A Study Protocol to evaluate the effectiveness of Cultural Competency Training Module (CCTM) on Knowledge, Attitude, Cultural awareness, and Cultural self-efficacy regarding Culturally Competent Nursing Care among Nursing Students

Sarita Bhattarai, Shaveta Sharma*

PhD. Scholar, Narayan Nursing College, GNSU, Professor, College of Nursing, ESI Hospital,

Asansol, West Bengal - 733207.

*Corresponding Author Email: shaveta322155@gmail.com

ABSTRACT:

Background: Cultural competence has been historically regarded as a fundamental element in enhancing cross cultural communication, minimizing the health disparities, improving access to quality care, boosting health literacy and promoting health equity. The present study aims to evaluate the efficacy of Cultural Competency Training Module (CCTM) that is designed to cultivate the knowledge, skill, and attitudes necessary for nursing students to better understand, view with respect, and respond appropriately to the cultural needs and preferences of patients under their care particularly in a vast and diverse nation like India. Methods: The study adapts a true experimental design with participation of 400 students, (200 in the study group and 200 in the control group) undergoing the final year B.Sc. Nursing course. Nursing Colleges will be randomly selected to participate in this study. Collection of the data will be initiated after the approval from the Institutional Ethical Committee and on completion of subject informed consent. Data will be collected using the pretested Cultural Competency Knowledge Assessment Questionnaire, Cultural Attitude Assessment Questionnaire, Cultural Awareness Scale, and a Cultural Self-efficacy Scale. Results: At the time of writing, data collection is still in process. A frequency and percentage table will be used for the analysis of demographic data. Pearson’s correlation will be used to find out the relationship between the variables, Chi square test will be used to find out the association between the variables. If samples seem to be normally distributed, Independent- t- test will be used for data analysis and if sample is not normally distributed, Mann-Whitney U test will be used for analysis of data. Conclusion: the study will offer, aims to provide a deeper, understanding of cultural concepts, foster more positive attitude towards diversity, enhance awareness of cultural influences on health, and increase confidence in delivering culturally sensitive nursing care Moreover, the CCTM may prove a valuable educational tool for enhancing cultural competence among nursing students.

KEYWORDS: Effectiveness, Cultural Competency Training Module (CCTM), Knowledge, Attitude, Cultural awareness, Cultural self-efficacy, Culturally Competent Nursing Care.

INTRODUCTION:

In the context of today’s culturally, diverse healthcare environment, cultural competence is a vital skill for nursing professionals. Nurses often care for patients from wide range of cultural, ethnic and linguistic backgrounds requiring not only clinical proficiency but also the ability to deliver culturally sensitive care. Despite this need, research studies shows that that nursing students lack sufficient knowledge, awareness and confidence to interact and engage effectively with culturally diverse population.

Cultural competence in nursing is recognized as a dynamic and evolving process that equips nurses to deliver safe, effective, and high-quality care to individuals from diverse cultural backgrounds (Sharifi, 2019)¹. As instances of culturally insensitive care continue to be reported, and nurses increasingly encounter challenges in providing care to diverse populations, the need to enhance the intercultural readiness of nursing students has become critical. Despite this urgency, limited evidence exists regarding the effectiveness of cultural competence training within undergraduate nursing programs. Furthermore, there remains a lack of consensus in the literature on the optimal structure, content, and delivery methods for such educational interventions (O’Brien, 2021)².

Cultural competency training has emerged as a pivotal educational strategy to address this gap. Such training aims to enhance learners, understanding of cultural differences, shape, positive attitudes and develop the self-awareness and efficacy required to interact respectfully and effectively cross sculptures yet despite growing recognition of its importance, the effectiveness of structure, cultural competency modules within undergraduate, nursing curricular means unexplored, particularly in terms of measurable outcomes like knowledge, attitude, cultural awareness, and cultural self-efficacy.

A randomized experimental study was conducted to assess the effectiveness of a Cultural Competence Training program based on the Campinha-Bacote model among undergraduate nursing students. A total of 88 third-semester students were divided randomly into intervention and control groups. The intervention group participated in a four-week educational program aligned with the Campinha-Bacote framework. Both groups completed demographic and cultural competence assessments at three points: prior to the intervention, immediately afterward, and one month later. At baseline, there were no significant differences between the two groups in demographic factors or levels of cultural competence (p>0.05). Post-intervention and at the one-month follow-up, the intervention group showed significantly improved cultural competence scores compared to the control group. The results support the effectiveness of structured educational interventions rooted in the Campinha-Bacote model for enhancing cultural competence in nursing students.³

