ing and reflection through narrative methodolo-

gies. Türedi et al. (2024) found, among practicing

Turkish professionals, that gender, educational

level, and prior experience influence intercultural

communication competence. Mohiyeddini (2024)

argued that medical education must evolve toward

culturally competent professionals, while Hilario-

Pizarro et al. (2023) identified four recurring axes

in the literature: the social role of the professional,

their professional development, intercultural

training proper, and its effective implementation.

A third axis of studies is situated at the level

of the clinical and ethical application of intercul-

tural care, where several authors argue that ethics

and interculturality should be cross-cutting ele-

ments of the curriculum and not isolated courses

(Nárvaez & Gómez, 2022; Gavilanes Llango et

al., 2022). Revelo (2019) and Lorenzo Serrano

(2019) documented, from ethnographic and com-

municational approaches, the value of the situated

ethics of care in Ecuadorian indigenous communi-

ties, while Melo et al. (2021) noted that structural

racism continues to hinder, in Brazil, indigenous

populations' access to ethical and equitable care.

Despite being distributed across three distinct

axes—teaching and curriculum, clinical and ethi-

cal application, and public policy—this body of

antecedents makes it possible to identify a con-

sistent pattern: although normative frameworks,

theoretical models, and pedagogical experiences

aimed at incorporating interculturality into health

training exist, their translation into study plans and

concrete pedagogical practices remains, in most

cases, partial or declarative.

Latin America is a territory of profound cul-

tural, ethnic, and linguistic diversity, where bio-

medical health systems coexist with traditional,

indigenous, peasant, and Afro-descendant care

practices that have their own cultural validity.

Various normative frameworks have installed the

discourse of interculturality as a desirable compo-

nent of health training; however, as the general

overview reviewed suggests, there is a considera-

ble distance between these declarative frame-

works and their effective curricular translation.

This gap constitutes a relevant research problem:

it is not enough for interculturality to be men-

tioned in regulations; it is necessary to examine

whether, and in what way, this approach perme-

ates the content and concrete learning experi-

ences.

In addition, the available literature is frag-

mented across disciplines, countries, and method-

ological designs, which hinders an overall view of

the state of the curricular incorporation of inter-

culturality in health. A systematic review that in-

tegrates this dispersed evidence is necessary to

identify common patterns and to provide an em-

pirical basis to guide future curricular reform

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processes in university health training at the Latin

American level.

In light of the above, the objective of this sys-

tematic review is to analyze the available empiri-

cal evidence on the incorporation of intercultural-

ity into the curricular content of university health

programs in Latin America, based on studies pub-

lished between 2020 and 2025 in at least nine

countries of the region, in order to identify the

main strengths, weaknesses, and training gaps re-

ported in the literature, as well as the pedagogical

and curricular strategies proposed for its strength-

ening and implementation.

METHODOLOGY

Operational definition of concepts and dis-

ciplinary scope

For the purposes of this review, the following op-

erational definitions of the central concepts that

structure the analysis are adopted. Interculturality

is understood, following Walsh (2023), as an eth-

ical, political, and epistemic disposition of rela-

tionship between culturally diverse groups aimed

at questioning and transforming the power struc-

tures that naturalize the subordination of some

knowledges to others, thus distinguishing it from

functional interculturality, which recognizes di-

versity without altering the underlying power re-

lations (Tubino, 2005, as cited in Miranda et al.,

2024). The intercultural curriculum is defined as

the set of contents, competencies, and training ex-

periences—explicit in study plans or implicit in

pedagogical practices—aimed at incorporating

this perspective into professional training. Inter-

cultural competence is understood, following

Campinha-Bacote (2002), as the ongoing process

by which a health professional develops the capac-

ity to work effectively within the cultural context

of the patient or community, while intercultural

sensitivity refers to the attitudinal and emotional

disposition that precedes and sustains such com-

petence, in line with Bennett's model as taken up

by Álvarez-Cruces et al. (2025b). Finally, coloni-

ality of knowledge is understood as the persis-

tence of epistemic hierarchies inherited from co-

lonialism that subordinate the knowledge and care

practices of indigenous, Afro-descendant, and

peasant peoples to biomedical knowledge as the

only legitimate authority.

Regarding disciplinary scope, this review

considered studies referring to health science pro-

grams in general (medicine, nursing, dentistry, ob-

stetrics, nutrition, physiotherapy, and related

fields, in accordance with the Population criterion

in Table 1). However, the theoretical framework

relies primarily on transcultural nursing theory

(Leininger, 1991; Watson, 1979) because it is,

within the health sciences, the discipline with the

greatest explicit theoretical development on cul-

turally congruent care, as confirmed by the corpus

of this review itself, in which most of the instru-

ments measuring intercultural competence and

sensitivity (Table 2) come from the nursing litera-

ture. This does not imply that this framework ex-

hausts the theoretical possibilities of other health

disciplines, but rather that it is used here as a com-

mon analytical starting point, in dialogue with the

contributions of critical pedagogy (Freire, 2005)

and critical interculturality (Walsh, 2023) that cut

across the analysis.

Design

This research is a systematic literature review

whose process of identification, selection, eligibil-

ity, and inclusion of studies was carried out fol-

lowing the guidelines of the PRISMA 2020 state-

ment (Page et al., 2021), which standardizes the

transparent reporting of systematic reviews

through a four-phase flow (identification, screen-

ing, eligibility, and inclusion).

Eligibility criteria

The eligibility criteria were structured on the basis

of the PICO model (Population, Intervention,

Comparison, and Outcomes), which is widely

used in health sciences research to delimit the

scope of a bibliographic search (Uman, 2011).

