One Course, Big Gains: Nursing Students’ Global Health Competency Rises Sharply

A single, well-structured course can measurably reshape how future nurses see their role in the world. That is the central finding of a new study from Sultan Qaboos University in Oman, where researchers tracked eighty undergraduate nursing students before and after they completed a curriculum-embedded global health course. The results, published in BMC Nursing, show a statistically significant jump in students’ perceived global health competency, with the largest gains appearing in the domain that matters most for modern healthcare: health equity and social justice.

The research team, led by Zainab Al Kindi of the Department of Community and Mental Health Nursing, set out to address a persistent gap in nursing education. Global health challenges, including emerging infections, population mobility, climate-related health risks, noncommunicable diseases, and health inequities, increasingly shape day-to-day nursing practice. Yet evidence on whether structured, curriculum-embedded courses actually improve students’ perceived competency has remained limited, particularly in countries where global health education is still maturing within undergraduate nursing curricula.

To measure the effect, the researchers used a one-group pre-test–post-test design, one of the most direct ways to evaluate change within a cohort. Each of the eighty participating students completed a questionnaire before the course began and again after finishing it. The measurement instrument was a course-aligned adaptation informed by the Global Health Competencies for Nurses framework, covering seven distinct domains: global burden of disease, global health priorities, social and environmental determinants of health, professional practice, health equity and social justice, programme management, and economic, sociocultural, and political awareness.

The headline result was unambiguous. Overall perceived global health competency rose from a mean of 2.46 on the pre-test, with a standard deviation of 0.81, to a mean of 3.08 on the post-test, with a standard deviation of 0.44. That represents a mean increase of 0.62 points, with a 95 percent confidence interval of 0.40 to 0.84. The paired-samples t test yielded t(79) = 5.62 and p < .001, while the paired-samples effect size, Cohen’s dz, came in at 0.63, a medium-to-large effect by conventional standards. Notably, the drop in standard deviation from 0.81 to 0.44 suggests the course did not merely lift the average; it also narrowed the spread between students, bringing lower-scoring students closer to their peers.

The improvement was not confined to a single dimension of competency. Students showed significant gains across all seven domains of the adapted scale. The largest single improvement appeared in health equity and social justice, where the mean increased by 0.90 points, with a 95 percent confidence interval of 0.68 to 1.12, t(79) = 8.14, p < .001, and a Cohen’s dz of 0.91. An effect size approaching 1.0 in a paired design indicates that, for the average student, the shift in perceived understanding of equity and justice was substantial, not a marginal statistical artifact.

Why would equity and social justice show the steepest climb? The authors’ framework places these concepts at the heart of global health thinking, and they are often the least familiar territory for students entering nursing school. Concepts such as the social determinants of health, structural inequities, and the uneven distribution of disease burden across populations require a conceptual reframing that clinical training alone rarely provides. A dedicated course gives students the vocabulary, evidence base, and analytical tools to see health outcomes as products of social, economic, and political arrangements, not just individual biology or behavior. The data suggest that once that reframing occurs, students recognize it themselves in their self-assessed competency.

The study also uncovered an interesting baseline pattern. Students who had previously participated in global health activities, such as exchanges, volunteer work, or related extracurricular engagement, reported higher competency before the course even began. This aligns with a broader principle in competency development: prior exposure builds familiarity and confidence. However, by the post-test, competency scores did not differ significantly across participant characteristics. In other words, the course appears to have leveled the field, giving students without prior global health exposure the same measurable boost that brought them up to par with their more experienced classmates.

Methodologically, the one-group pre-test–post-test design has known limitations that the findings should be read against. Without a control group, it is impossible to fully rule out alternative explanations such as maturation, concurrent coursework, or test-retest effects. Self-reported perceived competency also measures confidence and self-assessment rather than directly observed skill. Nevertheless, the design is well suited to course evaluation, and the consistency of improvement across all seven domains, combined with conventional statistical rigor including confidence intervals and paired effect sizes, strengthens the case that the course itself drove the change. The study received ethical approval from the Research and Ethics Committee of the College of Nursing at Sultan Qaboos University and was conducted in accordance with the Declaration of Helsinki, with data collection handled by someone not involved in teaching or assessment to reduce pressure on students.

The implications extend beyond one university in Muscat. The authors argue that integrating global health education within undergraduate nursing curricula offers a scalable approach to preparing future nurses for equity-oriented, culturally responsive, and globally informed practice. Because the course was embedded in the existing curriculum rather than offered as an optional add-on, the model does not require students to find extra time or resources, making it attractive for nursing schools in low- and middle-income countries and beyond. As climate change alters disease patterns and populations grow more mobile, the demand for nurses who understand global health dynamics will only intensify.

There is also a broader policy dimension. The researchers note that strengthening perceived global health competency in nursing education may support progress toward the United Nations Sustainable Development Goals related to health and quality education. A workforce of nurses who grasp the global burden of disease, the economics of health systems, and the politics of health inequity is better positioned to deliver care that closes gaps rather than widening them. For a profession that makes up the largest share of the global health workforce, that shift in perspective, achieved in a single course, may prove to be one of the most cost-effective investments in health equity available to educators today.

Subject of Research: The effect of a structured global health course on perceived global health competency in undergraduate nursing students

Article Title: Enhancing perceived global health competency among undergraduate nursing students: a pre-test–post-test course evaluation

Article References: Kindi, Z. A., Yahyaei, A. A., Joseph, M., & Sabei, S. A. (2026). Enhancing perceived global health competency among undergraduate nursing students: a pre-test–post-test course evaluation. BMC Nursing. https://doi.org/10.1186/s12912-026-05412-2

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05412-2

Keywords: global health competency, nursing education, undergraduate nursing students, curriculum evaluation, health equity, pre-test post-test study, social determinants of health, Sultan Qaboos University, BMC Nursing, nursing workforce, culturally responsive care, sustainable development goals