Cultural Competence and Transcultural Teaching Behaviors and Influencing Factors in Nursing Academia: A Mixed-Methods Study Among Nurse Educators

Abstract

Introduction

Cultural competence is crucial in nursing education, with nurse educators playing a key role. However, limited research has explored factors influencing their cultural competence.

Objectives

This study has two aims: to assess cultural competence levels and transcultural teaching behaviors among academic nurse educators and to explore the factors influencing these cultural competencies through both quantitative and qualitative analyses.

Methods

A convergent mixed-method design was used. A convenience sample of 45 nurse educators in a Saudi college completed the Cultural Diversity Questionnaire for Nurse Educators-Revised. Semi-structured interviews with 20 purposively selected educators provided insights into factors influencing cultural competence. Data were analyzed using inferential statistics and thematic analysis.

Results

The majority of nurse educators exhibited moderate cultural competence with a mean percent score of 73.55 ± 13.5, with cultural awareness being the highest and cultural encounters the lowest. Cultural competence, particularly awareness, played a significant role in shaping and predicting Transcultural Teaching Behaviors, with 92.3% of the variance in teaching behaviors. Thematic analysis identified personal factors, professional development, institutional support, and barriers that influence educators’ ability to foster cultural competence. Age, multilingualism, training, and professional growth were found to significantly enhance educators’ cultural competence.

Conclusion

Nurse educators show moderate cultural competence, with cultural awareness playing a key role in predicting Transcultural Teaching Behaviors. Strengthening cultural encounters through experiential learning and immersion programs is essential. The study highlights the need for professional development, curriculum integration, and institutional support to enhance cultural competence in nursing education.

Keywords

cultural competence transcultural teaching academic nurse educators mixed-method study semi-structured interviews qualitative themes Saudi Arabia

Introduction

The nursing profession is increasingly tasked with addressing cultural diversity in healthcare to meet the needs of globalized patient populations. Culture profoundly influences health perceptions, behaviors, and treatment outcomes, making cultural competence a critical skill for healthcare providers (Shahzad et al., 2021). Healthcare and nursing organizations worldwide emphasize the need for the provision of transcultural and sensitive care (American Nurses Association, 2021; Institute for Healthcare Improvement, 2021; Transcultural Nursing Society, 2020). Within nursing education, academic nurse educators play a central role in fostering cultural competence among students, equipping them to navigate diverse clinical environments and deliver culturally sensitive care (Paric et al., 2021). Despite its importance, gaps remain in understanding the cultural competence of nurse educators, particularly in non-Western contexts where multicultural challenges are often compounded by sociocultural and institutional factors and constraints (Abubakari et al., 2024).

Given these complexities, the study framework builds on the understanding that cultural competence is a dynamic, developmental process encompassing cultural awareness, knowledge, skills, encounters, and desire. These dimensions collectively enable healthcare professionals to provide effective care within diverse cultural contexts (Stubbe, 2020). Research highlights the need for exploring the levels of cultural competence among nursing educators and its influencing factors (Stubbe, 2020). This study addresses these gaps by employing a mixed-method approach to assess cultural competence levels and explore influencing factors from educators’ perspectives.

Review of Literature

Conceptual Framework

This study is guided by Campinha-Bacote's process of cultural competence in the delivery of healthcare services model, which conceptualizes cultural competence as an ongoing developmental process rather than a fixed goal (Campinha-Bacote, 1999, 2002, 2011). The model identifies five interrelated constructs that define cultural competence. Cultural awareness involves reflecting on and critically assessing one's cultural values, biases, and professional practices, forming the foundation for understanding diversity. Cultural knowledge refers to the acquisition of information about cultural differences to enhance decision-making and interactions. Cultural skills emphasize the ability to conduct culturally appropriate assessments and interventions, ensuring that care delivery aligns with the cultural context of patients and students. Cultural encounters, which involve direct engagement with individuals from diverse cultural backgrounds, provide opportunities to dispel stereotypes and refine understanding. Cultural desire represents the intrinsic motivation to embrace and engage in the journey toward cultural competence, driven by respect and genuine interest in diversity (Campinha-Bacote, 2002, 2011; Ličen & Prosen, 2023; Stubbe, 2020).

In addition, transcultural teaching behaviors enrich this framework by emphasizing the role of educators in integrating cultural concepts into their teaching practices and curricula (Fabry et al., 2024; Sealey, 2003). This expanded lens underscores the critical role that academic nurse educators play in equipping future nurses to provide culturally sensitive care (Tosun et al., 2024).