Original scientific articles with primary empirical

data, published between January 2020 and the

search closing date (January 2026) and available

in full text, were included; book chapters, books,

theses, conference proceedings, editorials, and lit-

erature reviews without original data were ex-

cluded because they are not systematically subject

to peer review, which makes it difficult to assess

their methodological quality uniformly. Table 1

summarizes the eligibility criteria according to

each component of the PICO model.

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Table 1

Eligibility criteria according to the PICO model for study selection

Component

Element

Inclusion criteria

Exclusion criteria

Population

Students and/or fac-

ulty of undergraduate

programs in the

health sciences (medi-

cine, nursing, dentis-

try, obstetrics, nutri-

tion, physiotherapy,

and related fields).

Undergraduate programs in the

health sciences.

Studies that include students, fac-

ulty, or curricula as the unit of

analysis.

Postgraduate programs or contin-

uing education as the exclusive

focus.

Studies conducted in populations

not linked to health training.

Intervention /

Phenomenon

Inclusion, integration,

or development of in-

terculturality as a

competence, curricu-

lar content, or peda-

gogical approach in

the training of health

professionals.

Design, implementation, or evalu-

ation of intercultural strategies in

the curriculum.

Programs or courses that address

cultural diversity, cultural compe-

tence, or intercultural health.

Studies focused exclusively on

linguistic diversity with no ex-

plicit link to interculturality.

Clinical interventions without a

training component.

Comparison

No mandatory com-

parison group is es-

tablished; however,

studies that contrast

curricular models

with and without an

intercultural approach

are considered.

Studies with or without a compar-

ison group.

Reviews that contrast different

approaches to intercultural train-

ing.

No exclusion applies for the ab-

sence of a comparator.

Outcomes

Findings related to

the development of

intercultural compe-

tencies, attitudes, per-

ceptions, curricular

changes, or impact on

professional practice

in health.

Studies reporting measurable re-

sults on intercultural competen-

cies or attitudes.

Analyses of curricular content

with original empirical data.

Studies without verifiable results.

Opinions, editorials, or theoretical

reflections without primary data.

Authors' own elaboration.

The criteria were applied independently by the reviewers; disagreements were resolved by consensus.

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The 2020 starting point reflects a deliberate

methodological decision: to prioritize the cur-

rency of academic output on interculturality in

health training over its complete historical cover-

age, given that this is a period marked by an in-

crease in the debate on equity and cultural rele-

vance in educational systems, heightened by the

COVID-19 pandemic and its differential effects

on ethnically and culturally diverse populations.

It is acknowledged, however, that this cut-off

may have excluded training experiences prior to

2020 in countries with a longer history of incor-

porating interculturality into health training, such

as Colombia; this limitation is explicitly ad-

dressed in the Limitations section. It should be

noted that, during extraction and analysis, it was

found that a subset of the identified studies con-

sisted of theoretical reflection essays and narra-

tive reviews without their own primary empirical

data; consequently, they were excluded from the

final extraction matrix, although their content

was preserved to inform the conceptual discus-

sion.

Information sources and search strategy

The search combined strings in Spanish and Eng-

lish, adapted to the language coverage of each da-

tabase. In Scopus, whose coverage is predomi-

nantly English-language, only the English strings

health AND interculturality AND higher educa-

tion and health AND interculturality AND uni-

versity were used, restricting the search to the ti-

tle, abstract, and keyword fields (equivalent to

TITLE-ABS-KEY). In Dialnet, whose coverage

is predominantly Spanish-language, only the

Spanish strings salud AND interculturalidad

AND educación superior and salud AND inter-

culturalidad AND universidad were used. In

Redalyc and LILACS, both sets of strings (Eng-

lish and Spanish) were used, and in SciELO the

Spanish strings were used together with the Eng-

lish string health AND interculturality AND uni-

versity. In Dialnet, Redalyc, LILACS, and

SciELO, the search was conducted through each

platform's general search engine, since none of

them offers field-restriction options comparable

to those of Scopus.

Selection process

The selection process was carried out in the

four phases proposed by PRISMA 2020 (Figure

1). In the identification phase, 21,798 records

were retrieved (Scopus = 37; Dialnet = 1,001;

Redalyc = 20,686; LILACS = 53; SciELO = 21).

After applying filters for date range, language,

document type (articles only), and open access,

21,079 records were removed, leaving 719 rec-

ords screened. Title screening excluded 644 rec-

ords, leaving 75 articles selected for full-text

screening. From this set, 32 duplicates were re-

moved (14 internal to Redalyc and LILACS; 6

cross-database; 12 when consolidating the final

list). All authors took part in the search and

screening of the studies; disagreements about el-

igibility were discussed collectively among the

reviewers and resolved on the basis of the previ-

ously established search and eligibility criteria.

After this clean-up, 43 articles met the eligi-

bility criteria relating to population and interven-

tion/phenomenon of interest (components P and I

of Table 1) and were formally included in the sys-

tematic review following the PRISMA 2020 flow

(Scopus + Dialnet = 29; Redalyc + LILACS = 11;

SciELO = 3). During full-text data extraction, it

was found that 16 of these 43 studies were theo-

retical reflection essays or literature reviews

without their own primary empirical data, and

therefore did not meet the eligibility criterion for

the Outcomes component of Table 1; conse-

quently, they were excluded from the data extrac-

tion matrix (Table 2), although their content was

kept as a conceptual reference for the discussion.

The remaining 27 studies, which did report pri-

mary empirical data, constitute the final corpus

of this review and are those presented in Table 2.

The complete process is illustrated in Figure 1.

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Figure 1

PRISMA flow diagram of the identification, screening, eligibility, and inclusion of studies

Source: Page et al. (2021)

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RESULTS

Table 2 presents the data extraction matrix cor-

responding to the 27 studies reviewed in this

systematic review. It is organized alphabetically by

author and includes, for each study, the methodol-

ogy used, the participating population, the country

and context in which it was carried out, and a syn-

thesis of the most notable results reported.

