Determinants of cultural humility

Meditation and cultural humility

Research has shown that some activities or exercises may foster cultural humility as well. To illustrate, as Or et al. (2024) revealed, one mental activity, called loving-kindness meditation, seems to promote cultural humility.

Benefits of loving-kindness meditation

To undertake loving-kindness meditation, individuals sit quietly, usually with their eyes closed, and direct their attention towards their breath for several minutes. Next, they direct this attention towards their heart for a while, before visualising someone they love unconditionally, perhaps a child. Then, these individuals attempt to cultivate the feelings they usually experience towards this person—perhaps feelings of warmth, tenderness, and hope, for example. Next, they learn to direct these feelings and thoughts towards themselves—that is, they feel warmth, tenderness, kindness, and so forth towards themselves. Subsequently, they attempt to extend the same feelings to an increasing breadth of individuals: their friends, their acquaintances, their managers, their rivals, or even strangers. Several other variants of this practice have been developed as well (Hutcherson, Seppala, & Gross, 2008).

Several studies have established the benefits of loving-kindness meditation. In a study that Fredrickson et al. (2008) conducted, individuals participated in six workshops, each lasting approximately one hour, in which they learnt this practice. Initially, these participants learnt how to direct love and compassion towards themselves. Subsequently, they learnt how to direct these feelings towards other individuals. During each hour, 15 to 20 minutes of the session was devoted to meditation, 20 minutes to discuss the progress of participants, and 20 minutes to information about meditation, such as how to integrate this practice with daily life.

Over the next 9 weeks, beginning with the first training session, participants completed daily reports, designed to assess mindfulness, hope, optimism, resilience, wellbeing, emotions, social relationships, illness, and sleep. Overall, loving-kindness meditation promoted more positive emotions—a benefit that was especially amplified after several weeks of meditation. These positive emotions were also correlated with many other benefits, including improvements in social relationships, purpose, hope, and health.

Even brief variants of this exercise can be helpful. In one study, conducted by Hutcherson et al. (2008), some participants were invited to close their eyes and to imagine two individuals they love unconditionally. The participants imagined receiving feelings of love and compassion from these individuals. After four minutes, participants were instructed to open their eyes and redirect these feelings towards a photograph of a stranger. In addition, participants repeated a series of phrases, all intended to wish this stranger happiness, health, and fortune. In the control condition, participants engaged in a similar exercise, but they initially formed images of acquaintances and evoked neutral emotions. The brief variant of loving-kindness meditation did improve the emotions of participants.

Furthermore, this brief variant of loving-kindness meditation improved emotions that were measured more subtly and obliquely. Specifically, after the intervention, participants were instructed to indicate whether various words, such as loyal or cruel, are positive or negative, as rapidly as possible. Before each word, a face would occasionally appear briefly. After loving-kindness meditation, individuals could respond more rapidly to positive but not negative words that followed a face. This finding implies the face was regarded more positively after the meditation.

Benefits of loving-kindness meditation to cultural humility

Loving-kindness meditation seems to foster cultural humility as well. In the study that Or et al. (2024) conducted, 58 undergraduate students in the America, listened to a script that outlined loving-kindness meditation. The participants were instructed to complete this exercise three to four times a week over a fortnight. Before and after this period, participants completed a series of questions, including the cultural humility scale (Hook et al., 2013). After completing kindness-loving meditation over two weeks, the cultural humility of participants improved significantly.

Training and cultural humility

Protocols that were specifically designed to foster cultural humility

To foster cultural humility in mentors of diverse youth, Sánchez et al. (2025) designed a comprehensive training program. The program was customised to America but could be tailored to suit other nations and regions as well. To commence this program, the mentors completed an online program that comprised three modules.

During the first online module, participants learned about key historical events in America that were relevant to racial matters and the various definitions and facets of racism. During the second online module, participants learned about their multiple identities and how these identities could shape the mentoring relationship. For example, they were exposed to social identity theory and learned how to demonstrate courage and bravery during conversations, called colour brave, rather than to shun references to ethnic and racial identity. During the final online module, participants learned about how membership of various social demographics can affect the experiences of people as well as their relationships. They considered how privileges and oppression can significantly affect the perceptions, attitudes, expectations, and lives of people—and how these dynamics could affect mentors and diverse youth differently.