Significance of the Study

Cultural competence is essential in nursing education, enabling students and educators to provide culturally responsive care. Nurse educators play a key role in preparing students to meet diverse patient needs and modeling culturally congruent care (Ličen & Prosen, 2023; Ličen et al., 2021; Rahimi et al., 2023). Transcultural nursing education enhances cultural awareness and sensitivity through curriculum interventions (Halabi & de Beer, 2018; Ličen & Prosen, 2023; Ličen et al., 2021; Tosun et al., 2024). The literature highlights that cultural competence among nurse educators is influenced by a range of factors, including demographic characteristics, personal experiences, professional development activities, and institutional support (Cai et al., 2021; Halabi & de Beer, 2018; Rahimi et al., 2023; Zeleke et al., 2024). However, significant barriers persist that hinder the development of cultural competence, underscoring the need for investigation from nurse educators’ perspectives (Rahimi et al., 2023).

Saudi Arabia provides a unique setting for examining cultural competence due to its reliance on an expatriate healthcare workforce and growing cultural diversity (Halabi & de Beer, 2018; Mani & Goniewicz, 2024). While research has largely focused on nursing students, understanding academic nurse educators’ cultural competence and its influencing factors is crucial. Addressing this gap is essential for advancing nursing education in Saudi Arabia, where cultural competence is increasingly prioritized. This mixed-methods study explores cultural competence among academic nurse educators. The quantitative component assesses competence levels using a validated and reliable questionnaire, while the qualitative component explores educators’ lived experiences through semi-structured interviews. This dual approach ensures a comprehensive understanding of the barriers and facilitators shaping cultural competence in nursing academia.

The study's significance lies in its potential to inform targeted interventions at institutional, curricular, and professional development levels. By identifying key challenges and enablers, the findings may guide policy improvements and enhance nursing education. Ultimately, this study contributes to global efforts promoting equity, inclusivity, and culturally responsive care in healthcare systems.

Aim of the Study

Research Questions

What are the levels of cultural competence and transcultural teaching behaviors among academic nurse educators?

What are the factors that influence cultural competence and transcultural teaching behaviors among nurse educators?

Methods

Study Design and Setting

The study was conducted at the College of Nursing-Jeddah (CONJ), affiliated with King Saud bin Abdulaziz University for Health Sciences. This study utilized a convergent mixed-method design to comprehensively explore cultural competence levels and the factors influencing them among academic nurse educators. The quantitative aspect used a cross-sectional design to assess cultural competence level among nurse educators, while the qualitative aspect employed an exploratory descriptive design with semi-structured interviews to explore factors influencing their cultural competence and transcultural teaching behaviors.

Study Participants and Inclusion/Exclusion Criteria

A total of 50 academic nurse educators from CONJ were invited to participate in the study. Inclusion criteria required participants to be actively employed as academic nurse educators at the college during the data collection period. Educators who were on leave or not engaged in teaching or academic duties at the time were excluded. Invitations were distributed through face-to-face communication, WhatsApp, and email. Participants had the option to complete the quantitative questionnaire either in paper format or via an electronic link, based on their preference. A total of 45 nurse educators (90.0%) completed the quantitative component, selected through convenience sampling.

For the qualitative component, 20 nurse educators were purposively selected from those who had completed the quantitative survey and expressed interest in participating further. These participants were chosen to represent diverse perspectives relevant to the study's focus. The sample size for the qualitative phase was guided by the principle of data saturation, defined as the point at which no new information or themes emerged (Saunders et al., 2018).

Data Collection Tools

Quantitative Tool

The Cultural Diversity Questionnaire for Nurse Educators-Revised (CDQNE-R), developed by Sealey (2003) was used to assess cultural competence. This instrument comprises two main sections:

- Demographic and professional data: This section includes questions for collecting information on participants’ demographic and professional characteristics, such as age, nationality, highest degree attained, specialty area, years of teaching experience, language fluency, exposure to cultural diversity, and participation in professional cultural development programs.

- Cultural competence subscales: The second section of the CDQNE-R represents items categorized into five subscales, each reflecting a dimension of cultural competence. These include cultural awareness (8 items), cultural knowledge (11 items), cultural skills (8 items), cultural encounters (6 items), and cultural desire (8 items). Additionally, the questionnaire integrates a Transcultural Teaching Behaviors subscale, which consists of 11 items. Responses are recorded on a 5-point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5), with higher scores indicating greater cultural competence. The reliability coefficient for the overall CDQNE-R scale was α = 0.94.

Qualitative Tool

A semi-structured interview guide was developed by the researchers to explore factors influencing cultural competence from the participants’ perspectives. To ensure clarity and relevance, the guide was reviewed by a panel of experts in nursing education and cultural studies. The interview questions encouraged participants to reflect on barriers, facilitators, and personal experiences that shaped their development of cultural competence. Key questions included: “What challenges are faced in fostering cultural competence in the teaching practice?” and, “What resources or factors have supported the development in this area?”

