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Behavior, Awareness, and Sensitivity of Healthcare Providers in a Multicultural Environment

*Russel Salvador Abalos-Fabia  -  Shaqra University, Saudi Arabia
Shadia Mohamed Khadrawi  -  Shaqra University, Saudi Arabia
Rosanta Oligan Ellasus  -  Shaqra University, Saudi Arabia
Open Access Copyright (c) 2019 Nurse Media Journal of Nursing

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Background: The healthcare workforce of Saudi Arabia is characterized by diverse cultural backgrounds as a consequence of the employment of expatriate workers from various countries. The heterogeneity of both providers of health services and clients results in cultural barriers that affect the delivery care. It is paramount to evaluate the cultural competence of healthcare providers (HCPs) to maintain quality holistic care.

Purpose: This study aimed to assess the cultural diversity experience, cultural competence behavior (CCB) and cultural awareness and sensitivity (CAS) of HCPs in a hospital setting of Saudi Arabia.

Methods: This was a cross-sectional study involving a survey of 104 HCPs from medical, nursing and laboratory technology disciplines that were taken based on a total sampling procedure. Data collection was conducted using the Cultural Competence Assessment (CCA) tool that measured cultural diversity experience, CCB, and CAS. Data analysis was performed and presented in descriptive statistics, and significant findings were computed using independent samples t-test, analysis of variance (ANOVA), and Pearson correlation coefficient.

Results: The characteristics of the respondents resulted in mean age of 38.7±10.4 who were predominantly Asians and nurses. The majority had working experience of 10 years and below, with more than half who had prior diversity training. Reported cultural diversity experience included all HCPs caring for Arab Middle Easterners and Asians and encountering at least one or more special population groups. There was an overall high cultural competence (5.28±0.46), high CCB (5.84±0.56) but only moderately high CAS (4.72±0.35). Significant differences were only identified between CCB scores and three demographic variables (racial/ethnic identification, the area of discipline and years of experience). No significant result was found between CAS scores and demographic variables as well as between CCB and CAS scores.          

Conclusion: Despite high CCB, the HCPs responded with lower CAS scores. Interventions should be initiated to increase CAS such as cultural diversity training and availability of cultural care resources.
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Keywords: Cultural competence; cultural awareness and sensitivity; cultural competence behavior; healthcare providers; Saudi Arabi
Funding: None

