Effectiveness of cultural humility and cultural competence training interventions for healthcare students to improve care for gender and sexual minority groups: a systematic review and meta-analysis

Background This review aimed to evaluate the effectiveness of cultural humility and cultural competence training interventions for healthcare learners by assessing improvements in learning outcomes relevant to care for gender and sexual minority (GSM) populations. Methods This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases, which are PubMed (NCBI), Scopus (Elsevier), Web of Science (Clarivate), and Google Scholar, were searched from January 2000 to December 2025 using a pre-defined search string “LGBTQ+persons,” “Sexual and Gender Minorities,” “Health personnel”, “Cultural competence”, and “Cultural humility”. We included randomised/non-randomised controlled trials and single-group pre- and post-test studies evaluating educational interventions around cultural humility for GSM health among healthcare learners. Interventions encompassed workshops, seminars, online or hybrid modules, and integrated curricula, with outcomes including self-reflection, knowledge, awareness, attitudes, clinical preparedness/skills, or patient satisfaction. Two independent reviewers extracted data using standardised extraction forms and assessed the risk of bias using the study-appropriate Joanna Briggs Institute (JBI) checklist. Data from continuous outcomes were pooled using random-effects meta-analysis and expressed as a pooled standardised mean difference (SMD) with 95% CIs. Statistical heterogeneity was assessed using I² statistics. Results Thirty-seven studies were included (36 single-group pre-post designs and one with a control group). A meta-analysis showed a statistically significant improvement in knowledge across eight studies (SMD = 1.13; 95% CI: 0.75 to 1.50; p < 0.00001), despite substantial heterogeneity (I² = 91%). Attitude changes across six studies were not statistically significant (SMD = 0.06; 95% CI: -0.18 to 0.3; p = 0.62) with high heterogeneity (I² = 80%). Competency outcomes from four studies ( n = 894) demonstrated a moderate, significant positive effect (SMD = 0.66; 95% CI: 0.41 to 0.91; p < 0.00001), with moderate heterogeneity (I² = 55%). Conclusions Educational interventions targeting healthcare learners that utilise the cultural humility and competence of SGM individuals significantly improve learners’ knowledge and clinical skills. However, evidence does not support a reliable impact on attitudes. Combining didactic content with interactive methods enhances learning outcomes. Because most included studies used single-group pre–post designs without control groups, pooled SMDs were calculated from within-group pre- and post-intervention comparisons. Therefore, despite promising results, methodological limitations, heterogeneity, and limited long-term data restrict the generalizability of findings. Trial registration PROSPERO, CRD42024533825.