Validity and Reliability

The instruments used in this study were administered in English and underwent content validity evaluation by a panel of experts. Reliability was assessed using Cronbach's alpha, which demonstrated strong internal consistency (α = 0.94), with statistical significance set at p ≤ 0.05. A pilot study involving two participants was conducted to evaluate the clarity and practical applicability of the instruments. Additionally, a pilot interview was performed, which indicated that no modifications were required for the final version of the instruments.

Data Collection

Following ethical approval from King Abdullah International Medical Research Center (KAIMRC), all academic nurse educators were invited to participate in the study. Quantitative data were collected using the self-administered CDQNE-R questionnaire, distributed in either paper or electronic form during scheduled work hours, based on participants’ preferences.

For the qualitative component, semi-structured interviews were conducted in English, the primary language of instruction. Interviews were scheduled at times and in locations convenient to participants, with most held in private academic meeting rooms within the college to ensure comfort and confidentiality. Participants were also given the option to choose an alternative location if preferred.

Each interview lasted 30 to 45 min, was audio-recorded with informed consent, and then transcribed verbatim to ensure accuracy. Interviews continued until data saturation was reached, defined as the point at which no new information or themes emerged. A total of 20 participants were interviewed, a number guided by both the achievement of data saturation and the need for diverse representation across academic ranks and teaching experience. Data collection was conducted over a 5-month period, during the 2022–2023 academic year, spanning from November 2022 to April 2023.

Ethical Considerations

The study adhered to the ethical principles set forth in the Declaration of Helsinki. Ethical approval was granted from KAIMRC with the approval number: SP19/033/J. Participants were fully informed about the study's purpose and procedures, and written informed consent was obtained prior to participation. Confidentiality and anonymity were strictly maintained throughout the study. Participation was voluntary, with participants assured of their right to withdraw at any time without any negative consequences.

Data Analysis

The data were entered and coded for analysis using the IBM SPSS software package (version 25). Descriptive statistics, including means, standard deviations, and frequencies, were applied to summarize the demographic characteristics of participants and assess the levels of cultural competence and transcultural teaching behaviors. To compare numerical data across different groups, Student's t-test and analysis of variance F-test were used. In addition, multiple regression analysis was employed to explore the influence of sociodemographic and experience-related factors on cultural competence. The level of significance for all statistical tests was set at p ≤ 0.05.

Qualitative Data Analysis and Trustworthiness

Thematic analysis, following Braun and Clarke's six-phase framework, was applied to the qualitative data. This process involved familiarizing the researchers with the data, generating initial codes, searching for themes, reviewing and defining themes, and producing the final report (Braun & Clarke, 2006). Manual coding was conducted to ensure detailed engagement with the data. The codes were developed inductively, capturing the key elements from participants’ narratives, and were subsequently grouped into broader themes. These themes reflected the barriers and facilitators influencing the development of cultural competence among educators. To ensure the trustworthiness of the analysis, independent coding was conducted, and discrepancies were resolved through discussion and consensus and participants’ feedback. The themes derived from the qualitative data were then triangulated with the quantitative findings to provide a comprehensive understanding of the factors influencing cultural competence .

Results

Demographic and Professional Characteristics

A total of 45 academic nurse educators participated in the quantitative component, representing 90.0% of those invited, while 20 educators (representing 40.0% of the total sample) participated in the qualitative interviews. Table 1 highlights that the majority of the participants in the current study (71.1%) were non-Saudi, predominantly from Asian (55.6%) and African (24.4%) backgrounds. The largest age group was between 41 and 50 years (44.4%), over half of the participants (51.1%) held doctoral degrees, and many had more than 15 years of teaching experience (35.6%). Most participants (88.9%) had resided in a country with a different culture, and over half (53.3%) were fluent in languages other than English. Although a majority (75.6%) had attended cultural training, 24.4% had not. Cultural content integration into teaching varied, with only 25.6% fully integrating it, while over half (51.3%) occasionally mentioned it. Additionally, 73.3% of participants assessed students’ cultural beliefs as part of their teaching practices. See Supplementary Table 1 for culture-related data.

Table 1.

Distribution of Nurse Educators by Demographic and Professional Data (N = 45).

Characteristic	Category	N	%
Nationality	Non-Saudi	32	71.1
Saudi	13	28.9
Age group	20 to 30 years	1	2.2
31 to 40 years	18	40.0
41 to 50 years	20	44.4
51 to 60 years	6	13.3
Cultural background	Asian	25	55.6
African	11	24.4
Other	9	20.0
Highest degree attained	Bachelor's	7	15.6
Master's	15	33.3
DNS/DNP/PhD	23	51.1
Years of teaching nursing	Less than 1 year	1	2.2
1–5 years	13	28.9
6–10 years	10	22.2
11–15 years	5	11.1
	More than 15 years	16	35.6
Nursing specialty	Adult nursing	16	35.6
Community nursing	5	11.1
Pediatric nursing	7	15.6
Maternity nursing	6	13.3
Psychiatric nursing	2	4.4
Nursing management	3	6.7
Critical care nursing	6	13.3

Research Question Results

Level of Cultural Competence

Table 2 and Figure 1 illustrate a moderate overall cultural competence, with a mean percent score of 73.55 ± 13.5. Among the dimensions, cultural awareness scored the highest (78.68 ± 16.7), while cultural encounters had the lowest score (67.50 ± 17.98).