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  1. Aldossary, A., While, A., & Barriball, L. (2008). Health care and nursing in Saudi Arabia. International Nursing Review, 55(1), 125-128. doi: 10.1111/j.1466-7657.2007.00596.x
  2. Almutairi, A., Adlan, A., & Nasim, M. (2017). Perceptions of the critical cultural competence of registered nurses in Canada. BMC Nursing, 16, 47. doi: 10.1186/s12912-017-0242-2
  3. Almutairi, A., McCarthy, A., & Gardner, G. (2015). Understanding cultural competence in a multicultural nursing workforce: Registered nurses’ experience in Saudi Arabia. Journal of Transcultural Nursing, 26(1), 16-23. doi: 10.1177/1043659614523992
  4. Aragaw, A., Yigzaw, T., Tetemke, D., & G/Amlak, W. (2015). Cultural competence among maternal healthcare providers in Bahir Dar city administration, Northwest Ethiopia: Cross-sectional study. BMC Pregnancy and Childbirth, 15, 227. doi: 10.1186/s12884-015-0643-8
  5. Bircher, J. (2005). Towards a dynamic definition of health and disease. Medicine, Health Care, and Philosophy, 8(3), 335-341
  6. Bird, C., & Rieker, P. (2008). Gender and Health: The effects of constrained choices and social policies. New York: Cambridge University Press
  7. Bunjitpimol, P., Kumar, R., & Somrongthong, R. (2018). Effectiveness of case-based cultural competency among nurses working in private hospitals of Bangkok, Thailand: A quasi-experimental study. Pakistan Journal Medical Sciences, 34(1), 179-184
  8. Campinha-Bacote, J. 2003. Many faces: Addressing diversity in health care. Online Journal of Issues in Nursing, 8(1), 123-130
  9. Casillas, A., Paroz, S., Green, A., Wolff, H., Weber, O., Faucherre, F., Ninane, F., & Bodenmann, P. (2014). Cultural competency of health-care providers in a Swiss University Hospital: Self-assessed cross-cultural skillfulness in a cross-sectional study. BMC Medical Education, 14(19)
  10. Cicolini, G., Della Pelle, C., Comparcini, D., Tomietto, M., Cerratti, F., Schim, S., Simonetti, V. (2015) Cultural competence among Italian nurses: A multicentric survey. Journal of Nursing Scholarship, 47(6), 536–543. doi: 10.1111/jnu.12165
  11. Dabney, K., McClarin, L., Romano, E., Fitzgerald, D., Bayne, L. Oceanic, P., Holmes Jr., L. (2016). Cultural competence in pediatrics: Health care provider knowledge, awareness, and skills. International Journal Environmental Research and Public Health, 13(14). doi: 10.3390/ijerph13010014
  12. D’Avanzo, C. (2008). Mosby’s pocket guide to cultural health assessment (4th ed). Missouri: Mosby
  13. Davey, A. (2018). The meaning of culture. Cultural Confidence. Retrieved from
  14. Debiasi, L. & Selleck, C. (2017). Cultural competence training for primary care nurse practitioners: An intervention to increase culturally competent care. Journal of Cultural Diversity, 24(2), 39-45
  15. Doorenbos, A., Schim, S., Benkert, R., & Borse, N. (2005). Psychometric evaluation of the cultural competence assessment instrument among healthcare providers. Nursing Research, 54(5), 324–331
  16. Georgetown University. (2004). Cultural competence in health care: it is important for people with chronic conditions? Health Policy Institute 5. Retrieved from
  17. Giger, J., & Davidhizar, R. (2008). Transcultural nursing assessment and intervention (5th ed.). London: Mosby
  18. Hanson, M. & Callahan, D. (eds.) (1999). Goal of medicine the forgotten issue in the health care reform. Washington, DC: Georgetown Press
  19. Harvey, C., & Allard, J. (2015). Understanding and managing diversity: readings, cases and exercises (6th ed.) Boston, MA: Person Education
  20. Klein, H. (2004). Cognition in natural settings: The cultural lens model. Advances in Human Performance and Cognitive Engineering Research, 4, 247-78
  21. Lampley, T., Little, K., Beck-Little, R. and Xu, Y. (2008). Cultural competence of North Carolina nurses: A journey from novice to expert. Home Health Care Management & Practice, 20 (6), 454-461. doi: 10.1177/1084822307311946
  22. Lin, C., Mastel-Smith, B., Alfred, D. & Lin, Y. (2015). Cultural competence and related factors among Taiwanese nurses. The Journal of Nursing Research, 23(4), 252-261. doi: 10.1097/jnr.0000000000000097
  23. Messner, W., & Schäfer, N. (2012). The ICCA facilitator's manual: intercultural communication and collaboration appraisal. London: GloBus Research
  24. Ministry of Health (MOH). (2015). Statistical Year Book 1436. Riyadh: MOH
  25. Morin, R. (2013). The most (and least) culturally diverse countries in the world. Pew Research Center. Retrieved from
  26. Riley, J. (2017). Communication in Nursing (8th ed.) USA: Mosby
  27. Saudi Arabian Cultural Mission (SACM). (2017). Culture, traditions and art. Retrieved from
  28. Saudi Gazette. (2014). Eighty-five percent of expatriates from 8 countries. Retrieved from
  29. Schein, E. (2010). Organizational culture and leadership: Volume 2 of the Jossey Bass business & management series (4th ed.). San Francisco: John Wiley & Sons
  30. Spector, R. (2017). Cultural diversity in health and illness (9th ed.). New Jersey: Pearson Education
  31. Schim, S., Doorenbos, A. & Borse, N. (2006). Cultural competence among hospice nurses. Journal of Hospice and Palliative Nursing, 8(5), 302-307
  32. Starr, S. & Wallace, D. (2009). Self-reported cultural competence of public health nurses in a southeastern U.S. public health department. Public Health Nursing, 26(1), 48–57. doi: 10.1111/j.1525-1446.2008.00753.x
  33. The Royal Australian College of General Practitioner (2011). Multicultural health. The RACGP Curriculum for Australian General Practice. Retrieved from

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