Next, the participants completed synchronous online training, lasting about two hours. The training revolved around how to embed principles of justice, equity, diversity, and inclusion into their mentoring. For example, they learned about how to inspire diverse youth to develop a positive identity as well as how to apply the principles of active listening to learn more about racism and culture. The participants then practiced these principles with one another online in breakout rooms.

Participants received monthly emails to reinforce some of these principles. Finally, case managers offered additional support to these mentors, helping these individuals apply the principles they learned to their mentoring sessions. At the time this protocol was published, the researchers had yet to evaluate the efficacy of this intervention quantitatively.

An illustration of a training protocol that was designed to foster cultural humility

Arora et al. (2025) outlined a training protocol they designed to foster cultural humility. Their program, called the Strategic Treatment Assessment for Youth, was designed to improve treatment of youth from racial or ethnic minorities. Nevertheless, this protocol could be adapted to suit many other settings. The training protocol revolves around four pillars or practices:

engage in reflection,
recognise client wisdom,
rebalance power, and
remain dedicated to lifelong learning.

First, to engage in reflection, health practitioners should explore their biases or assumptions about various cultures, recognise these beliefs may be flawed, appreciate that some therapeutic principles may not be applicable to all cultural settings, and realise that culture is relevant to all clients. For example, practitioners may consider whether the goals of therapy or measures of progress are relevant to specific clients.

Second, to recognise client wisdom, health practitioners should attempt to learn from clients and welcome feedback from these clients. For instance, practitioners might consider how they could better learn about the experiences, perspectives, and cultural values of their clients. In addition, practitioners should consider how they can adapt their approaches to integrate the wisdom or practices of their clients into the therapeutic journey. They may, for example, attempt to instil the spiritual beliefs or cultural rituals of these clients into the therapeutic plan.

Third, to rebalance power, the health practitioner should attempt to empower clients. That is, whenever possible, health practitioners and clients should be partners in assessing needs, formulating the treatment plan, evaluating progress, and adjusting this plan. Practitioners should strive to question and to relinquish their need to be the expert and consider how they can more effectively invite and elevate the voice of their client during the sessions.

Finally, to remain dedicated to lifelong learning, health practitioners should consider their existing skills or knowledge on how to be a culturally humble clinician, explore their limitations in cultural humility, and contemplate how they could address these limitations. These practitioners may identify times in which they do not experience cultural comfort and then seek opportunities, such as resources, advice, or cultural experiences, to foster this comfort.

Multicultural training

When students complete training in counselling, psychology, or similar professions, they often attend multicultural training workshops. Although these experiences may vary widely, this training tends to encompass discussions about

awareness of how personal biases and experiences might shape misleading assumptions about diverse communities,
the lived experiences, perspectives, norms, and values of individuals from diverse communities,
practical skills on how to adapt communication, assessments, and interventions to accommodate individuals from diverse communities.

However, whether such multicultural training fosters cultural humility warrants investigation. During multicultural training, individuals might learn to appreciate that culture is multifaceted, dynamic, and nuanced, encouraging a motivation to learn and fostering cultural humility. Alternatively, after they attend workshops or similar events, individuals may overestimate their knowledge about culture, promoting cultural arrogance rather than humility.

To assess these possibilities, Kondili et al. (2022) investigated the association between multicultural training and cultural humility. The sample comprised 131 participants who were enrolled in counselling courses at a Master level and who completed an online questionnaire. The questionnaire included

a question about the number of multicultural training courses the individuals had previously attended,
the Multidimensional Cultural Humility Scale (Gonzalez et al., 2020)—a measure of cultural humility that assesses five distinct facets, such as openness and self-reﬂection,
the Comprehensive Intellectual Humility Scale to gauge four facets of intellectual humility, such as respect towards diverse perspectives and openness to revise beliefs,
the Quiet Ego Scale—a measure that assesses the tendency of individuals to consider the perspectives of other people while pursuing their personal needs.

As a hierarchical regression analysis revealed, the number of multicultural training courses that counselling students attended was positively associated with cultural humility—even after controlling intellectual humility and quiet ego. These finding imply that multicultural training tends to foster cultural humility rather than cultural arrogance. Future research, however, is warranted to explore the direction of causality, because cultural humility might inspire people to attend multicultural training rather than vice versa.