Table 2

Data extraction matrix: interculturality in the curricular content of university health programs

Authors

(year)

Methodology

Population

Country / context

Summary of results

Álvarez-

Cruces et

al. (2025a)

Multiple case study

with a hermeneutic

scope; document

analysis of graduate

profiles and in-depth

interviews; Grounded

Theory.

179 key in-

formants: in-

ternship stu-

dents, directors,

faculty, and

clinical guides.

Chile; health disci-

plines at three re-

gional higher edu-

cation institutions.

Current curricula do not integrate the

International Migrant Health Policy;

the concept of "Gríngola Cultural" is

coined to describe how faculty and

clinicians deliberately ignore migra-

tory and ethnic factors, which trans-

lates into subtle racism and negative

vicarious learning in internships.

Álvarez-

Cruces et

al. (2025b)

Interpretive qualita-

tive study; virtual

semi-structured inter-

views, mixed coding

under Bennett's Inter-

cultural Sensitivity

Model.

15 program

heads and cur-

riculum coordi-

nators in the

health area.

Chile; three re-

gional higher edu-

cation institutions.

Those who design health curricula

show an intercultural sensitivity

stalled in ethnocentric stages (Mini-

mization and Defense), upholding the

fallacy of universality and delegating

intercultural training to the clinical

field; only Nutrition shows incipient

signs of Acceptance.

Cantele P.

(2023)

Descriptive study

based on the systema-

tization of experi-

ences; proposes a mi-

cro-curricular design

for decolonial tele-

education.

Wise elders,

shamans, fac-

ulty, and stu-

dents of the in-

tercultural

health program.

Venezuela; Uni-

versidad Indígena

de Venezuela, Ye-

kuana community

of Cacuri.

A decolonial tele-education model

was designed that integrates Yekuana

wise elders into the health curricu-

lum, using their own identity codes to

overcome geographic barriers and

avoid the Westernization of

knowledge.

Castillo

Mariqueo

et al.

(2024)

Cross-sectional de-

scriptive study; anal-

ysis of courses trans-

formed through Ser-

vice-Learning.

259 undergrad-

uate students

from five health

disciplines.

Chile; Universidad

Católica de Te-

muco, Mapuche

territory.

The cross-cutting Integrated Health

Modules device, using a Service-

Learning methodology, articulates

family, community, and intercultural

health through interdisciplinary rota-

tions, fostering critical self-reflection

and two-way partnerships with Ma-

puche communities.

Cruz

Romero &

Ospina

Lozano

(2024)

Systematization of

experiences with an

ethnographic ap-

proach; four-year ter-

ritorial intervention,

participant observa-

tion, and interviews.

Four dentistry

students, one

faculty mem-

ber, and the Pi-

jao community

(~50 families).

Colombia; Pijao

indigenous com-

munities, Ortega,

Tolima.

Territorial practice in Pijao communi-

ties made it possible to move from

conventional clinical dentistry to Col-

lective Oral Health, showing that cur-

ricular design can act as a driver of

rights enforcement in the face of state

neglect.

Esquivel

Rubio et

al. (2023)

Account of profes-

sional experiences

with a narrative de-

sign; chronological

analysis of field inter-

ventions (2018-

2022).

Migrant popu-

lation (Haiti,

Honduras, El

Salvador, Gua-

temala); nurs-

ing faculty and

students.

Mexico; northwes-

tern border, Mexi-

cali, Baja Califor-

nia.

The "Salud Migrante" project on the

Mexicali border identified language

barriers and discrimination; applying

Purnell's model, the team managed to

culturally adapt sexual health inter-

ventions through dialogue with mi-

grant community leaders.

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Ferreira do

Nasci-

mento et

al. (2025)

Exploratory docu-

mentary and geospa-

tial research; cross-

referencing of enroll-

ment databases with

thematic maps

(ArcGIS).

50 indigenous

university stu-

dents from 42

ethnic groups.

Brazil; Intercul-

tural Indigenous

Faculty (FAINDI),

Mato Grosso.

The Intercultural Indigenous Faculty

(FAINDI) operates as an institutional

catalyst by validating pre-existing

community capacities and designing a

curriculum that dialogues symmetri-

cally between Western biomedical

theories and the worldviews of 42

ethnic groups.

Ferreira do

Nasci-

mento et

al. (2020)

Exploratory qualita-

tive study (COREQ);

in-depth interviews,

Freirean thematic

content analysis.

11 graduated

indigenous

nurses in clini-

cal practice.

Brazil; public-uni-

versity graduates

from Mato Grosso,

native communi-

ties.

Indigenous nurses denounce the total

omission of indigenous health in their

Eurocentric university training and

the racism suffered during their stud-

ies; once graduated, they autono-

mously build intermedicality dia-

logues with traditional knowledge

holders.

Ferreira &

Martins

Borges

(2021)

Descriptive and ex-

ploratory study; doc-

ument analysis of

psychological care

records (2016-2017)

with frequency statis-

tics.

225 care re-

quests from im-

migrant stu-

dents.

Brazil; Federal

University of

Latin American

Integration, tri-

border area.

Cultural distance affects the mental

health of immigrant students (greater

anxiety, depression, and dropout); the

study warns of academic ethnocen-

trism, or "epistemicide," and calls for

training in intercultural care for uni-

versity staff.

Flores Flo-

res &

Calva

Cabrera

(2025)

Mixed, non-experi-

mental, cross-sec-

tional study; docu-

ment analysis with a

validated competency

instrument.

10 micro-cur-

ricular docu-

ments from

health pro-

grams.

