Influence of the university campus environment on sociocultural engagement and satisfaction of health professions education students: role of the sense of belonging

Abstract

Background

Sociocultural competence is essential for health professions education (HPE) students. However, the relationships between university campus environment, sense of belonging, and sociocultural engagement of HPE students remain unclear. We hypothesized that a university environment promoting students’ participation in social activities enhances their sociocultural engagement, which is mediated through the students’ sense of belonging, ultimately increasing their satisfaction with university experience.

Methods

The study included undergraduate HPE students (n = 638) at Gulf Medical University. We used a validated questionnaire for measuring sociocultural engagement of students (13 items). In addition, we used scales for measuring the supportive campus environment (8 items), quality of student relationships (4 items), students’ sense of belonging (5 items), and student satisfaction with university experience (one item). We examined the relationships between the study variables using path analysis.

Results

The campus environment had direct significant effects on the two dimensions of sociocultural engagement: sociocultural interactions and sociocultural adaptation (β = 0.18 and 0.24, P < .001, respectively). Similarly, the quality of student relationships had direct significant effects on sociocultural interactions and sociocultural adaptation (β = 0.29 and 0.26, P < .001, respectively). In addition, a supportive campus environment and student relationships had direct significant effects on the students’ sense of belonging (β = 0.41 and 0.35, P < .001, respectively). Furthermore, the sense of belonging directly affected student’s satisfaction with the university experience (β = 0.50, P < .001), and indirectly mediated the relationship between the supportive campus environment, student relationships, and student satisfaction (β = 0.33 and 0.26, P < .001, respectively). However, there was no direct significant effect of either supportive campus environment, student relationships, or sociocultural engagement of students on their satisfaction with university experience.

Conclusions

A supportive campus environment and positive student relationships significantly affected sociocultural engagement and sense of belonging among HPE students. Moreover, the sense of belonging serves as a partial mediator, linking the campus environment and the quality of student relationships to overall satisfaction with the university experience. While student satisfaction is primarily driven by the sense of belonging, sociocultural engagement did not have a significant direct impact on student satisfaction with university experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-024-06534-4.

Introduction

Effective clinical encounters rely on a thorough comprehension of the sociocultural factors that influence a patient’s health-related values, beliefs, and behaviors. Therefore, developing sociocultural competence is essential to delivering equitable and high-quality healthcare to patients from diverse backgrounds. The sociocultural engagement construct is conceptually related to social integration and the development of sociocultural competence among college students [1]. According to the Global Learning Qualifications Framework (GLQF), sociocultural engagement involves the expansion of perspectives and the cultivation of an appreciation for and respect toward diverse backgrounds and viewpoints [2].

We have recently developed a questionnaire for measuring sociocultural engagement of health professions education (HPE) students [3]. In addition, we have demonstrated supportive lines of evidence for the validity of the questionnaire including content-related evidence, validity of internal structure, and predictive validity evidence [3]. According to this study, the sociocultural engagement construct of HPE students demonstrated two interrelated dimensions: sociocultural interactions and sociocultural adaptation [3]. Sociocultural interaction refers to the engagement of students with diverse cultural values, norms, and social practices, promoting shared understanding and meaningful relationships. It emphasizes participation in activities that foster cultural exchange and mutual respect. On the other hand, sociocultural adaptation is the process of acquiring the behavioral competencies necessary for effective functioning within a new sociocultural context. It is assessed by the extent of self-reported challenges encountered in interpersonal interactions and the execution of everyday activities [4].

The current study is guided by two key theoretical frameworks: Wenger’s social theory of learning [5], and frameworks of student engagement in higher education, particularly in the HPE context [6–8]. Wenger’s theory conceptualizes learning as social participation, highlighting active involvement in community of practices (CoP) and interactions [5]. For university students transitioning into a new community, active participation supports identity development by reconciling their personal social and cultural values with those of the new environment. This process is strengthened through the cultivation of a sense of belonging within the college community [6, 9].

On the hand, the frameworks of student engagement illustrate the antecedents, mediators, dimensions, outcomes of student engagement [6–8]. Engagement is viewed as an internal psychological state influenced by individual student attributes, institutional structures, psychosocial dynamics, and wider sociocultural contexts [6, 9]. In the HPE context, engagement encompasses cognitive, behavioral, emotional, agentic, and sociocultural dimensions [8]. Key mediators of engagement include motivation, self-efficacy, sense of belonging, and reflectivity [6, 7].

