The effectiveness of cultural competence interventions in nursing: A systematic review and meta-analysis

Background

The growing need to provide culturally competent nursing care has increased the importance of implementing and evaluating cultural competence interventions in healthcare settings. Previous research showed that increasing healthcare professionals' cultural competence can reduce racism and inequalities and enhance their ability to navigate cultural diversity. Whilst some evidence shows that educational interventions can improve cultural competence of healthcare professionals, a summary of this evidence is lacking, especially regarding the effectiveness of such interventions on nurses' cultural competence and patient-related outcomes.

Objectives

In this systematic review, the effectiveness of cultural competence interventions on nurses' levels of cultural competence and patient-related outcomes is assessed.

Design

A systematic review and a meta-analysis were conducted.

Methods

We searched in MEDLINE, Embase, CINAHL, PsychINFO, ERIC and CENTRAL up to September 2023 for studies using a quasi-experimental or experimental design. We used the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guideline for methodological and reporting guidance. Two researchers independently assessed the eligibility of the studies and their methodological quality. We assessed the quality of experimental studies using the Revised Cochrane Risk of Bias Assessment Tool for Randomized Trials (RoB 2), and the quality of quasi-experimental studies with the Risk of Bias in Nonrandomized Studies – of Interventions tool (ROBINS-I).

Results

Overall, 17 studies, three randomised controlled trials and 14 pre-test/posttest studies, were included in this review. Of these 17 studies, 12 provided sufficient, appropriate data for inclusion in the meta-analysis. Cultural competence interventions were offered through education and training (including lectures, presentations, case studies, discussions, or various reflection activities) or technology-based applications and support (mobile app, online database, or web-based training). Education and training were shown to slightly increase nurses' levels of cultural competence, with a low certainty of the evidence. Technology-based applications and support may increase nurses' levels of cultural competence, but the evidence is very uncertain. No pooling of studies was possible for the patient-related outcomes.

Conclusion

Education and training can improve the level of nurses' cultural competence; therefore, they should be offered as continuing education for nurses. However, our confidence in the underlaying evidence for cultural competence interventions is low due to the imprecision and risk of bias of included studies; thus, the results should be interpreted with caution. Despite the growing interest in and body of research on nurses' cultural competence interventions, our review indicates a significant lack of studies examining the impact of such interventions on patient-related outcomes.