
==== Front
PEC Innov
PEC Innov
PEC Innovation
2772-6282
Elsevier

S2772-6282(24)00086-4
10.1016/j.pecinn.2024.100338
100338
Short communication
Nurturing compassion and cultural humility in health professions students through a brief mindfulness practice
Or Justina justina.or@my.kc.edu
a⁎
Anderson Amy M. amy.anderson@scc.spokane.edu
b
Golba Elizabeth A. elizabeth.golba@kc.edu
a
a Health Sciences, Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
b Spokane Community College, 1810 N Greene St, Spokane, WA 99217, USA
⁎ Corresponding author. justina.or@my.kc.edu
23 8 2024
15 12 2024
23 8 2024
5 10033825 4 2024
4 8 2024
22 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
Objective

Given the importance of compassion and cultural humility in healthcare providers, the study aspired to investigate the effects of a brief mindfulness practice on compassion and cultural humility in health professions students.

Methods

A quantitative, one-group pre-test/post-test study was conducted with 58 participants from undergraduate health profession education programs in the United States. Participants completed questionnaires measuring mindfulness, compassion, and cultural humility before and after engaging in an eight-minute loving-kindness meditation exercise three to four times per week for two weeks.

Results

There were statistically significant increases in mindfulness, compassion, and cultural humility after participants engaged in the brief loving-kindness meditation exercise, with small to moderate effect sizes.

Conclusion

Brief mindfulness practices may be helpful for cultivating essential qualities such as compassion and cultural humility in health professions students.

Innovation

The findings add to the research gap about the effects of mindfulness on health professions students' compassion and cultural humility. Using mindfulness as a training tool in health professions education may foster compassion, cultural humility, and mindfulness in health professions students who will become healthcare providers, addressing individual health concerns but also broader social issues related to social justice and health equity.

Highlights

• Compassion and cultural humility are essential qualities for health professionals.

• Health professions students' compassion, cultural humility, and mindfulness increased after a brief mindfulness practice.

• Brief mindfulness practices may foster compassion and cultural humility in health professions students.

Keywords

Compassion
Cultural humility
Mindfulness
Health professions students
Health professions education
==== Body
pmc1 Introduction

Since health professionals interact with diverse clientele, it is pivotal that these individuals have embody a fusion of compassion and cultural humility, so that they act in culturally respectful and sensitive ways. Compassion is defined as having concerns for the suffering of others and wishing to help to reduce distress [1]. When health professionals demonstrate compassion in interactions with patients, they learn about their patients as whole persons, foster healing alliances, and lessen suffering [2]. Cultural humility involves “having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority towards an individual's cultural background and experience” (p. 353) [3]. When health professionals embody cultural humility, they acknowledge cultural biases, strive to overcome these biases, and continuously reflect on their own social position and interactions with other people from diverse cultural backgrounds [4,5].

Compassion and cultural humility have many benefits in healthcare. When workers demonstrate compassion, patients' satisfaction, treatment adherence, and overall health increase [6]. Likewise, when healthcare professionals exhibit cultural humility, communication, safety culture, perceptions of learning opportunities, the cohesiveness of interprofessional teams, and health equity are enhanced [[7], [8], [9], [10]]. Therefore, compassion and cultural humility can help mitigate the inequities that occur when health professionals hold implicit biases toward marginalized individuals [11]. Hence, it is important to instill these traits in health professions students who will become future health professionals [12].

Mindfulness is “a metacognitive skill involving attentional control (including paying attention to one's experience in the present moment), emotional regulation, self-awareness, and a nonjudgmental and curious orientation toward one's experiences” [11]. Research suggests the potential of mindfulness for fostering compassion and cultural humility in health professions students. For instance, engagement in loving-kindness meditation was found to improve compassion as measured by other-focused emotions and perceived social connectedness [13]. Despite a lack of empirical research on mindfulness and cultural humility, recent studies revealed that brief loving-kindness meditation exercises could decrease implicit social biases and discriminatory behaviors [[14], [15], [16]]. These findings suggest that mindfulness may also facilitate cultural humility, as health professionals self-examine and self-regulate with increased awareness of thought processes and decreased cognitive workload [11]. Hence, mindfulness serves as a promising tool to cultivate compassion and cultural humility in health professions students, which could ameliorate health inequity as they become independent health professionals upon graduation [11,17,18].

