The Effectiveness of Simulated Cultural Humility Training on Nurse's Ability to Provide Culturally Competent Care and Patient Satisfaction in HMC, Doha, Qatar. (culture)

Globalization has significantly increased cultural diversity across many countries. Cultural diversity has been identified as an important factor influencing disease progression and health outcomes. Failure to provide culturally appropriate care may result in patient dissatisfaction, poor treatment adherence, and adverse health outcomes. Moreover, a lack of empathy toward patients' cultural values can lead to stereotyping and biased clinical decision-making by healthcare providers.

In Qatar, where the patient population is highly diverse, having a multicultural healthcare workforce is a major strength. However, an increasingly diverse patient population necessitates that cultural competence be integrated as a core component of healthcare professionals' training to ensure the delivery of high-quality, patient-centered care.

This study aims to train nurses in culturally competent care and evaluate its impact on nursing practice and patient satisfaction. Nurses who meet the inclusion criteria will be selected using a simple random sampling technique. Nurses' ability to provide culturally competent care will be assessed using the Cultural Competence Self-Assessment Checklist, while patient perception will be evaluated using a culturally competent patient satisfaction survey.

The experimental group will undergo simulated cultural humility training consisting of four modules, with each module lasting two hours and including objective evaluations and follow-up assignments. The control group will not receive the simulated cultural humility training during the study period. At the end of the seventh week, both the experimental and control groups' ability to provide culturally competent care will be reassessed using the same assessment tools.

The collected data will be analyzed using a paired t-test for within-group comparisons and ANOVA to assess differences between groups and related variables.

Study Overview

• Status: Active, not recruiting
• Conditions: Curtural Humility Training Among Expart Nurses
• Intervention / Treatment: Behavioral: Simulated Cultural Humility Training

Detailed Description

Introduction Globalization has significantly increased cultural diversity across the world, particularly in Qatar, where 88.4% of the population consists of expatriates representing nearly 94 nationalities and approximately 190 spoken languages (Shepherd et al., 2019). Qatar's healthcare system reflects this diversity, with a workforce drawn from over 70 countries. While this multicultural environment is a major strength, it also presents challenges in delivering culturally sensitive and patient-centered healthcare.

Nurses play a pivotal role in ensuring culturally appropriate care. However, variations in cultural beliefs, communication styles, and healthcare expectations can negatively influence nurse-patient interactions if not adequately addressed. These challenges highlight the need for effective cultural competence and humility training within Qatar's healthcare system.

Background Cultural competence in nursing traditionally refers to the ability to understand and respect patients' cultural beliefs, values, and practices to deliver appropriate care. However, many existing cultural competence programs focus primarily on static, surface-level knowledge of specific cultural groups, limiting their applicability in highly dynamic and multicultural environments such as Qatar (Tang et al., 2019).

Cultural humility offers a more adaptive and reflective approach, emphasizing lifelong learning, self-reflection, recognition of power imbalances, and openness to individual patient identities. This framework promotes flexibility and deeper nurse-patient relationships, making it particularly suitable for multicultural healthcare settings.

Studies indicate that culturally competent care improves nurse-patient communication, trust, and patient satisfaction (Červený et al., 2022). Conversely, barriers such as language difficulties, lack of culturally sensitive care plans, and limited empathy reduce care quality. Research conducted in Qatar identified significant gaps in nurses' ability to address cultural and spiritual needs (Moratillo, 2021), and nearly 60% of patients at Hamad Medical Corporation reported dissatisfaction with how cultural aspects of care were addressed (Mukhalalati et al., 2023).

These findings demonstrate an urgent need for structured, context-specific cultural humility training to improve nursing care quality and patient satisfaction. This study aligns with Qatar National Vision 2030 by supporting healthcare excellence, inclusivity, and social cohesion.

Objectives Primary Objective

To evaluate the effectiveness of simulated cultural humility training in improving nurses' cultural competence and enhancing patient satisfaction related to culturally competent care.

Secondary Objectives

To assess nurses' baseline levels of cultural competence (awareness, knowledge, and skills).

To determine the effectiveness of simulated cultural humility training in improving patient-centered nursing care.

To compare patient satisfaction with culturally responsive nursing care before and after the intervention.

To explore the relationship between nurses' demographic characteristics and baseline cultural competence levels.

Methodology This study employs a parallel-group randomized controlled trial (RCT) design with a 1:1 allocation ratio. Block randomization with varying block sizes will be used to ensure balanced group allocation. The study will be conducted across three Hamad Medical Corporation (HMC) facilities: Al Wakra Hospital, Hamad General Hospital, and Rumailah Hospital.

Allocation concealment will be maintained using sequentially numbered, sealed opaque envelopes prepared by an independent statistician. Outcome assessments will be conducted at baseline and post-intervention.

Tools and Measures Tool 1: Cultural Competence Self-Assessment Checklist This 37-item tool, developed by the Central Vancouver Island Multicultural Society, assesses three domains: awareness, knowledge, and skills. Items are rated on a 4-point Likert scale (1-4), with total scores ranging from 37 to 148. Local validation will be conducted through expert review and cognitive pre-testing in the Qatari context.

