Exploring the core characteristics of competence in healthcare assistants: A scoping review

BACKGROUND: Demographic and epidemiological changes, along with shifts in family structure in China, have led to a growing demand for healthcare. The National Health Commission advocates the implementation of healthcare assistants (HCAs), aiming to reduce reliance on family caregivers and enhance the quality and efficiency of individual care through professionalised service delivery. However, their clinical competence remains insufficiently defined and empirically underexplored. OBJECTIVE: This review aimed to map the essential competence required of HCAs to ensure safe, person-centred, and sustainable implementation across various healthcare settings. METHODS: This scoping review was conducted following the Joanna Briggs Institute guidelines and reported in line with the PRISMA-ScR checklist. Five databases encompassing PubMed, CINAHL Complete, EMBASE, PsycINFO, and Web of Science were searched for citations from inception to present. Included studies were peer-reviewed empirical papers focused on HCA competence. The quality of included studies was assessed using the Crowe Critical Appraisal Tool. Two independent reviewers performed the literature screening, data extraction, and quality appraisal. The Patterns, Advances, Gaps, Evidence of practice, and Research Recommendations (PAGER) framework was adopted for data aggregation and synthesis, and the results were narratively synthesised. RESULTS: Of 24,545 citations yielded, 49 studies met the inclusion criteria for synthesis. HCA competence was collated and grouped into five resulting categories: (1) fundamental care; (2) observations; (3) specialised care; (5) clinical knowledge and skills. Sixteen core knowledge and skills were identified as fundamental for HCAs (n = 41), and the competence of principle observations and administrative support were reported in nearly half studies (n = 21). HCAs' roles also extended to specialised areas (n = 24) and complex clinical knowledge and skills (n = 37). CONCLUSIONS: This review offered a comprehensive overview of the competencies among HCAs. The results demonstrated clear competence requirements in fundamental care, meeting an individual's daily living needs, and in administrative support to ensure organisational efficacy. HCAs also reported practicing extended specialist care; however, the competencies associated with this remained ambiguous. Future research should clarify HCA clinical competence to ensure clarity about their roles and responsibilities. REGISTRATION: This study has been registered with the Open Science Framework under the identifier 10.17605/OSF.IO/5RGUC, date 09/06/2025.