Figure 1.

Mean score of cultural competence and its dimensions among nurse educators.

Table 2.

Mean Score of Cultural Competence and its Dimensions among Nurse Educators.

Dimension	Mean % Score ± SD	Mean ± SD
Overall cultural competence	73.55 ± 13.5	3.68 ± 0.68
Cultural awareness	78.68 ± 16.7	3.93 ± 0.84
Cultural knowledge	73.84 ± 13.94	3.69 ± 0.70
Cultural skills	71.81 ± 15.23	3.59 ± 0.76
Cultural desire	74.31 ± 15.22	3.72 ± 0.76
Cultural encounters	67.50 ± 17.98	3.38 ± 0.90
Transcultural teaching behaviors	74.44 ± 15.02	3.72 ± 0.75

SD = standard deviation.

Regression Analysis Between Cultural Competence Dimensions and Transcultural Teaching Behaviors

Table 3 presents significant relationships across all dimensions, highlighting the importance of cultural competence in fostering transcultural teaching behaviors. The strongest relationship was observed for overall cultural competence, with an R² value of 0.923, indicating that 92.3% of the variance in transcultural teaching behaviors is explained by overall cultural competence. The B value of 0.86 reflects the practical impact, where a one-unit increase in overall cultural competence leads to a 0.86-unit increase in transcultural teaching behaviors. Among the individual dimensions, cultural awareness exhibited a strong relationship, with an R² value of 0.836. See Table 3 for more values.

Table 3.

Regression Analysis Between Cultural Competence Dimensions and Transcultural Teaching Behaviors.

Cultural competence dimensions	R²	F (p)	B	β	t (p)	95% CI
Cultural encounters	0.427	32.07 (<0.001*)	0.78	0.65	5.63 (<0.001*)	(0.60, 0.96)
Cultural desire	0.781	153.05 (<0.001*)	0.90	0.88	12.37 (<0.001*)	(0.80, 1.00)
Cultural awareness	0.836	219.02 (<0.001*)	1.02	0.91	14.80 (<0.001*)	(0.90, 1.14)
Cultural knowledge	0.690	95.57 (<0.001*)	0.77	0.83	9.78 (<0.001*)	(0.65, 0.89)
Cultural skills	0.729	115.41 (<0.001*)	0.87	0.85	10.74 (<0.001*)	(0.75, 0.99)
Overall cultural competence	0.923	514.71 (<0.001*)	0.86	0.96	22.69 (<0.001*)	(0.80, 0.92)

R²: coefficient of determination; B: unstandardized coefficients; β: standardized coefficients; t: t-test of significance; F: F for ANOVA test; *Statistically significant at p ≤ 0.05; ANOVA = analysis of variance.

Demographic and Professional Characteristics and Culture Competence

Certain demographic and cultural-related variables including age, cultural training, and language fluency showed significant differences in perceived cultural competence. See Supplementary Table 2 for the detailed values. Moreover, the regression analysis results presented in Table 4 revealed that age had a significant positive impact. For each additional year of age, there was an increase in cultural competence (B = 0.86, p = 0.001) and transcultural teaching behaviors (B = 0.72, p = 0.002). Language fluency was another critical factor, with educators fluent in a language other than English demonstrating significantly higher levels of cultural competence (B = 0.77, p = 0.001) and transcultural teaching behaviors (B = 0.68, p = 0.001). Cultural training also played a significant role. Educators who had participated in cultural training showed higher levels of cultural competence (B = 0.45, p = 0.003) and transcultural teaching behaviors (B = 0.38, p = 0.004). Years of experience and professional development showed significant impact on overall cultural competence (B = 0.32, p = 0.024; B = 0.29, p = 0.045); however, their influence on transcultural teaching behaviors was weaker (B = 0.25, p = 0.057; p = 0.146). In summary, these findings underscore the importance of targeted interventions, such as language development programs, cultural competence training, and fostering reflective practices, to enhance the cultural competence and transcultural teaching behaviors of nurse educators.

Table 4.

Demographic and Professional Characteristics as Predictors of Cultural Competence.

