There is a growing need for learning cultural competence and sensitivity in health care, as professionals increasingly work with diverse patient and client populations as well as colleagues from various cultural backgrounds. This also places new demands on health education, which must prepare future professionals to navigate cultural diversity, communicate effectively, and provide equitable care.

The Erasmus+ Global-funded SA-IS project addresses this need by promoting cultural competence and sensitivity in health education through the creation of a culture and sensitivity questionnaire integrated into the virtual learning environment (VLE). This tool allows exchange students to assess their cultural competence before and after their mobility period.

This article is part of the presentations related to the Future Health HUB and Erasmus+ SA-IS projects, delivered at the Health Education Without Borders: Innovation Through Collaboration conference held in Maputo on April 10, 2025. This article describes the Cultural Competence and Sensitivity questionnaire developed in the project and presents responses collected with it from seven students participating in exchange: two from ISICSA and five from Savonia.

The Head–Hands–Heart model

The framework of the questionnaire is grounded in the Head–Hands–Heart- model:

• Head / Knowledge – Understanding the norms, values, beliefs, and practices of different cultures.

• Hands / Skills – Applying cultural knowledge in real-world settings, adapting communication styles, and navigating multicultural environments.

• Heart / Attitudes – Developing awareness of one’s own cultural perspective and sensitivity toward others, including empathy and respect.

Students completed the self-assessment survey online both before and after their exchange experience. The purpose was to measure growth in cultural competence and identify areas for further learning and reflection.

Dealing with difficulties and becoming more capable

Participating in an international exchange provides rich opportunities for learning and personal growth—but it also presents real-life challenges. In this project, students completed the Cultural Competence and Sensitivity questionnaire before and after their exchange. Their reflections offer valuable insights into both their expectations and the realities they encountered.

From Expectations to Reality

Before departure, students expressed concerns about potential difficulties, particularly language barriers and communication challenges, especially in clinical settings and everyday interactions. Many were unsure how they would adjust to different values, customs, and professional practices in a new cultural environment.

There was also an awareness that healthcare systems abroad might differ significantly from those at home—with unfamiliar hygiene standards, medical tools, or treatment practices. In addition to feeling unsure, students were concerned about safety and had to adjust to a new and sometimes unpredictable environment.

During the exchange, many of these anticipated challenges materialized. Students encountered difficult living conditions, infrastructure limitations, and culture shock in clinical settings. However, instead of retreating, they responded with adaptability, openness, and resilience. They sought peer and local support, focused on learning, and transformed challenges into meaningful learning moments.

Deepening Knowledge – Head

Students said they learned more about other cultures and became more self-aware. They gained a clearer understanding of how cultural norms influence daily life and healthcare practices. Through comparison, they also developed a deeper awareness of their own cultural background and biases. This process helped them recognize stereotypes, question assumptions, and build respectful, culturally responsive interactions. They also learned to interpret non-verbal communication and adapt their behavior accordingly.

Strengthening Skills – Hands

The practical experience of the exchange helped students develop important intercultural and professional skills. Communicating in English—and sometimes in the local language, such as Portuguese—enhanced their language proficiency and confidence. They also strengthened interpersonal skills by interacting with locals, engaging in community life, and working in clinical environments. Students applied theory in practice, used digital tools in creative ways, and adapted to resource-limited situations. Tools like blogs helped students think critically and reflect on their personal development. Sometimes, they saw or experienced unfair situations and took action to support inclusion and fairness.

New Ways of Thinking – Heart

Perhaps the most profound changes occurred in attitudes and values. Students became more open-minded and curious, willing to leave their comfort zones and embrace new perspectives. They grew in empathy and respect, seeing people as individuals rather than stereotypes.

They also developed a stronger sense of responsibility and courage—challenging discriminatory behavior, acknowledging mistakes, and learning from difficult or uncomfortable moments. Many described a new and lasting commitment to equity, safety, and inclusion—values they aim to carry forward into their professional lives. Above all, students described their exchange as a deeply transformative personal experience. They returned home not only with greater knowledge and skills, but with a broader, more grounded understanding of the world—shaped by real-life experience rather than assumptions.

The Importance of This Tool

Using the Cultural Competence and Sensitivity Questionnaire before and after the exchange experience is valuable for both students and teachers. For students, it encourages self-reflection, helps them track their growth, and brings awareness to the attitudes, knowledge, and skills they develop through international experiences. For teachers, the tool offers insights into students’ learning processes and challenges, supporting better guidance, preparation, and follow-up. Ultimately, the questionnaire strengthens the educational impact of mobility by turning experience into structured, meaningful learning.

Author:

Marja Gröhn-Rissanen, International Coordinator, Senior Lecturer, MSc, Rn. Savonia University of Applied Sciences, Department of Health care, marja-liisa.grohn-rissanen@savonia.fi.