Tool 2: Patient Satisfaction Survey Adapted from the Health Quality & Safety Commission (New Zealand), this 14-item survey evaluates patient satisfaction regarding culturally competent care using a 4-point Likert scale. The adapted version will undergo content validation and pilot testing for reliability.

Sample Size and Study Setting Based on an estimated effect size from prior simulation-based studies, a total sample size of 100 nurses (50 per group) is required, accounting for a 10% attrition rate. The study will be conducted in medical and surgical inpatient units at Al Wakra Hospital, Hamad General Hospital, and Rumailah Hospital.

Eligible participants include expatriate nurses with limited experience in Qatar and patients aged ≥18 years who receive care from participating nurses.

Intervention

The intervention consists of simulated cultural humility training, delivered through standardized modules covering:

Basics of cultural competence Cultural barriers and population-specific conditions Self-awareness and stages of cultural understanding Skill-centered approaches, including empathy and transcultural communication

All sessions will use uniform simulation scenarios, facilitator manuals, and fidelity checklists to ensure consistency.

Study Procedures Eligible nurses will complete baseline assessments using Tool 1, along with demographic data. Patient feedback will be collected using Tool 2. Nurses scoring below the eligibility threshold will be randomized into intervention or control groups. The intervention group will undergo face-to-face simulation training, while the control group will receive no training during the study period. Post-intervention assessments will be conducted in the seventh week.

Data Management and Ethics All collected data will be coded to ensure anonymity. Electronic data will be stored in a password-protected database accessible only to the research team, and physical documents will be securely stored. De-identified data will be retained for five years in compliance with Qatar Ministry of Public Health guidelines. Ethical approval and informed consent will be obtained prior to study initiation.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Qatar
  • Doha, Qatar
    • Hamad Medical Corporation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Expatriate nurses with ≤3 years of experience in Qatar, no prior cultural humility training, and a baseline cultural competence score ≤74

Exclusion Criteria:

• Nurses from Arabic Speaking Countries working in HMC, Nurse working in HMC who had undergone cultural humility training, Outpatient, emergency, operation theater and critical care nurses working in HMC.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cultural Humility Training Group; Nurses receiving simulated cultural humility training	Behavioral: Simulated Cultural Humility Training; Cultural Humility Training Group; Other Names: no intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cultural Competence Score using Cultural Competence Self-Assessment Checklist (CCSAC)	Change in nurses' cultural competence score measured using the Cultural Competence Self-Assessment Checklist (CCSAC). Score range: 37-148 Higher scores indicate better cultural competence	4 moths
Patient Satisfaction Score using Patient Satisfaction Questionnaire	Patient satisfaction level assessed using a validated patient satisfaction questionnaire. Score range: 14-56 Higher scores indicate higher patient satisfaction	4 months

Collaborators and Investigators

• Sponsor: Hamad Medical Corporation

Publications and helpful links

General Publications

• Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: Perspectives of healthcare providers. Journal of Multicultural Counseling and Development, 47(4), 263-280. Tang, C., Tian, B., Zhang, X., Zhang, K., Xiao, X., Simoni, J. M., & Wang, H. (2019). The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. Journal of Advanced Nursing, 75(4), 749-759. https://doi.org/10.1111/jan.13854 Brunett, M., & Shingles, R. R. (2018). Does having a culturally competent health care provider affect the patients' experience or satisfaction? A critically appraised topic. Journal of Sport Rehabilitation, 27(3), 284-288. https://doi.org/10.1123/jsr.2016-0123 Moratillo, M. G. P., & Jabonete, G. F. (2023). Cultural competence and caring behavior among inpatient staff nurses in Al Wakra Hospital, Qatar. Journal of Nursing Practice, 10(2), 45-56. Mukhalalati, B., & Sadek, M. (2023). Cultural competence among healthcare professional educators in Qatar: A mixed-methods study. International Journal of Medical Education, 14(3), 101-110. Understanding Assessments: A Tool for Families · Engage · Events and Trainings · News · Champion Learning. Empower Leadership. Ignite Colorado's Future. Who We Are · Our Impact https://www.coloradoedinitiative.org/wp-content/uploads/2015/10/cultural-competence-self-assessment-checklist.pdf. AVMA. (n.d.). CULTURAL COMPETENCE SELF-ASSESSMENT CHECKLIST. https://www.avma.org/sites/default/files/2022-02/DiversityCulturalCompetenceChecklist.pdf NZ Patient Experience Surveys | Cultural Safety Cognitive .Working with clinicians, providers, consumers and whānau to improve health and disability support services.https://www.hqsc.govt.nz/assets/Our-data/Publications-resources/Cultural_Safety_Cognitive_Pretest_Report_PDF_April_2021.pdf Lau, Phyllis & Woodward-Kron, Robyn & Livesay, Karen & Elliott, Kristine

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: April 28, 2026
• First Submitted That Met QC Criteria: May 25, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: cultural humility training
• Other Study ID Numbers: MRC-01-25-713

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: doing it for Phd Purpose

Drug and device information, study documents

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