1.1 Purpose of the study

Compassion and cultural humility are important in healthcare, and mindfulness facilitates other qualities relevant to them. However, a gap in the literature about using mindfulness to cultivate compassion and cultural humility currently exists. As such, the purpose of this study was to examine the effects of a brief mindfulness practice on compassion and cultural humility in health professions students. Three research questions (RQs) guided the study: RQ 1) Is there a statistically significant difference in health professions students' mindfulness awareness before and after engaging in a brief mindfulness practice? RQ 2) Is there a statistically significant difference in health professions students' compassion before and after engaging in a brief mindfulness practice? RQ 3) Is there a statistically significant difference in health professions students' cultural humility before and after engaging in a brief mindfulness practice?

2 Methods

To address the research questions, a quantitative, one-group pre-test/post-test study was conducted. The a priori analysis computed with G*Power Version 3.1.9.7 software [19] indicated that the minimum sample size needed to attain 80 % power for identifying a medium effect (0.50) [20] at a significance level of 0.05 with two tails for a paired-samples t-test was 34 participants. After Institutional Review Board approval, a convenience sampling technique was chosen to recruit participants from undergraduate health profession education programs in a four-year college in the Midwestern United States and a community college in the Northwestern United States through emails.

To measure mindful awareness, compassion, and cultural humility, the Mindful Attention Awareness Scale (MAAS) [21], Santa Clara Brief Compassion Scale (SCBCS) [1], and Cultural Humility Scale (CHS) were utilized [3], all of which have demonstrated good validity and reliability. Then, participants were sent a questionnaire where they provided informed consent and responded to questions from the instruments. One day after participants completed the questionnaire, they received an eight-minute loving-kindness meditation audio recording based on Levett-Jones' meditation script [22], which they used to guide themselves through the mindfulness activity. They were instructed to engage in the activity three to four times per week for two consecutive weeks. After the two-week period, participants received a follow-up questionnaire to verify that they had engaged in the mindfulness activity as directed. Then, they were asked to respond to the instrument items again within three days of receipt.

3 Results

There were 95 health professions students who participated in the pre-test. However, 35 of them did not complete the post-test, leading to an attrition rate of 36 %. Two participants did not provide adequate datasets. Thus, 58 participants' datasets were included in the analysis. Table 1 contains information about the participants' demographics such as race, gender, age range, and field of study, whereas Table 2 illustrates information about the participants' pre- and post-test scores for mindfulness, compassion, and cultural humility. Paired samples t-tests with bootstrapping indicated statistically significant increases in the compassion (M Diff = 0.279, SD = 0.723, t(57) = 2.944, p = .01, d = 0.387), cultural humility (M Diff = 0.214, SD = 0.415, t(57) = 3.929, p < .001, d = 0.516), and mindfulness (M Diff = 0.424, SD = 0.728, t(57) = 4.44, p < .001, d = 0.583) of health professions students, with small to moderate effect sizes (see Tables 3 and 4).Table 1 Demographics

Table 1	N	%	
Race			
Asian	6	10.3 %	
Biracial or Multiracial	4	6.9 %	
Black/African	4	6.9 %	
Latinx	4	6.9 %	
White/Caucasian	40	69.0 %	
Gender			
Man	7	12.1 %	
Woman	51	87.9 %	
Age			
18–24	34	58.60 %	
25–34	8	13.80 %	
35–44	8	13.80 %	
45–54	6	10.30 %	
55–64	2	3.40 %	
Field of Study			
Nursing	23	39.70 %	
Pre-Occupational Therapy	1	1.70 %	
Pre-Physician Assistant	4	6.90 %	
Radiography	8	13.80 %	
Respiratory Care	1	1.70 %	
Sonography	7	12.10 %	
Unspecified Healthcare Studies	14	24.10 %	

Table 2 : Paired samples statistics.