Scenarios

Other training in cultural humility primarily revolves around scenarios in which medical practitioners demonstrate cultural insensitivity or bias. For example, Reyes et al. (2026) designed a curriculum, comprising 20 short sessions, that was designed to foster cultural humility in medical students, residents, physicians, and surgeons. During each session, participants discussed scenarios like

a physician who expresses the belief, to a patient, that individuals who have undergone bariatric surgery do not usually like to exercise, epitomising a stereotype,
a woman who is diagnosed with cerebral palsy is not asked about her sexual history, even though other patients with similar presentations would be asked, exemplifying ableism,
a Korean medical student is frequently invited to act as an interpreter when patients are Korean—and has even been labelled as “the interpreter”.

As an evaluation of the program revealed, individuals who attended more than ten sessions were more likely than peers to deploy strategies that prevent or address discrimination—a key facet of cultural humility.

Educational animations

To demonstrate cultural humility, comfort, and opportunities, practitioners should strive to learn from each client about the cultural experiences, values, and beliefs of this person. Nevertheless, as Alucozai et al. (2024) revealed, practitioners who watch videos or read other materials about a culture may also experience greater cultural comfort.

To illustrate, in the study that Alucozai et al. (2024) published, undergraduate nursing students, enrolled in an American university, watched this animated video, lasting nine minutes, about Muslim clients. The video revolved around a Muslim female patient. During this video, a male practitioner unexpectedly visits the Muslim female patient who had removed her hijab, eliciting distress. The video presents some insights about

the hijab, the head covering, designed to demonstrate modesty to unrelated males, often perceived as a form of expression rather than oppression,
avoidance of pork, alcohol, and pork byproducts such as gelatine—obliging practitioners to identify medication that is devoid of gelatine and alcohol,
the herbs and supplements they may be ingesting as well as other alternative healing practices,
concerns around pelvic exams, pap smears, or other invasive procedures,
variations across cultures,
the need to honour the family,
the obligations during Ramadan, such as fasting during the day, although some medication is permitted such as eye drops,
preference towards practitioners of the same sex,
the observation that emergencies override many of these obligations,
the need to communicate and to reach joint decisions rather than preach unilaterally.

Before, immediately after, and six weeks after watching the video, participants answered questions that assess their knowledge of how health care should be adapted to accommodate Muslim patients. In addition, to assess cultural comfort, participants completed the Comfort and Behaviour with Interactions subscale of the cultural awareness scale (Rew et al., 2003), comprising items like “I am very comfortable working with people whose beliefs, values and practices are different from my own”. As the findings revealed

cultural comfort did improve immediately after watching the video—but this comfort was not maintained six weeks later,
arguably, after a delay, individuals may be concerned they had forgotten vital information, suggesting that a refresher or opportunities to apply this knowledge may be necessary,
improvements in knowledge, however, were maintained six weeks later.

How experienced counselling educators foster cultural humility

To design training programs on cultural humility, educators need to appreciate the events and experiences that foster such humility. To characterise these events and experiences, Zhu et al. (2021) interviewed 14 experienced counselling educators on two occasions each, inviting these participants to share their insights about how counsellors develop cultural humility. The researchers adopted the grounded theory approach that Corbin and Strauss (2014) promulgated in their seminal book. The ensuing theory outlines some key insights (Zhu et al., 2021).

First, the counselling educators discussed the significant of cultural humility. That is

after individuals attempt multicultural training in Western nations, they often feel the need to demonstrate their multicultural credentials, diminishing their appreciation of intangible qualities such as curiosity and openness,
similarly, this multicultural training may amplify differences between the culture of counsellors and the culture of clients, potentially impeding the motivation to learn from one another,
the counselling educators thus positioned cultural humility as a quality, stance, or presence that promotes this curiosity, openness, and motivation to learn from one another and is maintained in all circumstances,
yet the educators emphasised that humility does not equate to a suppression of opinions or avoidance of conflict but instead revolves around a deep commitment to genuinely exchange ideas with diverse individuals and to learn from one another.

Next, the counselling educators outlined the beliefs or assumptions that can foster this cultural humility. Specifically, individuals are more inclined to experience cultural humility after they recognise and learn that

culture is multifaceted and manifests uniquely in each person,
learning about a culture is a lifelong commitment—in contrast to the perception that people can learn about an entire culture
all cultures are valuable but limited.