Ecuador; Faculty

of Human Health,

public university

of Loja.

The health programs allocate unequal

time to research and maintain tradi-

tional summative assessment, which

limits the effective incorporation of

the human and intercultural compo-

nent despite declaring dynamic teach-

ing strategies.

García Pé-

rez et al.

(2022)

Exploratory pedagog-

ical research with a

historical-trend ap-

proach; document

analysis and source

triangulation.

Medicine cur-

ricula and pro-

grams on

Health Situa-

tion Analysis.

Cuba; university

medical training

and community

health.

Health Situation Analysis became

historically consolidated as a curricu-

lar axis in Cuban medicine, but insuf-

ficient intercultural links persist for

achieving a truly comprehensive

community intervention.

Guerra-

Zúñiga &

Segovia-

Chamorro

(2020)

Descriptive and inter-

pretive qualitative

study; analysis of

graphic artifacts and

focus groups.

17 medical stu-

dents in focus

groups.

Chile; School of

Medicine, Univer-

sidad de Valpara-

íso.

Graphic medicine (comics) proved a

powerful tool for addressing social

determinants of health, making the

hidden curriculum visible, and con-

solidating cross-cutting competencies

such as empathy and reflexivity, de-

spite initial student resistance.

Larson,

Choufani,

Płaszewsk

a-Żywko

(2025)

Descriptive qualita-

tive study; content

analysis of reflection

papers from an inter-

national virtual

course, following

COREQ.

18 nursing stu-

dents from Po-

land and the

United States.

Poland and the

United States; vir-

tual course on the

health of Ukrain-

ian refugees.

Polish and American nursing students

identify problematic communication,

neglected trauma-informed care, and

compromised vaccination status as

the main barriers to intercultural care

of Ukrainian refugees, recommending

certified interpreters and curricular

training in trauma and intercultural

competence.

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Martínez

Pabón et

al. (2022)

Exploratory qualita-

tive research; docu-

ment review of cur-

ricula (SNIES) and

semi-structured inter-

views.

15 accredited

Physiotherapy

and 26 Nursing

programs.

Colombia; na-

tional coverage.

Only 3% of physiotherapy courses

and 5% of nursing courses include an

intercultural approach; a biologicist

model predominates that confuses

multiculturalism with critical inter-

culturality, without moving beyond

Walsh's (2008) proposal.

Pérez

Pinto,

Aquino

Zúñiga,

Cisneros

Chacón, &

Berttolini

Díaz

(2024)

Exploratory qualita-

tive case study; semi-

structured interviews

with graduates and

employers, affinity

diagram.

Seven Intercul-

tural Nursing

graduates and

three employ-

ers.

Mexico; Universi-

dad Intercultural

del Estado de Ta-

basco, Ch'ol popu-

lation.

Intercultural nursing graduates in Ta-

basco value the integration of tradi-

tional medicine and the mother

tongue into the curriculum, but both

prove limited in practice: traditional

medicine cannot be applied in clinical

settings because of allopathic regula-

tions, and oral command of the native

language is insufficient upon gradua-

tion, affecting communication with

indigenous patients.

Quintano-

Méndez et

al. (2023)

Cross-sectional psy-

chometric study; Ex-

ploratory Factor

Analysis for scale

validation.

127 health pro-

fessionals who

are clinical in-

structors and

tutors.

Chile; clinical

placement sites of

the Universidad

Católica de Te-

muco.

Validates a highly reliable scale

showing that intercultural training

("knowing how to be") is a construct

distinct from technical clinical

knowledge, requiring its own explicit

training strategies.

Rivera

Lersundi

(2021)

Phenomenological

qualitative case

study; life stories of

nurses.

Nurses who

provide care in

contexts of cul-

tural diversity.

Chile; nursing

training and prac-

tice in intercultural

contexts.

Identifies stages and dimensions of

intercultural competence in nursing

care, which fosters more respectful

relationships; points to the insuffi-

cient presence of this approach in cur-

ricula.

Rosero

Medina,

Zuñiga

Meneses,

Ortega

Hernández,

Guzmán

Rivera, &

Ordoñez

Andrade

(2025)

Hermeneutic qualita-

tive study; semi-

structured interviews

with faculty.

Nursing faculty

who teach

Totonac- and

Nahuatl-speak-

ing students.

Mexico; university

with Totonac and

Nahua indigenous

students.

Intercultural strategies in nursing edu-

cation are influenced by faculty tra-

jectory and institutional guidelines,

and are key to preserving cultural

identity and transmitting ancestral

knowledges despite institutional bar-

riers.

Sagarra-

Romero et

al. (2024)

Multicenter cross-

sectional quantitative

study; survey with

three validated psy-

chometric scales

(ISS, CCATool,

CAS).

168 undergrad-

uate nursing

students.

Europe; four insti-

tutions (Spain,

Turkey, Belgium,

Portugal), TC-

NURSE project.

European nursing students show high

intercultural sensitivity, but only

moderate cultural competence and

awareness, with no differences be-

tween years of study, showing that

cultural competence is not consist-

ently incorporated into study plans.

Salazar Es-

cobedo &

Galán

López

(2025)

Qualitative research;

literature review and

structured interviews.

38 advanced-

semester Nurs-

ing students.

Mexico; Universi-

dad Intercultural

del Estado de Pue-

bla, Sierra Norte.

The Bachelor's in Nursing with an in-

tercultural approach at UIEP fulfills a

relevant social function, strengthen-

ing language skills and articulating

biomedical knowledge with ancestral

knowledges in indigenous contexts.

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Sequeda

Villarraga

et al.

(2023)

Cross-sectional de-

scriptive quantitative

study; validated Cul-

tural Competence

Scale (CCS-S).

148 undergrad-

uate nursing

students.