Table 2	Statistic	Bootstrap	
Bias	Std. Error	95 % Confidence Interval	
Lower	Upper	
Compassion Post-test	Mean	5.959	−0.0039	0.101	5.752	6.141	
N	58					
Std. Deviation	0.759	−0.013	0.101	0.566	0.955	
Std. Error Mean	0.01					
Compassion Pre-test	Mean	5.679	−0.001	0.112	5.452	5.9	
N	58					
Std. Deviation	0.852	−0.016	0.083	0.678	1.007	
Std. Error Mean	0.112					
Humility Post-test	Mean	4.441	−0.003	0.058	4.319	4.55	
N	58					
Std. Deviation	0.477	−0.004	0.052	0.367	0.573	
Std. Error Mean	0.063					
Humility Pre-test	Mean	4.227	−0.002	0.068	4.095	4.355	
N	58					
Std. Deviation	0.527	−0.004	0.054	0.414	0.625	
Std. Error Mean	0.069					
Mindfulness Post-test	Mean	3.977	−0.001	0.1	3.772	4.18267	
N	58					
Std. Deviation	0.796	−0.01	0.07	0.647	0.921	
Std. Error Mean	0.105					
Mindfulness Pre-test	Mean	3.553	−0.0002	0.107	3.351	3.765	
N	58					
Std. Deviation	0.827	−0.01	0.072	0.671	0.951	
Std. Error Mean	0.109					
a Unless otherwise noted, bootstrap results are based on 1000 bootstrap samples.

Table 3 : Bootstrap for paired samples test.

Table 3	Mean	Bootstrap			
Bias	Std. Error	Sig. (2-tailed)	95 % Confidence Interval			
Lower	Upper	t	df	
Compassion Post-test - Compassion Pre-test	0.2793	−0.0030	0.0943	0.01	0.0897	0.4653	2.944	57	
Humility Post-test - Humility Pre-test	0.2140	−0.0005	0.0535	<0.001	0.1049	0.3174	3.929	57	
Mindfulness Post-test - Mindfulness Pre-test	0.4242	−0.0008	0.0937	<0.001	0.2495	0.6159	4.44	57	

Table 4 : Paired samples effect sizes

Table 4	Standardizer	Point Estimate	95 % Confidence Interval	
Lower	Upper	
Compassion Post-test - Compassion Pre-test	Cohen's d	0.7225	0.387	0.118	0.652	
Humility Post-test - Humility Pre-test	Cohen's d	0.4148	0.516	0.240	0.788	
Mindfulness Post-test - Mindfulness Pre-test	Cohen's d	0.7275	0.583	0.302	0.859	

4 Discussion and conclusion

4.1 Discussion

The study revealed statistically and practically significant improvements in compassion, cultural humility, and mindfulness following the brief loving-kindness mindfulness exercise. The findings align with previous research suggesting the benefits of mindfulness interventions to promote compassion and cultural humility among health professionals [[2], [3], [4], [5]]. Mindfulness interventions likely can increase self-awareness, which may impact students' sense of compassion and ability to attune to the feelings and experiences of themselves and of their patients. Moreover, they may promote cultural humility by encouraging students to approach diverse patients with respect and curiosity, thus cultivating a more empathetic and culturally humble healthcare practice.

There are several limitations in this study. First, despite adequate power, the small sample size may limit the generalizability of the findings. Second, social desirability bias might impact how students self-report on these instruments. Third, this was a short-term intervention without a control group, so while there were immediate improvements, the long-term sustainability of these effects is unclear. Furthermore, it is not known if these changes observed are directly due to the intervention. Future research could address some of these limitations. For example, a similar study with a larger sample of more diverse participants and a longitudinal design would be advised. Furthermore, a qualitative study could explore health professions students' perceptions.