An experimental study was conducted to explore the efficacy of a structured educational program aimed at enhancing cultural competence among public health nurses. The study, involving 76 participants, utilized a one-group repeated measures design. Over five weeks, nurses engaged in both theoretical and experiential learning activities, followed by a refresher session. Cultural knowledge was evaluated at four different time points using a validated instrument. The results showed a significant improvement in participants' cultural knowledge after the intervention (p < 0.01). Qualitative feedback further emphasized an increase in cultural awareness and sensitivity. Although the study did not include a control group, the findings support the value of structured educational interventions in advancing cultural competence among nursing professionals.⁴

A meta-analysis was conducted involving 15 studies to examine how educational programs influence cultural competence among nurses and nursing students. The review explored outcomes across knowledge, attitudes, and behaviors, finding that such interventions had a small to moderate overall positive effect, especially on knowledge and attitudes. However, inconsistencies were noted in research quality, study designs, and the tools used to assess outcomes. The authors emphasized the importance of using standardized measures and robust research designs in future studies. Their findings support the incorporation of structured cultural competence training into nursing education and continuing professional development.⁵

OBJECTIVE:

This study primarily aims to evaluate the effectiveness of the Cultural Competency Training Module in enhancing nurses' knowledge, skills, and attitudes essential for understanding, respecting, and appropriately addressing patients’ cultural needs and preferences. Secondary objectives include assessing and comparing pre- and post-test levels of knowledge, attitude, cultural self-awareness, and cultural self-efficacy related to culturally competent nursing care between the intervention and control group, to examine relationships among knowledge, attitude, cultural awareness, and self-efficacy and to identify associations between demographic variables and cultural competence outcomes.

RESEARCH HYPOTHESIS:

H1: A significant difference will exist in knowledge, attitude, cultural awareness, and self-efficacy between study and control groups post-intervention.

H2: A Significant correlations will exist among knowledge, attitude, cultural awareness, and self-efficacy

H3: Significant associations will be observed between demographic variables and cultural competence measures.

MATERIALS AND METHODS:

Research approach:

The study adopts a Quantitative research approach

Research design:

A true experimental Pretest post-test control group design will be adopted in this study.

Randomization and Sampling:

A total of 10 colleges will be selected through random sampling. The selected colleges will then be randomly allocated into two groups using simple randomization (lottery method). Five colleges (C1–C5) will be assigned to the experimental group, and five colleges (C6–C10) will be assigned to the control group. Within each college, only final year (7^th AND 8^th Semester) B.Sc. Nursing students will be considered for inclusion. From these students, a proportionate stratified random sampling technique will be applied to select eligible participants, ensuring equal representation across colleges.

Application of Proportionate Stratified Random Sampling:

· Within each college, the total number of eligible students will be treated as a stratum.

· The sample size from each college will be determined proportionately, based on the number of eligible students relative to the total across all colleges.

· Random selection of participants within each stratum (college) will be done using a computer-generated random number list.

Study setting:

Selected Nursing Colleges in West Bengal.

Sample size:

400 (200 in each arm).

Sample Justification:

Based on recommendations for estimating medium effect sizes⁶ (Cohen’s d = 0.5) and findings of prior studies^7,8, a sample of 400 ensures adequate power. Accordingly, the pilot study is being conducted on 20 participants in each intervention and control group (total -40) for 80% main trial power, considering its adequacy in estimation of medium effect size with sufficient precision for planning the main study. Thus, the proposed sample size for main study is Four hundred 400 (200 in in each arm)) which aligns with conventional benchmarks for behavioural interventions.

Criteria:

Inclusion Criteria:

· B.Sc. Nursing students from 7th and 8th semester.

· Students who are available during data collection period.

· Students studying in Nursing colleges of West Bengal.

Exclusion Criteria:

· Students unwilling to participate or unavailable due to illness:

Tools:

Tools that will be adopted for the present study for collection of data include, Demographic Proforma, a self-structured Cultural Competency Knowledge Assessment Questionnaire, a self-structured Attitude assessment questionnaire, standardized Cultural awareness Scale (CAS) and a self-structured Cultural self-efficacy Scale. All the instruments/tools used for data collection will be validated and checked for its reliability and internal consistency.

The Intervention Module:

The Cultural Competency Training Module (CCTM) is a systematically designed educational program aimed at strengthening nursing students' understanding, attitudes, and abilities to provide culturally responsive care. The intervention comprises five core components:

1. Introduction to Cultural Competency: Covers key concepts and the significance of cultural awareness in nursing practice.

2. Transcultural Nursing: Introduces core principles, goals, challenges, and practical strategies for applying transcultural nursing in clinical settings.