	Overall cultural competence					Transcultural teaching behaviors
Predictors	B	SE	t	p	95% CI (LL-UL)	B	SE	t	p	95% CI (LL-UL)
Age	0.86	0.11	7.82	0.001	0.64–1.0	0.72	0.14	5.14	0.002	0.44–1.0
Language Fluency	0.77	0.15	5.13	0.001	0.49–1.0	0.68	0.17	4.0	0.001	0.34–1.0
Cultural Training	0.45	0.13	3.46	0.003	0.19–0.71	0.38	0.12	3.17	0.004	0.15–0.61
Experience	0.32	0.14	2.29	0.024	0.04–0.6	0.25	0.16	1.56	0.057	−0.02–0.52
Professional Development	0.29	0.16	2.0	0.045	−0.02–0.6	0.21	0.18	1.17	0.146	−0.09–0.51

B: unstandardized coefficients; β: standardized coefficients; t: t-test of significance; statistically significant at p ≤ 0.05.

Qualitative Findings

The qualitative findings emerged from the thematic analysis revealed four main themes and 15 sub-themes that influence the cultural competence of nurse educators. These themes include personal factors, professional factors, institutional and societal influences, and barriers to cultural competence. See Table 5. The description of themes is presented with representative quotations that provide insight into educators’ experiences and perceptions.

Table 5.

Themes and Sub-Themes of Factors Affecting Cultural Competence of Nurse Educators.

Theme	Sub-theme
Personal factors	Cultural background
Language skills and fluency
Cultural awareness
Cultural immersion
Mentoring
Professional factors	Specialty area
Years of experience
Professional development
Cultural inclusion & transcultural behaviors
Societal and institutional influences	Student background & regional differences
Cultural diversity in healthcare
Globalization & interconnectedness
Barriers	Time constraints
Inadequate training
Limited exposure

Theme I. Personal Factors

Qualitative analysis revealed that nurse educators’ cultural competence is deeply influenced by personal factors. Educators shared how their upbringing in diverse cultural environments shaped their understanding of diversity and informed their teaching practices. One educator stated, “Being raised in a multicultural household shaped how I view diversity and incorporate it into my teaching.” Language skills and fluency, particularly in Arabic, English, and regional dialects, were emphasized as critical enablers for effective communication. As one participant noted, “Speaking Arabic and English fluently helps me connect with students from various regions of Saudi Arabia.”

Self-awareness of biases also emerged as a significant factor, with educators reflecting on the need to address their own assumptions before teaching cultural competence. One educator remarked, “I had to confront my own biases before I could teach students about cultural sensitivity effectively.” Experiences of cultural immersion, such as living abroad, enriched their understanding of diversity and respect for regional differences within Saudi Arabia. Another educator explained, “Living abroad helped me appreciate cultural diversity, but it also taught me to notice and respect regional differences within Saudi culture.” Mentoring relationships were identified as vital in shaping cultural competence, with mentors offering guidance on integrating cultural awareness into teaching. One educator shared, “My mentor always emphasized the importance of understanding the cultural nuances of students’ backgrounds, even within a single country.”

Theme II. Professional Factors

Participants highlighted that their specialty areas often dictate the emphasis placed on cultural competence in their teaching. For instance, those in psychiatric nursing noted the importance of addressing cultural beliefs about mental health in their lectures, as one educator shared: “In psychiatric nursing, cultural beliefs about mental health significantly influence care, so I focus on this in my teaching.” Similarly, community health educators emphasized the need to prepare students to adapt to culturally diverse populations during fieldwork, with one educator explaining: “In community health, students need to adapt to different populations during fieldwork, so I emphasize cultural adaptability.”

Years of teaching experience also emerged as a crucial factor, with educators demonstrating greater awareness of cultural nuances and their impact on teaching. One experienced educator reflected, “Over the years, I’ve learned that every student brings a unique perspective shaped by their cultural background.” These insights suggest that prolonged exposure to diverse teaching scenarios enhances educators’ cultural competence.

Professional development opportunities, particularly cultural competence workshops, were identified as enablers for integrating culturally relevant examples into teaching. One participant stated, “Attending cultural competence workshops gave me tools to integrate cultural examples into my lectures.” However, some educators highlighted a lack of accessible training programs, which limited their ability to enhance their skills in this area. The inclusion of cultural content in nursing curricula emerged as a critical enabler, with educators emphasizing the role of transcultural teaching behaviors in preparing students for culturally competent care. One participant noted, “Having cultural content as a mandatory part of the curriculum ensures students understand its importance.” However, the degree of integration varied, with some educators advocating for deeper and more consistent inclusion of cultural topics in their courses.

Theme III. Societal and Institutional Influences

The qualitative analysis revealed that students’ backgrounds and regional differences were identified as facilitators for cultural competence. Educators highlighted the richness of classroom discussions stemming from regional differences. One educator explained, “Even though the students are all the same nationality, their regional differences add richness to classroom discussions.” Cultural diversity in healthcare settings was another influential factor, with educators underscoring the need to prepare students for working in Saudi Arabia's increasingly multicultural healthcare system. One educator remarked, “Saudi healthcare is increasingly diverse, and I emphasize preparing students to work with expatriate colleagues and patients.” Similarly, globalization and interconnectedness were recognized as driving forces behind the need for culturally competent care, with one participant stating, “I prepare students to adapt to global standards of culturally competent care because nursing is an interconnected profession.”

