Examining Barriers and Facilitators to Integrating Culture of Health in Nursing Curricula: A Delphi Study

Purpose: The purpose of this research study is to examine the current state of integration of culture of health into academic nursing education at all education levels in one mid-south state. The study also aims to assess the perceived barriers, facilitators and readiness by deans and directors of schools of nursing about incorporating the concepts within the Robert Wood Johnson Foundation “Culture of Health” Framework into the curriculum.

Methods: All schools of nursing deans, chairs and directors within the state were eligible to participate in this study. Members of the state Action Coalition/Center for Nursing serving as representatives on the Culture of Health team presented an introduction about culture of health and the Delphi study at the biannual schools of nursing leadership meeting in February 2017. Following submission to the university institution review board, the study team identified deans and directors of schools of nursing to participate in the study. The nine deans and directors in Phase 1 of the Delphi study represent various nursing education levels including practical nursing, associate degree, baccalaureate and graduate nursing programs from various geographic areas around the state. The study team conducted phone calls to these participants in March and April using the following questions to guide the interviews.

1. What are your thoughts about integrating social determinants of health and culture of health concepts into the nursing curriculum? Is this something you are already doing in your school and if so, talk about the kinds of components or activities that are taking place.
2. Why do you think learning about social determinants and culture of health is important for nursing students?
3. What do you think are the barriers to integrating the concepts into the curriculum?
4. What do you think are the facilitators to integrating the concepts into the curriculum?

Results: Thematic analysis of the Phase 1 participants’ responses revealed themes, subthemes and specific exemplars. Emerging themes were “Perceived importance of integrating culture of health (COH), population health (PH), and social determinants of health (SDH) into the curriculum”; “Current status regarding the integration of COH, PH and SDH into nursing curricula across the state”; Examples of how COH, PH, and SDH are currently being integrated into curricula across the state”; “Perceived barriers of implementing COH, PH, and SDH into the current curriculum”; “Perceived facilitators to implementing COH, PH and SDH into the curriculum”; and “Resources need to implement COH into the curriculum.” From the themes, an electronic survey of closed- and open-ended items was created for Phase 2 of the study to validate findings of Phase 1 with those participants. The anonymous electronic survey is underway at this time.

After analysis of Phase 2 findings, an additional electronic survey will be created and distributed to all deans and directors of all nursing education programs of all educational levels in the state by the end of the summer. This survey and analysis will comprise Phase 3 of the Delphi study.

Implications: All findings will be shared with the state’s nursing school leaders at the fall 2016 biannual meeting of the deans and directors. The overarching goal is enabling schools of nursing leadership in culture of health integration in their respective nursing programs. Specific resources for integration can be created and shared among education programs.