CULTURAL SENSITIVITY TRAINING (CULSEN)

Determining the Effect of Cultural Sensitivity Training on Nursing Students' Cultural Sensitivity, Cultural Awareness and Ethnocentrism Levels

This randomized controlled experimental study aims to determine the effect of a cultural sensitivity training program on nursing students' cultural sensitivity, cultural awareness, and ethnocentrism levels. Fourth-year nursing students at Giresun University Faculty of Health Sciences are randomly assigned to an experimental group or a control group using simple randomization. The experimental group receives a 4-week cultural sensitivity training program (2 hours per week) including interactive lectures, discussions, case studies, video demonstrations, and role-playing activities. The control group continues with the standard nursing curriculum. Data are collected using the Intercultural Sensitivity Scale, Intercultural Awareness Scale, and Ethnocentrism Scale at baseline (pre-test) and after the intervention (post-test). The primary hypothesis is that participants receiving the training will show significant improvements in cultural sensitivity and awareness and a significant decrease in ethnocentrism compared to the control group.

Study Overview

• Status: Completed
• Conditions: Health Knowledge, Attitudes, Practice; Cultural Competency
• Intervention / Treatment: Behavioral: Cultural Sensitivity Training Program

Detailed Description

Background: Cultural sensitivity and awareness are essential competencies for nursing professionals providing care to diverse patient populations. Ethnocentrism, the tendency to view one's own culture as superior, can negatively affect patient care quality. Structured educational interventions during undergraduate nursing education may enhance culturally competent care delivery.

Study Design: This is a randomized controlled experimental study conducted at Giresun University Faculty of Health Sciences, Nursing Department, during April-May 2025. Fourth-year nursing students were selected because they have accumulated both theoretical knowledge and clinical experience and have interacted with individuals from diverse cultural backgrounds.

Sample Size: Power analysis was performed using G*Power 3.1. Based on the effect size of 0.685 reported by Topcu (2019), with 95% power and 5% significance level, a minimum of 60 participants (30 per group) was required. To account for potential attrition, 71 students were enrolled (35 experimental, 36 control). Three students in the experimental group were excluded due to non-attendance, resulting in a final sample of 67 participants (32 experimental, 35 control).

Randomization: Participants were assigned to groups using simple random randomization. An independent biostatistician generated the randomization table using an online calculator (calculatorsoup.com). Groups had only one common class day per week, minimizing cross-contamination risk. Participants were verbally instructed not to share intervention content.

Intervention: The experimental group received a 4-week Cultural Sensitivity Training Program delivered in classroom settings every Monday (11:00-13:00) in two 50-minute sessions. The program content included: Week 1 - Culture concepts, cultural elements, and the relationship between society and culture; Week 2 - Health, illness, and culture relationships including cultural factors in health behaviors and nutrition; Week 3 - Cultural sensitivity, cultural awareness, and ethnocentrism concepts with strategies for reducing ethnocentrism; Week 4 - Transcultural nursing and cultural care models including Leininger's Sunrise Model, Giger and Davidhizar's Transcultural Assessment Model, and Purnell's Cultural Competence Model. Teaching methods included interactive lectures with PowerPoint presentations, group discussions, question-and-answer sessions, case studies, video demonstrations, and role-playing scenarios. The training content was validated by field experts using the DISCERN quality assessment tool.

Control Group: The control group received no cultural sensitivity intervention during the study period. After post-test data collection, the control group also received the Cultural Sensitivity Training Program for ethical considerations.

Outcome Measures: Three validated instruments were used - (1) Intercultural Sensitivity Scale (Chen and Starosta, 2000; Turkish adaptation by Bulduk, Tosun and Ardic, 2010): 24-item, 5-point Likert scale measuring five emotional dimensions of intercultural sensitivity (Cronbach alpha=0.90); (2) Ethnocentrism Scale (Neuliep and McCroskey, 2001; Turkish adaptation by Ustun, 2011): 20-item, 5-point Likert scale (Cronbach alpha=0.92); (3) Intercultural Awareness Scale (Rozaimie et al.; Turkish adaptation by Yakar Karabuga and Alpar, 2017): 9-item, 5-point Likert scale with three sub-dimensions (Cronbach alpha=0.73). A 17-item Descriptive Characteristics Form was also administered.