The university campus environment, including the physical spaces, social interactions, and academic resources, plays a key role in shaping student experiences. A growing body of research highlights the benefits of culturally diverse universities in enhancing educational experiences, improving learning outcomes, and preparing students for multicultural workplaces and societies [10]. Structured opportunities to engage with diversity on campus are linked to better intergroup attitudes and civic engagement [11]. Additionally, a diverse and inclusive campus promotes peer interaction, cross-cultural understanding, and collaboration, essential for future healthcare professionals working in multicultural settings [12]. Furthermore, a welcoming campus with supportive facilities promotes a sense of belonging, improving both academic performance and well-being [13].

A sense of belonging in educational settings is defined as students’ perception of being accepted, valued, included, and supported by their teachers and peers. This concept also involves feeling like a meaningful and integral part of the university’s community and activities [14]. The degree to which students experience a sense of belonging is influenced by their responses to social interactions and the characteristics of the university environment [15]. Previous studies demonstrated that the students’ sense of belonging could be a mediator for enhancing their learning engagement [16], and is inversely correlated with medical students’ burnout [17]. The sense of belonging was also demonstrated to be a significant predictor of emotional and behavioral engagement of students [18]. However, while some research has explored its relationship with various dimensions of engagement in higher education [16, 18], the connection between a sense of belonging and sociocultural engagement among HPE students remains unexplored. Additionally, the interplay between a supportive university environment, students’ sense of belonging, and their sociocultural engagement in the HPE context has yet to be investigated. This gap in literature underscores the need for further examination to better understand these complex interactions.

Therefore, as illustrated in the conceptual framework of the study (Fig. 1), we examined the university’s supportive campus environment and quality of student relationships as antecedents for sociocultural engagement of students. In addition, we examined the role of the sense of belonging as a mediator in these relationships and the student satisfaction with the university experience as an outcome. The results from this study have the potential of not only adding to the HPE literature in this under-researched area but can also be used as feedback to university programs for the purpose of improving the quality of student experience in these programs. To that end, we have designed the study to answer the following questions: (1) To what extent does the university campus environment affect the sociocultural engagement of HPE students and their sense of belonging? (2) To what extent does the sense of belonging mediate the relationship between university campus environment and sociocultural engagement of HPE students? and (3) To what extent does the sense of belonging mediate the relationships between university campus environment and student satisfaction with university experience?

Fig. 1.

Conceptual framework of the study. The study variables included different components of sociocultural engagement including antecedents (supportive campus environment and quality of student relationships), mediators (sense of belonging), dimensions (sociocultural interaction and sociocultural adaptation), and outcomes (student satisfaction with the university experience)

Materials and methods

Study context

This study was conducted at Gulf Medical University (GMU), situated in Ajman, United Arab Emirates. GMU comprises six constituent colleges: Medicine, Dentistry, Pharmacy, Nursing, Health Sciences, and Healthcare Management and Economics. All colleges are situated on a single campus, enabling the efficient sharing of both physical and human resources to support the university’s academic operations. GMU’s student body is notably diverse, encompassing individuals from 77 different nationalities, thus fostering a rich and dynamic cultural environment.

Study instruments

The sociocultural engagement of students was measured using our recently developed and validated questionnaire for measuring sociocultural engagement of student’s questionnaire (SESQ) [3]. The questionnaire consists of 13 items which measure two interrelated dimensions pertaining to sociocultural engagement, namely, sociocultural interactions (8 items) and sociocultural adaptation (5 items).

The items of the university campus environment scales were adapted from the National Survey of Student Engagement (NSSE) indicators [19]. The supportive environment scale comprises 8 items that capture students’ views on the degree to which an institution emphasizes services fostering learning and development of students [20]. The scale covers aspects of university priorities, including (a) supporting academic success, (b) utilizing learning support services, (c) fostering contact among students from diverse backgrounds, (d) encouraging social involvement, (e) supporting overall well-being, (f) aiding in the management of nonacademic responsibilities, (g) participating in campus activities and events, and (h) attending events addressing significant social, economic, or political issues [20].

The student relationships scale consists of 4 items including the quality of relationships with peers, faculty, academic advisors, and admin staff [20]. The sense of belonging scale consists of five-items; three items were imported from previously validated sense of belonging scales [21, 22]. The first three items are: “I am thrilled to be in this university,” “I feel I am a good fit for this university,” and “I feel welcomed in this university” [21]. The other two items are: “This university is one of my favorite places,” and “I feel proud of being a part of this university” [22]. Although evidence of validity of campus environment and sense of belonging scales has been previously published, we examined in the current study the construct validity evidence of these scales using confirmatory factor analysis.