4.2 Innovation

This study introduces an innovative approach to enhancing compassion and cultural humility among health professions students through brief mindfulness practices, such as loving-kindness meditation. While previous research has highlighted the importance of mindfulness, compassion, and cultural humility in healthcare contexts, there has been limited investigation into the direct impact of brief mindfulness interventions on these outcomes. This study, utilizing a one-group pre-test/post-test design, addresses this research gap by demonstrating the effectiveness of a targeted, time-efficient mindfulness intervention for improving these crucial attributes [23,24].

The findings provide robust quantitative evidence for the practical benefits of integrating brief mindfulness practices into health professions education. By incorporating these practices into curricula, educators can foster future healthcare providers' holistic development, enhancing their personal and professional growth. Additionally, this approach prepares students to deliver more empathetic and culturally sensitive care, which is essential for improving patient-provider relationships and patient outcomes [23,24]. Finally, this novel approach has significant implications for broader societal issues related to social justice and health equity. This innovation addresses the need for effective educational interventions incorporating mindfulness to improve healthcare delivery and provider-patient interactions [23,24].

To achieve these outcomes, it is recommended that mindfulness practices, such as loving-kindness meditations, be interwoven throughout the entire curriculum, including clinical rotations [25]. Practical implementations can involve brief mindfulness interventions in class, such as mini-meditations or exercises focused on mindful communication, eating, and movement. Additionally, health profession students should be encouraged to practice mindfulness in their daily lives outside of school and clinical training, promoting holistic self-care, which may benefit healthcare workers' longevity. Furthermore, by providing opportunities for reflection and collaborative discussion about these practices, students can effectively monitor and enhance their mindfulness development [25].

This study bridges the fields of health promotion, health education, and health communication, offering a transformative approach to healthcare instruction. Demonstrating a scalable and accessible mindfulness intervention enriches the training of healthcare providers and fosters a culture of empathy and cultural sensitivity. This innovation contributes to improved health outcomes and addresses broader social issues related to healthcare equity and inclusion [23,24].

4.3 Conclusion

This study investigated the effects of a brief mindfulness practice on health professions students' compassion and cultural humility. The results highlight the potential benefits of brief mindfulness interventions in nurturing compassion, cultural humility, and mindfulness among health professions students. The goal of health education programs is to graduate compassionate health professionals with strong clinical skills, including the ability to work with patients from diverse backgrounds compassionately and mindfully [25]. As health profession students transition into healthcare settings to serve as providers, compassion and cultural humility can aid them in promoting patient-centered care, having an other-oriented approach to patient care, and demonstrating increased respect and appreciation for patients' diverse cultural backgrounds.

Ethics approval statement

The authors obtained Institutional Review Board (IRB) approval prior to conducting the study.

Funding

This work was not funded by any organization.

CRediT authorship contribution statement

Justina Or: Writing – review & editing, Writing – original draft, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Amy M. Anderson: Writing – review & editing, Writing – original draft, Investigation, Data curation. Elizabeth A. Golba: Writing – review & editing, Writing – original draft, Project administration, Investigation, Data curation, Conceptualization.

Declaration of competing interest

We, the authors, declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
==== Refs
References