Theme IV. Barriers to Cultural Competence

Educators identified several barriers that hinder their ability to develop and implement cultural competence in their teaching practices. Time constraints emerged as a prominent barrier, with educators highlighting the competing demands of teaching, research, and administrative responsibilities. One participant shared, “Balancing teaching, research, and administrative tasks leaves little time for cultural competence training.” This lack of time limited their opportunities to engage in professional development activities or integrate cultural concepts effectively into their curricula.

Inadequate training opportunities further exacerbated the challenges, with educators expressing a need for more structured and accessible programs to enhance their cultural competence. One educator remarked, “The absence of regular cultural competence workshops limits my ability to grow in this area.” The lack of institutional support for providing targeted training programs was seen as a significant gap in fostering cultural competence among educators.

Limited exposure to cultural diversity within the student body also emerged as a barrier, particularly in the Saudi context, where the majority of students share similar cultural backgrounds. One participant explained, “Since my work primarily involves individuals from similar cultural backgrounds, I rarely have the chance to interact with diverse international groups.” This homogeneity restricted educators’ ability to engage with and teach about real-world cultural diversity.

Integration of Findings

The integration of quantitative and qualitative findings provides a holistic perspective on cultural competence among nurse educators. Quantitative data highlight the levels of cultural competence and transcultural teaching behaviors, as well as measurable relationships between factors such as language fluency, training, and curriculum integration. Qualitative insights enrich these findings by offering a dmore profound understanding of educators’ experiences and the diverse factors that shape their cultural competence. These complementary approaches together point out the importance of institutional support, targeted training programs, and opportunities for cultural immersion to overcome barriers and foster cultural competence effectively.

Discussion

Cultural competence is essential in nursing education, as it shapes educators’ ability to prepare students for culturally responsive care. This study, using a convergent mixed-methods design, found that academic nurse educators exhibit moderate levels of cultural competence, with cultural awareness ranking highest and cultural encounters lowest. The quantitative results highlight cultural competence as a strong predictor of transcultural teaching behaviors, while the qualitative findings further explain these results by identifying the role of personal, professional, and institutional factors in shaping cultural competence. These findings align with Campinha-Bacote's (2002) model, which emphasizes cultural awareness as a fundamental step toward culturally competent nursing education.

Integration of Quantitative and Qualitative Findings

The study found that academic nursing educators exhibited a moderate level of cultural competence, with cultural awareness scoring the highest, followed by transcultural teaching behaviors, while cultural encounters scored the lowest. This result affirms that educators recognize the importance of cultural diversity in nursing education and its impact on care delivery. Similarly, Juntunen et al. (2024) and Rahimi et al. (2023), reported that cultural awareness is the foundation for culturally competent nursing education, allowing educators to create an environment that respects and values diversity. Moreover, Chen et al. (2020) reported that the mean score of the cultural awareness subscale ranked second after cultural desire, suggesting some variability in its relative importance across different contexts. The qualitative findings of the interviewed nurse educators reinforce this conclusion by revealing that educators who had prior international training, multilingual proficiency, or experience in multicultural clinical settings exhibited stronger cultural awareness. The results concur with Halabi and de Beer (2018) and Osmancevic et al. (2023), who emphasize that direct exposure to diverse cultures strengthens educators’ awareness and sensitivity.

However, the low scores for cultural encounters suggest a gap in direct engagement with diverse populations, which is a concern given the role of experience in developing cultural competence.

Similar findings were reported by Majnoon et al. (2023) and Chen et al. (2020), who noted that limited exposure to cultural diversity negatively affects the ability of educators to facilitate transcultural learning. The current qualitative findings justify this gap by revealing that many educators work in relatively homogeneous educational environments, limiting their ability to engage in real-world cultural interactions. Also, while some educators actively seek cross-cultural experiences through professional collaborations or mentorship, others rely solely on theoretical knowledge, which may limit their ability to effectively prepare students for diverse clinical settings.

Moreover, the quantitative results indicate that cultural competence is a strong predictor of transcultural teaching behaviors, accounting for 92.3% of the variance. This finding highlights the practical significance of cultural competence in nursing education, as educators with greater cultural awareness and experience are more likely to implement more effective transcultural strategies in their teaching. The qualitative interviews complement these findings by revealing that educators with international exposure, multilingual proficiency, and participation in cultural training are better equipped to engage students in discussions on cultural diversity. This supports previous research indicating that exposure to diverse cultures enhances an educator's ability to model and teach culturally competent care (Bobongie-Harris & Youse, 2023; Eden et al., 2024).