Colombia; border

area with Vene-

zuela, Cúcuta.

Nursing students in the border area

with Venezuela show a moderate

level of cultural competence, with

significant differences only according

to prior training and experience with

patients from other cultures; strength-

ening the curriculum is recom-

mended.

Silva

Guayasamí

n et al.

(2024)

Descriptive qualita-

tive research; struc-

tured online survey

with intercultural sen-

sitivity dimensions.

475 university

students.

Ecuador; Universi-

dad Nacional de

Chimborazo.

Most students value interculturality

positively in their training and want

language training, but a high percent-

age do not self-identify with any in-

digenous or Afro-descendant people,

which limits their understanding of

traditional medicines.

Silva Per-

tuz & Staa-

den Mejía

(2020)

Phenomenological

qualitative study; life-

history method with

interviews and trian-

gulation of voices.

Single case

study of an

Afro-descend-

ant Bacteriol-

ogy instructor.

Colombia; Univer-

sidad Metropoli-

tana de Barranqui-

lla, Caribbean re-

gion.

Through the life story of an Afro-de-

scendant instructor, her contribution

to health higher education is made

visible, showing historical debts of

substantive recognition toward indig-

enous and Afro-descendant knowl-

edges.

Tapia-Mie-

les, Chá-

vez Vélez,

Guaran-

guay-Cha-

ves, &

Sánchez-

Choez

(2022)

Observational docu-

mentary research;

comparative analysis

of curricular docu-

ments.

Curricular doc-

uments and

Nursing gradu-

ates.

Ecuador; Universi-

dad Laica Eloy Al-

faro de Manabí.

Nursing graduates consider their job

training adequate, but a need is iden-

tified to strengthen intercultural and

language competencies for discrimi-

nation-free care in the Ecuadorian

multicultural context.

Valdez

(2020)

Hermeneutic descrip-

tive qualitative re-

search; grounded the-

ory, interviews, and

focus groups.

Nursing stu-

dents, faculty,

and administra-

tors; Misak in-

digenous com-

munity.

Colombia; Univer-

sidad del Cauca,

Cauca region.

Bioethics training in nursing privi-

leges technical knowledge over the

human dimension, showing colonial-

ity of knowledge; the curriculum

needs to be humanized by incorporat-

ing intercultural perspectives and dia-

logue with indigenous communities.

Valdéz

Fernández

& Jácome

Velasco

(2025)

Case study with her-

meneutic Discourse

Analysis; documen-

tary corpus of reports,

syllabi, and public

policies.

Practicum re-

ports and

course curricula

of the final se-

mesters.

Colombia; Univer-

sidad del Cauca,

southwestern part

of the country.

There is a divorce between the poli-

cies that demand interculturality and

the micro-curricular reality, which

omits it; however, the rural territory

operates as an "emergent curriculum"

where students autonomously acquire

intermedicality skills.

Villela,

Locón, &

Gatica

(2020)

Descriptive research;

document review of

laws, curriculum, and

syllabus.

Curricular and

regulatory doc-

uments of Med-

icine and Sur-

gery.

Guatemala; Centro

Universitario de

Oriente

(CUNORI).

Although university regulations es-

tablish the intercultural axis, the Med-

icine syllabus does not explicitly in-

corporate it; there is evidence of an

absence of training in bilingualism

and intercultural health with respect

to native peoples.

Note. N = 27 studies with primary empirical data, ordered alphabetically by author. Authors' own elaboration.

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Before presenting the synthesis by thematic

categories, it is worth distinguishing the findings

according to the type of methodological design

used, since not all of them allow the same level of

generalization. Of the 27 studies included, three

used quantitative designs with validated psycho-

metric scales (Quintano-Méndez et al., 2023;

Sagarra-Romero et al., 2024; Sequeda Villarraga et

al., 2023), which allows more precise comparisons

of the level of intercultural competence and sensi-

tivity among subgroups of students or faculty, alt-

hough limited to the specific populations of each

study. Most of the remaining studies correspond to

qualitative designs (interviews, focus groups, case

studies, phenomenology, or grounded theory),

whose findings describe situated perceptions, expe-

riences, and meanings, without claiming statistical

generalization. A third group relies predominantly

on document analyses of curricula, syllabi, and in-

stitutional policies (for example, Ferreira do Nasci-

mento et al., 2025; García Pérez et al., 2022; Tapia-

Mieles et al., 2022), which report on the declarative

presence of interculturality in the formal curricu-

lum, but not necessarily on its effective implemen-

tation in the classroom or in clinical practice. Fi-

nally, a fourth group consists of systematizations of

experiences or narrative accounts of field interven-

tions (Cantele P., 2023; Cruz Romero & Ospina

Lozano, 2024; Esquivel Rubio et al., 2023), which

document specific, contextualized pedagogical

processes whose results cannot be directly extrapo-

lated to other settings. The thematic categories pre-

sented below integrate these different types of evi-

dence, so statements about general trends should be

read in light of the type of design that supports them

in each case. From the analysis of the corpus, four

thematic categories were identified: (1) the gap be-

tween institutional regulations and the actual cur-

riculum; (2) pedagogical strategies and curricular

devices for developing intercultural competence;

(3) the measurement of intercultural competence

and sensitivity in students and faculty; and (4)

structural barriers and the coloniality of knowledge

in the care of indigenous and migrant populations.

These categories were constructed inductively

from the synthesis of the results of each study (Ta-

ble 2), grouping the articles according to the main

focus of their finding—normative-curricular,

pedagogical-instrumental, evaluative, or struc-

tural—and were discussed and agreed upon among

the authors; a single study may contribute evidence

to more than one category when its content justifies

it.

