This Standard is secondary legislation made by the Physiotherapy Board under section 118(i) of the Health Practitioners Competence Assurance Act 2003.
A PDF version of this standard is available here.
Introduction
Physiotherapists in Aotearoa New Zealand practise within a culturally diverse environment and in order to practice safely and effectively as outlined in HPCA Act 118(i) they are required to practice in a culturally safe, culturally competent and culturally responsive manner when engaging with kiritaki, other health professionals and communities whose cultures and backgrounds may differ from their own, or their colleagues.
Culturally safe and competent physiotherapists engage in critical self‐reflection to recognise their own biases, acknowledge systemic power imbalances, and actively share power within the therapeutic relationship, ensuring that knowledge, values, and voice of kiritaki are meaningfully integrated into decision‐making.
Kiritaki identify with many different cultures, and these need to be considered without the health practitioner determining what aspect(s) of culture are important as it could be more than one at any given time.
Intersectionality is an important concept to consider as many elements as possible of culture affect how individuals experience services provided.
Cultural safety and cultural competence are concepts that are separate, but they also interweave.
They are fundamental to providing and shaping:
- how a physiotherapist works;
- how services are delivered; and
- how services are received by kiritaki.
Ultimately, this approach supports authentic and inclusive therapeutic and professional relationships and promotes more equitable, kiritaki centred care outcomes by recognising the broader relational, structural, and institutional contexts in which care is delivered.
Relationship with Physiotherapy Standards Framework:
This Standard should be read in conjunction with He kawa whakaruruhau ā matatau Māori: Māori cultural safety and competence standard, other Standards, the Physiotherapy practice thresholds and competencies, Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct that regulate physiotherapy practice in Aotearoa New Zealand.
Definitions
Introduction
The definitions of cultural safety and cultural competence are separate, but they do interweave. This is because both concepts pertain to meaningful, equitable outcomes in health.
Current definitions of cultural safety owe much to the foundational work of Dr. Irihapeti Ramsden and Māori nurses’ work in Aotearoa New Zealand in the 1990s, who defined cultural safety as:
“A focus for the delivery of quality care through changes in thinking about the importance of cultural factors, power relationships and patients’ rights.”
Defined terms
Culture
Means the shared values, beliefs, customs, behaviours, and traditions of a particular group of people. It shapes how individuals perceive health, illness, treatment, and healing. Kiritaki culture affects the way health, well‐being and illness are understood, the choices regarding their health, how healthcare services are accessed and the responses to engagement and interventions.
Culture is not limited to ethnicity, it includes (but is not limited to) factors such as:
- socioeconomic status
- being neurodiverse
- lived experience of a disability
- tāngata whaikaha Māori
- personal/institutional/organisational language
- religion
- gender identity
- sexual identity
- body bias.
Cultural safety
In the context of physiotherapy in Aotearoa New Zealand, means:
Cultural safety requires health professionals to examine themselves and the potential impact of their own identities and culture on their practice. Culturally safe health professionals acknowledge and address their own power, privilege, biases, attitudes, assumptions, stereotypes, prejudices, and characteristics that may affect the quality of care provided. Cultural safety requires a critical consciousness where health professionals engage in ongoing self‐reflection and hold themselves accountable for culturally safe practice, as defined by patients and their communities, and as measured through progress towards achieving health equity. Culturally safe health professionals influence healthcare to reduce bias and achieve equity within the workforce and working environment. Cultural safety benefits all patients and communities.
(Curtis et al., 2025, p. 2).
Cultural competence
In the context of physiotherapy in Aotearoa New Zealand, means:
Cultural competency refers to a set of knowledge about culture(s), along with the associated skills and behaviours that health professionals require, to deliver high quality health care and achieve equitable health outcomes for all groups.
(Curtis et al., 2025, p. 2)
Cultural responsiveness
Is to weave cultural safety and cultural competence together (sharing the relationship between kiritaki and physiotherapist and working together with respect).
Health literacy
Being able to obtain, understand and use health information to navigate health services and make appropriate health decisions.