3. Cross-Cultural Communication: Highlights the significance of effective communication in multicultural healthcare settings, common barriers associated with , and strategies to enhance communication and promote culturally competent care.

4. Legal and Ethical Considerations: Addresses legal risks such as discrimination and ethical responsibilities in providing culturally sensitive care.

5. Organizational Strategies: Focuses on institutional approaches to support and sustain a culturally competent nursing workforce.

Ethical Consideration:

Ethical clearance for the study has been obtained from the Institutional Ethics Committee (IEC). Prior to the commencement of data collection, formal permission will be sought from the administrative authorities of the selected study setting. Participation in the study will be completely voluntary. Written informed consent will be secured from all participants after explaining the purpose and procedures of the study. Confidentiality and anonymity of the information provided by each participant will be maintained. They will also be informed of their right to withdraw from the study at any stage without any repercussions. The securely stored data will be exclusively accessible to the principal investigator.

Steps of Intervention:

Preparation Phase:

· Approval obtained from IEC and DRC

· Subject Information sheet and Informed consent prepared for participants,

· Reliability and validity of research tools to checked for its adoption in the study

· Selection of Colleges (random assignment of college to experimental and control group)

· Participant Recruitment (selection of all eligible participants)

Pre-Intervention:

Administration of Pre-Test for both the groups.

Intervention Phase:

Implementation of Cultural Competency Training (for Experimental Group).

Post-Intervention Data Collection:

Administration of Post-Test for both the groups.

Statistical Analysis:

At the time of manuscript preparation, data collection is still ongoing. Upon its completion, descriptive statistics will describe demographic characteristics. Pearson’s correlation will test relationships among variables for a normally distributed continuous data. Chi-square will assess categorical associations. Independent t-tests or Mann-Whitney U tests will compare group means. Significance set at p<0.05. SPSS will be used.

DISSEMINATION PLAN:

The results of the study will be submitted for publication in peer-reviewed journals relevant to nursing education, cultural competence, and healthcare research. The findings will be presented at relevant national and international conferences, workshops, and seminars focused on nursing education, cultural competence, and health equity. A summary report of the study findings will be shared with participating institutions (Nursing colleges, including faculty) and curriculum developers, to inform potential integration of cultural competency training modules in nursing education. Results may also be shared through institutional websites, academic social networks (e.g., ResearchGate, Academia.edu), and professional platforms to reach a broader audience.

DISCUSSION:

This study protocol describes the effectiveness of Cultural Competency Training Module (CCTM) on Knowledge, Attitude, Cultural awareness, and Cultural self-efficacy regarding Culturally Competent Nursing Care among Nursing Students that aims to enhance knowledge, attitude, cultural awareness, and cultural self-efficacy among nursing students. Cultural competence has been increasingly recognised as a critical component of high-quality patient centred nursing care, especially in diverse and multicultural health settings. The findings of this study are anticipated to highlight the significance and effectiveness of structured educational interventions in equipping nursing students to provide culturally competent care. These expected outcomes are consistent with previous research that advocates for the use of targeted educational programs to improve cultural competence among healthcare professionals and students..^8,9 Evidence about the improvement in knowledge scores is highlighted in the findings from similar studies where knowledge-based learning significantly improved students' understanding of cultural dynamics in healthcare.¹⁰Significantly higher cultural self-efficacy scores among the intervention group further highlights the CCTM's success in building students' confidence in applying culturally competent care in clinical settings. This finding is vital because self-efficacy is closely linked to the likelihood of implementing learned skills in practice

Overall, the findings from this study may affirm that the Training module on Cultural Competency could be an effective tool for improving nursing students’ preparedness to offer culturally sensitive and equitable care. Integrating such modules into nursing curricula can significantly contribute to reducing healthcare disparities and improving patient outcomes in multicultural environments.

DECLARATION OF CONFLICTING INTERESTS:

The authors declares that there are no conflicts of interest related to the research, authorship, or publication of this article.

ACKNOWLEDGEMENT:

The authors sincerely acknowledge the cooperation and support of the faculty and students of the participating nursing institutions involved in coordination of this study. Appreciation is also extended to the experts who contributed to the process of developing and validation of the Cultural Competency Training Module as well as the research instruments.

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11. Available from: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0363-x

Received on 21.07.2025 Revised on 20.08.2025

Accepted on 16.09.2025 Published on 25.10.2025

Available online from November 04, 2025

Asian J. Nursing Education and Research. 2025;15(4):221-225.

DOI: 10.52711/2349-2996.2025.00045

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