Gap between institutional regulations and

the actual curriculum

Villela et al. (2020) showed that, although the reg-

ulations of the Universidad de San Carlos de Gua-

temala establish the importance of the intercultural

axis, the Medicine program's syllabus does not ex-

plicitly incorporate it, leaving a gap in training in

bilingualism and intercultural health. Martínez

Pabón et al. (2022) found that only 3% of physio-

therapy courses and 5% of nursing courses in Co-

lombia addressed intercultural content, showing

the predominance of a biologicist model that con-

fuses multiculturalism with Walsh's (2008) critical

interculturality.

This tension is also reproduced in Chile: Álva-

rez-Cruces et al. (2025b), for example, argue that

those who design health curricula show an intercul-

tural sensitivity stalled in ethnocentric stages, up-

holding the fallacy of universality and delegating

intercultural training to the clinical field. Álvarez-

Cruces et al. (2025a) found that curricula do not in-

tegrate the International Migrant Health Policy,

coining the concept of "gríngola cultural" to de-

scribe how migratory factors are deliberately ig-

nored, generating subtle racism in internships.

This gap is also manifested in bioethics train-

ing. Valdez (2020) found that bioethics training in

Colombian nursing privileges technical

knowledge, evidencing coloniality of knowledge,

while Valdéz Fernández & Jácome Velasco (2025)

identified a divorce between public policies and

micro-curricular reality, although they highlight

that the rural territory operates as an "emergent cur-

riculum" where students autonomously acquire in-

termedicality skills. In Ecuador, Flores Flores &

Calva Cabrera (2025) confirmed that health pro-

grams maintain traditional summative assessment,

limiting the incorporation of the intercultural com-

ponent despite declaring teaching strategies.

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Pedagogical strategies and curricular de-

vices for developing intercultural compe-

tence

On the other hand, several studies report train-

ing experiences described by their authors as effec-

tive approaches to the curricular treatment of inter-

culturality in the health area. Ávila León & Hernán-

dez Díaz (2020), for example, designed an intercul-

tural communicative competence course taught in

English for Cuban physicians on international mis-

sions. Cantele P. (2023), likewise, developed a de-

colonial tele-education model at the Universidad

Indígena de Venezuela, which integrates Yekuana

wise elders directly into the curriculum, avoiding a

single, Westernized view of knowledge.

On a larger institutional scale, Castillo

Mariqueo et al. (2024) described, in Chilean Ma-

puche territory, a cross-cutting Integrated Health

Modules device that articulates family, community,

and intercultural health through service-learning.

Rosero Medina et al. (2025) found that intercultural

strategies at a Mexican university depend heavily

on faculty trajectory. Cruz Romero & Ospina

Lozano (2024) documented, in Colombian Pijao

communities, a transition from conventional den-

tistry to Collective Oral Health through sustained

territorial practice.

On a smaller scale, Guerra-Zúñiga & Segovia-

Chamorro (2020) found that graphic medicine

(comics) is powerful for addressing social determi-

nants and consolidating empathy, despite initial

student resistance. Salazar Escobedo & Galán

López (2025) found that the Bachelor's in Nursing

at the Universidad Intercultural del Estado de Pue-

bla effectively articulates biomedical knowledge

with ancestral knowledges.

Measurement of intercultural competence

and sensitivity in students and faculty

Quintano-Méndez et al. (2023) validated a scale

showing that intercultural training is a construct

distinct from technical clinical knowledge, which

requires explicit training strategies. Rivera Ler-

sundi (2021) identified stages in the development

of intercultural competence among Chilean nurses,

pointing to its insufficient curricular presence.

At the international level, Sagarra-Romero et

al. (2024) found, among European students, high

intercultural sensitivity but only moderate cultural

competence and awareness, with no differences be-

tween years of study. Sequeda Villarraga et al.

(2023) found a similar pattern in a Colombian bor-

der area, with differences associated only with

prior training and experience with patients from

other cultures.

Two Ecuadorian studies qualify these findings:

Tapia-Mieles et al. (2022) found that graduates

considered their training adequate, although they

identified the need to strengthen intercultural and

language competencies. Silva Guayasamín et al.

(2024) found that, despite valuing interculturality

positively, a high percentage of students did not

self-identify with any indigenous or Afro-descend-

ant people, limiting their understanding of tradi-

tional medicines.

Structural barriers and coloniality of

knowledge in the care of indigenous and

migrant populations

Ferreira do Nascimento et al. (2020) documented

that Brazilian indigenous nurses denounce the

omission of indigenous health in their Eurocentric

training and the racism suffered during their stud-

ies. Ferreira do Nascimento et al. (2025) showed,

by contrast, that the Intercultural Indigenous Fac-

ulty of Mato Grosso validates pre-existing commu-

nity capacities, dialoguing between biomedical the-

ories and the worldviews of 42 ethnic groups.

Regarding migration, Esquivel Rubio et al.

(2023) identified language barriers toward the Hai-

tian population in Mexicali, managing to culturally

adapt their interventions through Purnell's model.

Ferreira & Martins Borges (2021) found that cul-

tural distance increases anxiety and dropout among

immigrant students in Brazil, warning of an aca-

demic "epistemicide." Larson et al. (2025) docu-

mented that Polish and American students identify

problematic communication and neglected trauma

care as the main barriers to caring for Ukrainian

refugees.

Finally, Pérez Pinto et al. (2024) found that in-

tercultural nursing graduates in Tabasco valued the

integration of traditional medicine and the Ch'ol

language, although both proved limited in practice

because of allopathic regulations and insufficient

command of the language upon graduation. Silva

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Pertuz & Staaden Mejía (2020) made visible,

through the life story of an Afro-descendant Co-

lombian instructor, the historical debts of recogni-

tion that higher education maintains toward its own

indigenous and Afro-descendant faculty.

