Student nurses' attitudes to social justice and poverty: An international comparison

Background: In both the United Kingdom (UK) and the United States (US), health inequities are proving resistant to improvement. Nurses are ideally placed to advocate for social justice. It is therefore important that nurse education encourages awareness of the social determinants of health and equips students to act to address health inequity. However, little is known about student nurses' attitudes to social justice and poverty and the impact of pedagogical strategies used to teach the determinants and patterns of health inequities. Objectives: To assess and compare UK and US student nurses' attitudes towards social justice and poverty before and after learning about social determinants of health and health inequities. Design: Cross-sectional study with embedded before and after design using validated measures. Setting: Two universities: one urban UK university and one US university with urban and rural campuses. Participants: 230 student nurses in the UK (n = 143) and US (n = 87) enrolled in courses teaching content including health inequities and social determinants of health. Results: Student nurses generally disagreed with stigmatizing statements about people living in poverty and mostly agreed with statements promoting social justice. However, US students were significantly more likely to have positive attitudes towards both social justice (p = 0.001) and poverty (p < 0.001). In multiple regression analyses, engagement in social justice-promoting activities, activism and higher levels of education were associated with positive attitudes to social justice and poverty. Statistically significant positive changes in attitudes to poverty and social justice after their courses were observed only among US student nurses. Conclusion: UK and US student nurses' attitudes to poverty and social justice were generally positive. Education around social determinants of health and health inequity had a different effect in the UK and the US. There is a need to explore further what specific components of educational programmes lead to positive changes in attitudes.