(The physiotherapist is responsible for presenting health information in a way that kiritaki can understand).
Intersectionality
A framework for understanding how different aspects of an individual identity such as race, gender, class, and disability interact and overlap to create unique experiences of privilege or oppression.
Kaiāwhina
Support person, assistant, advocate.
Kiritaki
Patient, client, consumer.
Mana
Status or authority.
Reflexivity
The process of critically examining your own thoughts, biases, and beliefs and how they influence your actions and perceptions, particularly in a research or social context (ongoing).
Tāngata whaikaha Māori
Māori people with lived experience of disability.
Tangata whenua
Māori people of a particular locality, or as a whole the original inhabitants of Aotearoa.
Tauiwi
Non‐Māori, European, Pākēhā
Whānau
(Whakapapa) Extended family, family group, a familiar term of address to a number of people
(Kaupapa) In the modern context the term is sometimes used to include friends/work colleagues who may not have any kinship ties to other members.
Terminology
Must: is where the statement sets a minimum standard that all physiotherapists are obliged to achieve.
Should: is where a statement marked as ‘should’ recognises that in some contexts and situations the physiotherapist requires a degree of flexibility in their response. Guidance is offered by the ‘should’ statement, but it is up to the individual physiotherapist to decide, and be able to justify, by using their professional judgement and/or seeking advice from experienced colleagues.
Te Tiriti o Waitangi
The Board | te Poari acknowledges Te Tiriti o Waitangi as a founding document of Aotearoa New Zealand and respects Māori as tangata whenua. The Standard integrates the articles and overarching Principles of Te Tiriti o Waitangi with the aim to improve health equity between Māori and Tauiwi.
Te Tiriti o Waitangi was signed in 1840 between the British Crown and many indigenous Māori leaders and is one of Aotearoa New Zealand’s founding documents. Te Tiriti o Waitangi is te reo Māori version of this agreement, and the Treaty of Waitangi is the English language version. There are notable differences observed between the English and Te Reo Māori texts.
To practise effectively in Aotearoa New Zealand, a physiotherapist needs to understand the relevance of and be able to apply the Tiriti o Waitangi principles, while promoting equitable opportunity for positive health outcomes within the context of Māori health models, including Whānau (family health), tinana (physical health), hinengaro (mental) and wairua (spiritual health).
Purpose of the Standard
Terms and wording used within this standard which are underlined are defined in the defined terms.
The purpose of this Standard is to ensure that physiotherapists engage in continuous learning, a process of self‐reflection and critique of their own practise to promote equitable outcomes and demonstrate lifelong learnings in cultural safety and cultural competence. This includes:
- Demonstrating awareness and understanding of cultural safety and cultural competence, including insight into their own culture, how it is shaped, and the potential impact of their cultural perspectives on practise.
- Applying cultural safety and cultural competence in practice through demonstrating engagement, observations and reflections, including learnings from kiritaki, colleagues and peers.
- Engaging in ongoing reflection on their own culture, inherent power dynamics, and the services they provide, from the perspective of kiritaki, and within the organisation/institution context.
New Zealand law
Physiotherapists must be familiar with the law governing this area of practice including, but not limited to, the:
Health Practitioners Competence Assurance Act 2003
New Zealand Bill of Rights Act 1990
The Code of Health and Disability Services Consumers’ Rights 1996
Awareness of own culture and understanding how culture impacts and effects kiritaki
When working as a physiotherapist, a physiotherapist must:
- critically self‐reflect on their own culture, identity, attitudes and how these may impact interactions with kiritaki, colleagues and staff who may hold different cultural values and beliefs
- acknowledge their own limitations of cultural knowledge, and demonstrate openness to respectful ongoing learning and engagement with kiritaki
- respond appropriately and respectfully when asked by kiritaki to modify their approach in order to provide culturally appropriate service
- recognise when approaches or services may not be acceptable to kiritaki for cultural or other reasons and be appropriately responsive.