These findings align with Bobongie-Harris and Youse (2023), who emphasized that educators’ cultural competence enhances transcultural teaching strategies, benefiting students and the broader educational environment. Eden et al. (2024) reinforced the need for teaching approaches that incorporate cultural awareness, sensitivity, and inclusivity in nursing education. Similarly, Majnoon et al. (2023) and Chen et al. (2020) highlighted the importance of integrating transcultural nursing concepts into both theoretical and clinical curricula, supporting the present study's findings.

However, the study's qualitative findings contribute new insights by identifying factors that enhance or hinder cultural awareness. Educators who had prior international training or experience working in multicultural environments expressed greater confidence in addressing cultural differences. Conversely, those with limited exposure to cultural diversity reported challenges in integrating transcultural concepts into their teaching. This suggests that awareness alone is insufficient without experiential learning opportunities, reinforcing the need for structured cultural encounters within nursing curricula (Halabi & de Beer, 2018; Osmancevic et al., 2023).

Influence of Personal and Professional Factors on Cultural Competence

The study identified both personal and professional factors that shape and influence cultural competence. The regression analysis revealed that age, language fluency, and cultural training significantly improved both cultural competence and transcultural teaching behaviors. Experience and professional development also contributed to overall cultural competence but had a weaker effect on teaching behaviors. These factors underscore the importance of age, multilingualism, training, and professional growth in enhancing cultural competence among nurse educators.

The qualitative findings from interviews further emphasize that language proficiency, prior multicultural exposure, and international education are crucial in developing competence. Previous studies support these results. For instance, Al-Ansary (2017) found that age and participation in cultural competency training were strongly associated with higher cultural competence scores. Rahimi et al. (2023) and Summers (2017) also highlighted that formal training boosts educators’ confidence in handling cultural diversity. Additionally, Brainee (2024) and Almutairi et al. (2015) found that multilingual educators are better equipped to communicate and engage in diverse cultural contexts, promoting cross-cultural understanding. However, the researchers also noted that newer generations of educators may be better prepared to integrate cultural diversity into their teaching (Almutairi et al., 2015; Brainee, 2024). This shift suggests that nursing education programs should incorporate language training as part of cultural competence development (Osmancevic et al., 2023).

Institutional and Societal Influences in the Saudi Context

A unique contribution of this study is its focus on institutional and societal factors influencing cultural competence in Saudi Arabia, a country with a diverse expatriate healthcare workforce (Halabi & de Beer, 2018; Mani & Goniewicz, 2024). Unlike Western contexts where multicultural exposure is widespread, this study highlights how Saudi nurse educators’ competence is shaped by international academic training, globalization, and regional cultural traditions.

Many Saudi nurse educators hold advanced degrees from European or American institutions, which may contribute to their cultural competence through international exposure. This finding aligns with Grandpierre et al. (2018) and Kula et al. (2021), who reported that global education enhances cultural competence by broadening perspectives on healthcare and diversity. However, the qualitative data revealed regional differences in traditions and variations in cultural content across nursing curricula might create disparities in educators’ preparedness to teach culturally congruent care. Parallel with previous research in the Saudi context, these findings suggest a need for standardized transcultural nursing education programs that ensure all educators receive equal training in cultural competence, regardless of their academic background (Aboshaiqah et al., 2017; Cruz et al., 2017).

Barriers to Cultural Competence Development

Despite these facilitators, educators face persistent barriers to developing cultural competence, including time constraints, lack of formal training, and limited exposure to cultural diversity. These barriers have been documented in previous research, with Rahimi et al. (2023) and Walden (2020) emphasizing insufficient institutional support as a major challenge. Farber (2019) and Abou Hashish and Awad (2019) found that many nursing educators feel unprepared to teach culturally and ethical congruent care, which may limit students’ readiness for diverse clinical settings.

Additionally, the qualitative findings revealed that workload pressures often prevent educators from participating in cultural competence workshops, reinforcing the need for institutional support to facilitate professional development (Abou Hashish et al., 2024; Rahimi et al., 2023; Summers, 2017). Moreover, Falatah et al. (2020) and Alosaimi and Ahmad (2016) identified similar barriers in clinical practice, noting that linguistic and cultural differences create challenges for both educators and students. To address these gaps, universities and policymakers should implement structured professional development programs, with a focus on practical cultural encounters, mentorship, and language training (Aboshaiqah et al., 2023; Alnajjar & Abou Hashish, 2021).

Strengths and Limitations of the Study

This study has several strengths. The mixed-methods design enhances its comprehensiveness by integrating quantitative and qualitative approaches, providing both measurable insights and deeper contextual understanding of cultural competence among nurse educators. This methodological integration strengthens the validity and reliability of findings, offering a holistic perspective on the subject. Additionally, the study utilized well-validated tools such as CDQNE-R, ensuring accuracy and consistency in data collection.

