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

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.