Causal Model of Cultural Competence and Behavior among Nurses in Thailand’s International Hospitals

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Thanida Khongsamai
Ungsinun Intarakamhang


Thailand is recognized as an international medical hub and so it is important for its nurses to have appropriate cultural care behaviors to provide care for patients from different countries and cultures. This study aimed to examine the causal model and identify the causal variables affecting the cultural competence and cultural care behavior of professional nurses working in international hospitals in Bangkok, Thailand. The study was based on structural equation modeling analyses of the data collected from 451 registered nurses, selected by stratified random sampling. The data were collected using a set of questionnaires, based on five instruments using six-point rating scales, with the confidence level ranging from 0.67 to 0.94. The results showed that the assumption of a causal relationship model fitted with the empirical data (SRMR = 0.078, RMSEA = 0.072, GFI = 0.97 NFI = 0.97, CFI = 0.97, c2/df = 3.35). The factors related to the nurses’ cross-cultural experience and cultural attitudes had a direct effect on their cultural competence, (β = 0.22, 0.88, p < .05). Also, their perceived organizational support and cultural competence had a direct effect on the nurses’ cultural care behavior (β = 0.11, 0.63, p < .05). This model could explain 84% of the variance in the cultural care behavior of the nurses in the data set. It was revealed that appropriate cultural care behaviors can be developed by increasing cultural competence and from having perceived organizational support. This research recommends that organizations should support training courses to enhance the experience and attitudes of nurses regarding their cultural competence and cultural care behaviors.

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Khongsamai, T., & Intarakamhang, U. (2020). Causal Model of Cultural Competence and Behavior among Nurses in Thailand’s International Hospitals. The Journal of Behavioral Science, 15(2), 54-69. Retrieved from
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