Application of cultural safety and cultural competence knowledge and communication skills in practice
A physiotherapist must:
- recognise the inherent power dynamic between kiritaki and physiotherapist
- uphold the mana of, and demonstrate respect to kiritaki, whānau and community
- consider the impact of their own identity, beliefs, values or cultural biases on kiritaki, family their whānau, kaiāwhina and community
- ensure that any assessment of kiritaki health literacy for the purposes of communicating with them is evidence‐based and not affected by bias or stereotyping
- actively listen to and provide ongoing opportunities for kiritaki input within interactions and the services provided
- provide respectful, inclusive, and culturally responsive physiotherapy services and interactions
- promote respectful, inclusive and culturally appropriate interaction and physiotherapy services
A physiotherapist should:
- challenge all forms of discrimination, cultural bias, and systemic barriers which may contribute negatively on kiritaki and outcomes.
- observe, listen, and recognise how the organisation/institution operates and, where potential discrimination is identified; articulate this to an appropriate peer or senior in the organisation and seek action to remediate.
Ongoing reflection
Ongoing individual and collective reflection can improve experiences and health outcomes for kiritaki.
Individuals’ reflections contribute to improved organisational responsiveness of cultural needs, behaviours and health advancement.
A physiotherapist must:
- continually demonstrate reflexivity – about their own culture, identity, attitudes (bias, assumptions, pre‐formed attitudes), behaviours and how these influence their practise
- continually reflect on kiritaki perspectives and experiences (how it went for them), through observing, listening and responding appropriately
- demonstrate critically reflective skills within the context of the organisation/institutional culture and its impacts on the experience and outcomes for kiritaki.
A physiotherapist should:
- identify organisational/institutional and system barriers and enablers that affect equity and equality
- demonstrate knowledge and strategies and/or skills that can be utilised to safely navigate and address organisational/institutional and system barriers.
Related resources
Aotearoa New Zealand Code of Ethics and Professional Conduct (2025) Principles 1 and 4 Physiotherapy practice thresholds in Australia & Aotearoa New Zealand (2024) Cultural competence (pp 11‐ 13) and Key competencies 1.1,1.4, 2.1, 2.2, 3.1,3.3,4.1, 4.4,4.5,5.1,6.2, and 7.2
ACC 2024 He Kawa whakaruruhau‐ cultural safety
Bacal, K., Jansen, P., Smith, K. (2006). Developing cultural competency in accordance with the Health Practitioners Competence Assurance Act. New Zealand Family Physician, 33 (5), 305–309.
Curtis, E., Loring, B., Jones, R., Tipene‐Leach, D., Walker, C., Paine, S.-J., & Reid, P. (2025). Refining the definitions of cultural safety, cultural competency and Indigenous health: Lessons from Aotearoa New Zealand. International Journal For Equity in Health, 24 Article 130.
Health Quality and Safety Commission (2021) Measuring culturally safe care through the patient experience surveys
Cultural Safety and Cultural Competence: what does it mean for physiotherapists? NZ Journal of Physiotherapy, 34 (3), 160–166.
New Zealand Journal of Occupational Therapy, 54(1), 4–10
Physiotherapy Board of New Zealand | Te Poari Tiaki Tinana o Aotearoa (2022) He kawa whakaruruhau ā matatau Māori: Māori cultural safety and competence standard,
Tae Ora Tinana. Māori partner of Physiotherapy New Zealand.
Tipene‐Leech et al (2024) Cultural safety and the medical profession in Aotearoa New Zealand: a training framework and the pursuit of Māori health equity NZ medical journal
Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Meaning of the treaty. Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Principles of the treaty.
Walker, Sarah et al (2024) What does it mean to be an allied health professional working in rural Aotearoa New Zealand? A qualitative study Aust J Rural Health. 2024 Feb;32(1):53–66. doi: 10.1111/ajr.13061. Epub 2023 Nov 14.
Effective 1 May 2026 This statement is scheduled for review in 2030. Legislative and/or technical changes may make this statement obsolete before this review date. We acknowledge the working group members involved in the review of the Cultural safety and cultural competence standard.