DISCUSSION

In line with the objective of this systematic re-

view—to analyze the available empirical evidence

on the incorporation of interculturality into the cur-

ricular content of university health programs, in or-

der to identify the main strengths, weaknesses, and

training gaps reported in the literature, as well as

the pedagogical and curricular strategies proposed

for its strengthening and implementation—the

findings are organized below around these axes.

First, the gap between regulations and the actual

curriculum, seen in Villela et al. (2020), Martínez

Pabón et al. (2022), and Álvarez-Cruces et al.

(2025a, 2025b), can be read through Walsh's

(2023) distinction between functional and critical

interculturality. A good share of the studies re-

viewed describe experiences that fall within the

former register: they incorporate declarative men-

tions without altering the curricular structure that

continues to place biomedical knowledge as the

only legitimate authority. This diagnosis coincides

with Miranda et al. (2024), who argue that regional

indigenous health policies operate under a func-

tional interculturality assimilable to neoliberal mul-

ticulturalism. Véliz-Rojas & Bianchetti-Saavedra

(2023) systematized, along the same lines, that in-

tercultural competence has materialized in a frag-

mented way, without achieving cross-cutting inte-

gration. This pattern echoes the early warning of

Walsh (2008), who already identified that the mul-

ticultural reforms of recent decades in Latin Amer-

ica have frequently operated as a discursive inclu-

sion that does not redistribute power, absorbing the

demand for cultural recognition without altering

the structures that Walsh (2023) seeks to "crack" a

decade later; the findings of this review suggest that

this institutional crack remains, in the field of

health, a pending task rather than a consolidated

achievement. This reading is not exclusive to the

Latin American context: Melro et al. (2023), in a

scoping review of the frameworks used to design

and evaluate courses addressing historical

colonialism in Indigenous peoples' health, docu-

mented a convergent pattern of fragmentary incor-

poration and an absence of robust evaluation

frameworks in health science programs across dif-

ferent regions, which situates the gap detected in

this corpus as part of a broader structural tension

between curricular decolonization projects and

their effective institutionalization.

This biomedical hegemony (Menéndez, 2024)

is manifested sharply in Pérez Pinto et al. (2024),

where allopathic regulations prevent the applica-

tion of traditional medicine already formally inte-

grated into the curriculum, and in Ferreira do Nas-

cimento et al. (2020), where graduated indigenous

nurses must autonomously build the intermedical-

ity dialogues that their Eurocentric training did not

provide.

These findings are in dialogue with Santos's

(2010) proposal of an ecology of knowledges.

Within this framework, non-hierarchical dialogue

between knowledges remains, in training practice,

more an aspiration than a reality. Cantele P.’s

(2023) experience at the Universidad Indígena de

Venezuela is one of the few exceptions that ap-

proaches this ideal, which suggests that replicating

experiences like this requires explicit institutional

decisions—such as the creation of specific pro-

grams, formal alliances with indigenous communi-

ties, and the allocation of dedicated resources—and

does not depend solely on the initiative of an indi-

vidual instructor or researcher. This same tension

between theoretical framework and training prac-

tice was explicitly named by Ferreira & Martins

Borges (2021), who identified in Brazilian immi-

grant students a process of academic "epistemi-

cide"; their empirical finding gives situated con-

creteness to Santos's (2010) theoretical warning

about the systematic destruction of cultural

knowledge operated by abyssal thinking, showing

that this mechanism is not limited to the relation-

ship between biomedicine and traditional medi-

cines, but also runs through the subjective experi-

ence of those trained within curricula that do not

recognize their own cultural background as a legit-

imate interlocutor.

Valdéz Fernández (2023) found in the re-

viewed literature that Campinha-Bacote's model

and Leininger's (1991) Theory are the predominant

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frameworks in intercultural training, confirming

that these proposals have permeated the conceptual

field of Latin American transcultural nursing.

However, this declarative adoption does not guar-

antee effective implementation: Rivera Lersundi

(2021) and Quintano-Méndez et al. (2023) show

that intercultural competence remains insufficient

in formal curricula, in contrast to Watson's (1979)

argument that cultural recognition must be consti-

tutive, and not accessory, of professional training.

This multiplicity of theoretical frameworks coex-

isting without an integrative synthesis—

Campinha-Bacote's model, Leininger's (1991) the-

ory, and Watson's (1979) proposal—is not an arti-

fact exclusive to the Latin American literature: De-

María et al. (2024) found, in the European context,

a similar heterogeneity in the conceptualization of

the cultural competence construct, together with a

still limited adoption of evidence-based training in-

terventions. The coincidence between both settings

suggests that the conceptual fragmentation identi-

fied in this corpus does not respond solely to re-

gional methodological weaknesses, but to a funda-

mental theoretical indefiniteness that runs through

the field of intercultural competence in health at the

international level, and that probably contributes to

the difficulty of consolidating evaluable and com-

parable curricular devices across programs.

The results of the present research converge

with international reviews of the state of the art on

the subject. The methodological heterogeneity ob-

served, with a predominance of descriptive qualita-

tive designs, echoes Arruzza & Chau's (2021) ques-

tioning of the robustness of the available evidence.

The moderate or low levels of cultural competence

reported by Bolarinwa & Nkansah (2025) coincide

with the findings of Sagarra-Romero et al. (2024)

and Sequeda Villarraga et al. (2023) in the present

corpus. The conclusion of Gradellini et al. (2021)

on the effectiveness of cross-cutting and sustained

strategies finds direct support in Castillo Mariqueo

et al. (2024) and Cruz Romero & Ospina Lozano

(2024), both cases of institutional continuity over

time.