Statistical Analysis: Data were analyzed using SPSS 25.0. Normality was assessed using skewness and kurtosis coefficients (within ±1.5 range). Parametric tests were used including paired samples t-test for within-group comparisons, independent samples t-test for between-group comparisons, and chi-square test (with Fisher's Exact Test when necessary) for demographic homogeneity. Statistical significance was set at p<0.05. Instrument reliability was assessed using Cronbach's alpha coefficients.

Ethics: The study was approved by Karadeniz Technical University Health Sciences Scientific Research Ethics Committee (Decision No: 158, Date: December 12, 2024). Institutional permission was obtained from Giresun University Rectorate (Decision No: E-13301833-100-55965, Date: December 13, 2024). Written informed consent was obtained from all participants.

• Study Type: Interventional
• Enrollment (Actual): 67
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Central
    • Giresun, Central, Turkey (Türkiye), 28200
      • Giresun University, Faculty of Health Sciences, Department of Nursing

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Being a fourth-year student enrolled in the Nursing Department, Faculty of Health Sciences, Giresun University during the 2024-2025 academic year
• Voluntarily agreeing to participate in the study

Exclusion Criteria:

• Being a foreign national student
• Not volunteering to participate in the study

Withdrawal Criteria:

• Failing to attend at least two training sessions during the study period
• Incomplete or incorrect completion of data collection instruments

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental: Cultural Sensitivity Training; Fourth-year nursing students receiving a 4-week cultural sensitivity training program consisting of two 50-minute interactive sessions per week, including lectures, discussions, case studies, video demonstrations, and role-playing activities.	Behavioral: Cultural Sensitivity Training Program; A structured 4-week educational program delivered in classroom settings (Mondays 11:00-13:00). Week 1: Culture concepts and society-culture relationship. Week 2: Health, illness and culture relationship. Week 3: Cultural sensitivity, cultural awareness and ethnocentrism. Week 4: Transcultural nursing and cultural care models (Leininger's Sunrise Model, Giger-Davidhizar's Transcultural Assessment Model, Purnell's Cultural Competence Model). Teaching methods include PowerPoint presentations, group discussions, Q&A sessions, case studies, video demonstrations, and role-playing scenarios.
No Intervention: No Intervention: Standard Curriculum; Fourth-year nursing students continuing with the standard nursing curriculum without any additional cultural sensitivity training during the study period. The training program was provided to this group after post-test data collection.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Intercultural Sensitivity Scale Score	Measured using the Intercultural Sensitivity Scale (Chen and Starosta, 2000; Turkish adaptation by Bulduk, Tosun and Ardic, 2010). A 24-item, 5-point Likert scale measuring five emotional dimensions: interaction engagement, respect for cultural differences, interaction confidence, interaction enjoyment, and interaction attentiveness. Items 2, 4, 7, 9, 12, 15, 18, 20, and 22 are reverse scored. Higher scores indicate greater intercultural sensitivity. Cronbach's alpha = 0.90.	Baseline (pre-test, before intervention) and 4 weeks (post-test, immediately after completion of the training program)
Change in Ethnocentrism Scale Score	Measured using the Ethnocentrism Scale (Neuliep and McCroskey, 2001; Turkish adaptation by Ustun, 2011). A 20-item, 5-point Likert scale with a score range of 20-100. Items 4, 7, 9, 12, 15, and 19 are reverse scored. Higher scores indicate higher levels of ethnocentrism. Cronbach's alpha = 0.92.	Baseline (pre-test, before intervention) and 4 weeks (post-test, immediately after completion of the training program)
Change in Intercultural Awareness Scale Score	Measured using the Intercultural Awareness Scale (Rozaimie et al.; Turkish adaptation by Yakar Karabuga and Alpar, 2017). A 9-item, 5-point Likert scale with three sub-dimensions: existing cultural awareness (items 1, 6, 8, 9), felt cultural awareness (items 3, 5), and cultural communication awareness (items 2, 4, 7). Score range is 9-45. Lower scores indicate greater intercultural awareness. Cronbach's alpha = 0.73.	Baseline (pre-test, before intervention) and 4 weeks (post-test, immediately after completion of the training program)

Collaborators and Investigators

• Sponsor: Giresun University

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2025
• Primary Completion (Actual): April 20, 2025
• Study Completion (Actual): June 30, 2025

Study Registration Dates

• First Submitted: February 16, 2026
• First Submitted That Met QC Criteria: February 16, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 16, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Nursing Education; Nursing Students; Cultural Sensitivity; Cultural Awareness; Cultural Sensitivity Training
• Additional Relevant MeSH Terms: Behavior
• Other Study ID Numbers: E-13562490-050.01.04-595443

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No