Finally, as the counselling educators proposed, cultural humility often emanates from a tension that people experience between their assumptions and an interaction with another culture—such as discovering the role of family members differs from expectations. These tensions can elicit feelings of doubt, discomfort, or shame. Such feelings may precipitate cultural humility, but only in response to specific intervening conditions. For example

this tension fosters cultural humility only when individuals accept the discomfort, quietly learn about their misconceptions, pursue a deeper understanding, maintain egalitarian relationships, acknowledge errors, and seek assistance,
cultural immersion does not always promote cultural humility, because familiarity may culminate in biases rather than exploration, unless individuals can introspect and contain tensions, frustrations, and anxieties,
furthermore, trusting relationships may encourage the self-disclosure that is necessary to explore misconceptions and forge a deeper understanding.

Cultural immersion and cultural humility

According to Atkins and Lorelle (2022), if health practitioners, such as counsellors, are granted opportunities to immerse themselves in more cultural opportunities, they should gradually develop cultural humility. To explore this possibility, the researchers conducted a qualitative study on the impact of this immersion in cultural opportunities on the beliefs and practices of student counsellors.

In this study, 21 American students, enrolled in postgraduate counselling courses, attended a conference, lasting two weeks, in Thailand. The conference was designed to enable American and Thai individuals, including students, academics, and the public, to exchange cultural knowledge that is relevant to counselling. The conference included presentations, discussions, and excursions in which American individuals learned about the nation and the culture. Readings, reflections, interviews, and presentations complemented this cultural exchange. After this experience,

the American students participated in focus groups and interviews,
the facilitators asked questions that assess how this cultural immersion shaped their professional practices and beliefs,
the researchers applied phenomenological data analysis to characterise the lived experience of these participants (Moustakas, 1994).

This analysis revealed the pronounced benefits of this cultural experience (Atkins & Lorelle, 2022). This experience foster beliefs and practices that epitomise cultural humility. For example,

participants felt that, after this experience, they were more receptive and open to diverse perspectives,
these individuals also felt that conversations with diverse individuals, challenging questions from instructors, and safe relationships enhanced the impact of this experience on personal growth,
participants became more aware of certain privileges they experience they had not appreciated before—and experienced gratitude and appreciation as a consequence,
some participants became attuned to the degree to which their community had shaped their beliefs and felt marginally disoriented when exposed to other cultures, epitomised by quotes like “….how you have been culturally formed to believe the world is in the environment you’re in, and I think getting out of that environment cracks that open”.

The effect of other variants of humility

Researchers tend to regard cultural humility as distinct from other variants of humility, such as intellectual humility. However, as Kondili et al. (2022) revealed, some of these other variants of humility may facilitate or foster cultural humility.

In this study, 131 participants, all of whom were enrolled in counselling courses, completed an online questionnaire. This questionnaire entailed the Multidimensional Cultural Humility Scale—a measure of cultural humility that assesses five distinct facets, such as openness, self-awareness, and self-reﬂection. The questionnaire also entailed the Comprehensive Intellectual Humility Scale to gauge four facets of intellectual humility, such as limited overconfidence in beliefs, openness to revise beliefs, and respect towards diverse perspectives. Finally, this questionnaire also included the Quiet Ego Scale—a measure that comprises four distinct facets:

detached awareness, similar to mindfulness,
inclusive identity or the degree to which individuals feel a connection to other people and the environment,
perspective taking, typified by items like “Before criticising somebody, I try to imagine how I would feel if I were in their place”, and
personal growth, typified by items like “For me, life has been a continuous process of learning, changing, and growth”.

As the findings revealed, when the researchers examined only the overall measures, a quiet ego, but not intellectual humility, was positively related to cultural humility. However, when the researchers examined the facets of these scales, other relationships surfaced. To illustrate

two facets of intellectual humility—respect towards diverse perspectives and limited overconfidence—were positively related to one facet of cultural humility: self-awareness or the inclination of individuals to seek feedback or information about their strengths and limitations,
likewise, two facets of intellectual humility—the willing to revise beliefs and respect towards diverse perspectives—coupled with one facet of a quiet ego—personal growth—were positively associated with self-reflection or the tendency of individuals to question personal biases.

Accordingly, some facets of intellectual humility and a quiet ego may foster cultural humility. For example, when individuals recognise their beliefs may be biased, feel motivated to expand their knowledge to overcome these biases, and thus respect diverse perspectives, cultural humility may be more natural and effortless.