The distinctive contribution of this review lies

in the empirical confirmation of the gap pointed out

by Álvarez-Cruces et al. (2021): the 27 studies

identified, carried out between 2020 and 2025 in at

least nine countries, suggest that this gap is in the

process of being actively addressed, although pat-

terns of fragmentation persist that limit generaliza-

ble conclusions about comparative effectiveness.

This review also brought to light tensions in

the studies' results. While Ferreira do Nascimento

et al. (2025) and Salazar Escobedo & Galán López

(2025) document experiences in which intercultur-

ality effectively permeates curricular design, Mar-

tínez Pabón et al. (2022) and Hernández-Martínez

et al. (2021) show a critical persistence of exclu-

sion; the latter reports that about 86% of Colom-

bia's ethnic populations lack access to ethno-educa-

tion in health. This heterogeneity suggests that the

explanatory factors are not merely normative, but

depend on situated conditions, such as sustained in-

stitutional commitment and the availability of long-

term community partnerships, as Cantele P. (2023),

Castillo Mariqueo et al. (2024), and Cruz Romero

& Ospina Lozano (2024) jointly suggest.

CONCLUSIONS

From the analysis of the studies included in

this systematic review, it is possible to conclude

that interculturality has been incorporated predom-

inantly in a declarative manner into the normative

frameworks of health science programs, without

translating, in most cases, into an effective trans-

formation of curricular content, course syllabi, and

concrete pedagogical practices.

Among the main strengths identified is the ex-

istence of training experiences that have managed

to incorporate interculturality in a cross-cutting and

sustained manner over time, particularly when such

experiences are grounded in long-term community

partnerships, such as the Integrated Health Mod-

ules documented in Chilean universities or the ter-

ritorial practice with Pijao indigenous communities

in Colombia. Likewise, innovative teaching strate-

gies were identified, such as graphic medicine or

decolonial tele-education models, reported by their

authors as favorable for developing cross-cutting

competencies such as empathy and critical reflex-

ivity, as well as validated instruments that allow the

level of intercultural competence and sensitivity

achieved by students and faculty to be measured

more precisely.

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Among the main weaknesses and training

gaps, it was repeatedly found that the proportion of

courses with explicit intercultural content in the

health programs analyzed is markedly low, that a

biomedical-biologicist model predominates that

delegates intercultural training to the clinical field

instead of assuming it as a curricular responsibility,

and that even when traditional medicine or native

languages are formally incorporated into the curric-

ulum, their effective application in professional

practice is limited by current allopathic clinical reg-

ulations and by insufficient language proficiency

upon graduation. Likewise, specific structural bar-

riers were identified in training oriented to the care

of indigenous, migrant, and Afro-descendant pop-

ulations, including racism experienced during the

training trajectory, the absence of training in

trauma-informed care for refugee populations, and

an identity disconnect of the student body from the

peoples whom such training aims to serve cultur-

ally.

These findings suggest that the curricular

transformation toward a critical and effective inter-

culturality in Latin American health training re-

quires strategies that go beyond the declarative in-

corporation of isolated content, and that are ori-

ented toward the design of cross-cutting, institu-

tionally sustained curricular devices built in direct

dialogue with the communities and knowledges

they aim to recognize.

This review has limitations that should be

noted. First, the search was restricted to five data-

bases and to a limited time period between 2020

and the search closing date, which may have ex-

cluded relevant studies published before that period

or indexed in databases not consulted. Second, the

final corpus shows a significant geographic con-

centration in a small number of countries, mainly

Chile, Mexico, Colombia, Brazil, and Ecuador,

while other national contexts of the Latin American

region, with equally complex ethnic and cultural

realities, are not represented in the available empir-

ical evidence, which limits the generalizability of

the findings to the region as a whole.

In light of the findings and limitations noted,

there is a need to expand empirical production to-

ward Latin American countries and contexts cur-

rently underrepresented in the available literature,

particularly those with a high indigenous or Afro-

descendant population density that do not yet have

their own studies on the incorporation of intercul-

turality into their health science programs.

It would also be valuable for future research to

delve into the longitudinal follow-up of graduates

of programs with an intercultural approach, in or-

der to determine whether the competencies de-

clared in the graduate profile effectively translate

into culturally relevant professional practices once

graduates are inserted into the health system, and

not only into self-reported perceptions at the end of

university training. Finally, it is suggested that the

institutional conditions that explain the heterogene-

ity of results identified in this review be examined

in greater depth, that is, which organizational, nor-

mative, and community factors allow some training

experiences to achieve an effective and sustained

curricular interculturality, while others remain at a

merely declarative level, in order to generate guid-

ance applicable to the design and curricular reform

of health science programs in the region.

Use of artificial intelligence

Claude (Anthropic) was used as a support tool for

the English translation of this manuscript. The au-

thors bear full and sole responsibility for the con-

tent of the manuscript.

Funding

This research was conducted within the framework

of the research project “Interculturality as Policy in

Higher Education: Discourses and Practices in

Health Sciences in Zone 6 from an Interdisciplinary

and Sustainable Approach,” winner of the XXI call

for research projects of the Vice-Rectorate for Re-

search of the Universidad de Cuenca.

Author contributions

Contributions are reported according to the CRediT

taxonomy. Freddy Patricio Cabrera-Ortiz: concep-

tualization, investigation, formal analysis, and

writing of the original draft. Mauricio Esteban

Reyes-Guaranda: conceptualization, investigation,

methodology, data curation, and writing (review

and editing). Christhye Ionne Briones-Arias: inves-

tigation, data curation, and validation. Nube Janeth

Clavijo-Morocho: project administration, funding

acquisition, and validation.

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Acknowledgments

The authors thank the Vice-Rectorate for Research

of the Universidad de Cuenca for funding the re-

search project within whose framework this manu-

script was prepared, winner of the XXI call for re-

search projects.

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