1 Plante T.G. Mejia J. Psychometric properties of the Santa Clara brief compassion scale Pastor Psychol 65 2016 509 515 10.1007/s11089-016-0701-9
2 Sinclair S. Hack T.F. Raffin-Bouchal S. McClement S. Stajduhar K. Singh P. What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada BMJ Open 8 3 2018 e019701 10.1136/bmjopen-2017-019701
3 Hook J.N. Davis D.E. Owen J. Worthington E.L. Jr. Utsey S.O. Cultural humility: measuring openness to culturally diverse clients J Couns Psychol 60 3 2013 353 366 10.1037/a0032595 23647387
4 Mosher D.K. Hook J.N. Captari L.E. Davis D.E. DeBlaere C. Owen J. Cultural humility: a therapeutic framework for engaging diverse clients Pract Innov 2 2017 221 10.1037/pri0000055
5 Foronda C. Baptiste D.L. Reinholdt M.M. Ousman K. Cultural humility: a concept analysis J Transcult Nurs 27 2016 210 217 10.1177/1043659615592677 26122618
6 Watts E. Patel H. Kostov A. Kim J. Elkbuli A. The role of compassionate care in medicine: toward improving patients’ quality of care and satisfaction J Surg Res 289 2023 1 7 10.1016/j.jss.2023.03.024 37068438
7 Foronda C. MacWilliams B. McArthur E. Interprofessional communication in healthcare: an integrative review Nurse Educ Pract 19 2016 36 40 10.1016/j.nepr.2016.04.005 27428690
8 Hook J.N. Boan D. Davis D.E. Aten J.D. Ruiz J.M. Maryon T. Cultural humility and hospital safety culture J Clin Psychol Med Settings 23 2016 402 409 10.1007/s10880-016-9471-x 27752981
9 Kibakaya E.C. Oyeku S.O. Cultural humility: a critical step in achieving health equity Pediatrics 149 2 2022 e2021052883 10.1542/peds.2021-052883
10 Or J. Golba E. The relationships between cultural humility, intercultural effectiveness, and therapeutic communication in health professionals J Allied Health 52 3 2023 119 127
11 Burgess D.J. Beach M.C. Saha S. Mindfulness practice: a promising approach to reducing the effects of clinician implicit bias on patients Patient Educ Couns 100 2 2017 372 376 10.1016/j.pec.2016.09.005 27665499
12 Chang E.S. Simon M. Dong X. Integrating cultural humility into health care professional education and training Adv Health Sci Educ Theory Pract 17 2012 269 278 10.1007/s10459-010-9264-1 21161680
13 Seppala E.M. Hutcherson C.A. Nguyen D.T. Loving-kindness meditation: a tool to improve healthcare provider compassion, resilience, and patient care J Compassionate Health Care 1 2014 5 10.1186/s40639-014-0005-9
14 Kang Y. Gray J.R. Dovidio J.F. The nondiscriminating heart: lovingkindness meditation training decreases implicit intergroup bias J Exp Psychol Gen 143 3 2014 1306 1313 10.1037/a0034150 23957283
15 Lueke A. Gibson B. Mindfulness meditation reduces implicit age and race bias: the role of reduced automaticity of responding Soc Psychol Personal Sci 6 3 2015 284 291 10.1177/19485506145596
16 Lueke A. Gibson B. Brief mindfulness meditation reduces discrimination Psychol Conscious 3 1 2016 34 44 10.1037/cns0000081
17 Rebar C.R. Heimgartner N.M. A renewed commitment to cultural humility Medsurg Nurs 30 2 2021 147 148
18 Velott D. Sprow Forté K. Toward health equity: mindfulness and cultural humility as adult education New Dir Adult Contin Educ 2019 161 2019 57 66 10.1002/ace.20311
19 Faul F. Erdfelder E. Buchner A. Lang A.G. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses Behav Res Methods 41 2009 1149 1160 10.3758/BRM.41.4.1149 19897823
20 Cohen J. Statistical power analysis for the behavioral sciences 1988 Routledge Academic
21 Carlson L.E. Brown K.W. Validation of the mindful attention awareness scale in a cancer population J Psychosom Res 58 2005 29 33 15771867
22 Levett-Jones T. A 10-minute loving-kindness visualisation 2018 University of Technology Sydney NSW
23 Pham A.V. Goforth N.A. Aguilar L.N. Burt I. Bastian R. Diaków D.M. Dismantling systemic inequities in school psychology: cultural humility as a foundational approach to social justice Sch Psychol Rev 51 6 2022 692 709
24 Sengupta P. Saxena P. The art of compassion in mental healthcare for all: Back to the basics Indian J Psychol Med 46 1 2024 72 77 38524943
25 Hassed C. The art of introducing mindfulness into medical and allied health curricula Mindfulness 12 8 2021 1909 1919 10.1007/s12671-021-01647-z