However, certain limitations should be acknowledged. The cross-sectional design captures data at a single point in time, limiting causal inferences between variables, such as the relationship between transcultural teaching behaviors and cultural competence. Additionally, the reliance on self-reported data introduces potential social desirability bias, as educators may overestimate their cultural competence, particularly in areas like cultural encounters. Incorporating objective measures or student feedback could have provided a more accurate assessment. Lastly, the study focused on educators’ perspectives without including nursing students’ insights, which could have offered a more comprehensive evaluation of how educators’ cultural competence impacts learning experiences in both classroom and clinical settings.

Implications of the Study

Implications for Nursing Education, Practice, and Policy

This study highlights the need for curriculum reform that integrates cultural competence as a core component of nursing education. Institutions should embed cultural awareness, knowledge, skills, and encounters into curricula to prepare students for culturally responsive care. Mandatory professional development programs for nurse educators should focus on Transcultural Teaching Behaviors, enhancing self-awareness, cultural understanding, and teaching effectiveness. Cultural immersion opportunities, such as clinical placements and exchange programs, should be expanded to provide hands-on experience with diverse populations.

In clinical practice, nurse educators with strong cultural competence play a crucial role in preparing students to care for diverse patient populations. Educators should model inclusive teaching strategies and culturally competent behaviors while incorporating culturally relevant case studies into their instruction. Healthcare institutions should invest in ongoing cultural competence training for nursing staff to improve patient outcomes and provider readiness. Creating culturally inclusive environments in healthcare settings can reduce disparities in care, enhance patient satisfaction, and ensure culturally appropriate service delivery.

To support these efforts, policymakers should establish standardized cultural competence frameworks within nursing curricula and clinical training. Institutional policies should promote structured mentorship, faculty development programs, and continuous professional training to sustain improvements in cultural competence among nursing educators and students. By aligning education, practice, and policy, the nursing workforce will be better equipped to deliver culturally competent care in an increasingly diverse healthcare landscape.

Implications for Future Research

Future research should explore cultural competence in nursing education across several areas. Longitudinal studies are needed to assess the long-term effects of Transcultural Teaching Behaviors on educators and students, identifying effective teaching strategies and evaluating cultural competence training over time. Comparative studies across different countries or healthcare systems could provide insights into how cultural competence develops in diverse settings. Additionally, research should examine students’ perspectives, as their feedback is essential in evaluating teaching effectiveness. Finally, qualitative studies on cultural immersion, including exchange programs and clinical placements, could offer deeper insights into how direct cultural exposure enhances teaching and practice.

Conclusion

This study provides valuable insights into the cultural competence of nurse educators in Saudi Arabia, revealing moderate overall competence, with cultural awareness ranking highest and cultural encounters being the lowest. The findings emphasize the critical role of overall cultural competence and cultural awareness in predicting Transcultural Teaching Behaviors, highlighting the importance of inclusive and reflective teaching practices. Key factors influencing cultural competence include personal attributes, professional development, institutional support, and existing barriers that impact educators’ ability to foster cultural competence.

The results underscore the significance of age, multilingualism, training, and professional growth in enhancing cultural competence among nurse educators. Furthermore, the study emphasizes the need for targeted interventions to overcome barriers such as time constraints and limited exposure to diverse populations. Strengthening cultural encounters through experiential learning, structured clinical placements, and cultural immersion programs is vital to improving cultural competence. Ultimately, this study highlights the importance of ongoing professional development, curriculum integration, and institutional support in cultivating a culturally competent nursing workforce.

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Footnotes

Acknowledgments

The authors would like to extend their sincere gratitude and thankfulness to all nursing educators who participated in the current study for their invaluable support.

ORCID iD

Ebtsam Aly Abou Hashish

Ethics Approval and Consent to Participate

This study adhered to the ethical guidelines outlined in the Declaration of Helsinki. The college of Nursing-Jeddah (CONJ) and King Abdullah International Medical Research Center (KAIMRC) approved the study (IRB- SP19/033/J).

Authorship Contribution

EAAH is a principal investigator; contributed to ideation; conceptualization; supervision; software; resources; project administration; methodology; investigation; formal analysis; data curation; writing – original draft; writing – review & editing; visualization; validation; final draft preparation; correspondence. HA and EZB is a one of co-investigators; contributed to conceptualization; methodology; data curation; formal analysis; visualization; validation; writing – original draft; writing – review & editing. HARA and RAB contributed to conceptualization; methodology; investigation; formal analysis; data curation; visualization; validation; writing – original draft; writing – review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Upon reasonable request from corresponding author.

Supplemental Material

Supplemental material for this article is available online.

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