Data collection and sampling

The study was conducted on students at the colleges of medicine, dentistry, pharmacy, nursing, and health sciences (including physiotherapy, medical imaging, and laboratory medicine). We employed a convenience sampling method to gather data from undergraduate students. Participants were recruited during the period from 25 October 2023 to 14 November 2023. Students in graduate programs were excluded from the study sample. Self-administered questionnaires were distributed as online surveys via Google Forms during class, ensuring both anonymity and confidentiality to promote honest responses. Prior to distribution, informed written consent was obtained from participants, and the forms were made available to students across various HPE programs. The target population of the study was 850 HPE students and the average response rate was 75.20% (n = 638).

Validity and reliability of the study instruments

Table 1 shows the confirmatory factor analysis results which indicate robust psychometric properties for all three scales. The fitness indices of the three scales demonstrate strong model fit, as evaluated using confirmatory factor analysis. The Supportive Campus Environment Scale (8 items) showed a χ²/df ratio of 4.26, CFI of 0.99, RMSEA of 0.07 (90% CI: 0.06–0.09), SRMR of 0.02, and AIC of 88.00, indicating an acceptable fit. The Quality of Student Relationships Scale (4 items) exhibited excellent fit with a χ²/df ratio of 2.24, CFI of 0.99, RMSEA of 0.04 (90% CI: 0.03–0.06), SRMR of 0.004, and AIC of 28.00. Similarly, the Sense of Belonging Scale (5 items) achieved strong fit, with a χ²/df ratio of 1.91, CFI of 0.99, RMSEA of 0.04 (90% CI: 0.03–0.07), SRMR of 0.008, and AIC of 40.00. In addition, the data demonstrates excellent construct reliability of the supportive environment scale (0.94), student relationships scale (0.93), and sense of belonging scale (0.93).

Table 1.

Model fit for measurement models of the supportive campus Environment Scale, Quality of Student relationships Scale, and sense of belonging Scale in health professions education students (n = 638)

Study scales	χ 2	df	χ 2/ df	CFI	RMSEA (90% C.I.)	SRMR	AIC
Supportive Campus Environment Scale (8 items)	72.49	17	4.26	0.99	0.07 (0.06 − 0.09)	0.02	88.00
Quality of Student Relationships Scale (4 items)	2.24	1	2.24	0.99	0.04 (0.03 − 0.06)	0.004	28.00
Sense of Belonging Scale (5 items)	7.56	4	1.91	0.99	0.04 (0.03 − 0.07)	0.008	40.00

The relationships between the university campus environment, sociocultural engagement and the satisfaction of HPE students with university experience

In the current study, we conducted confirmatory factor analysis to test the construct validity of the study scales and path analysis to analyze the relationships between all the study variables simultaneously. Path analysis is a statistical model that focuses on examining direct and indirect relationships among study variables. This analysis is widely used to understand the mechanism through which independent variables (predictors) affect a dependent variable (outcome) by operating through intermediate variables (mediators). The output of this analysis includes standardized path coefficients and various fit indices for evaluating the model’s goodness of fit. Different indices were used to assess the goodness-of-fitness of the model. These indices included the Comparative Fit Index (CFI), Chi-Square (χ²) and χ²/df ratio, Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and the Akaike Information Criterion (AIC) [23, 24]. Missing data (representing less than 2% of the total dataset) were managed using listwise deletion. When the proportion of missing data is 5% or less, listwise deletion is considered a justifiable method for handling incomplete data [25]. Quantitative data are entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 28.0. Analysis of Moment Structures (AMOS) program version 21 is used for studies involving confirmatory factor analysis, structural equation modeling and path analysis. A P-value < 0.05 was considered statistically significant.

Results

Demographic variables

The gender distribution of the study sample comprised 72.6% female and 27.4% male participants. Most of the cohort identified as Asian (47.6%), followed by students from the Middle East (40.5%). African participants constituted 8.4% of the sample, while 3.5% were from Western backgrounds. In terms of academic programs, the largest group of participants were undergraduate medical students (62.7%), followed by students enrolled in dentistry (19.4%), nursing (7.7%), pharmacy (5.0%), and health sciences (5.2%). Female students demonstrated significantly higher scores than their male counterparts in the quality of relationships, t(678) = 2.23, p = .036, while no significant gender differences were observed in other variables. A one-way ANOVA revealed no significant differences among students from different academic programs or nationalities concerning any study variables, including sociocultural engagement (interactions and adaptation), quality of relationships, supportive campus environment, or sense of belonging.

Relationships between the study variables

Figure 2 illustrates the relationships between the study variables. The model demonstrated excellent fitness between the structural and measurement models (χ2 = 4.21, df = 2 (P = .122), χ2/df = 2.51, CFI = 1.00, RMSEA = 0.05, SRMR = 0.01, and AIC = 54.00).

Fig. 2.

Path analysis of the supportive campus environment, quality of student relationships, sociocultural engagement (sociocultural interactions and sociocultural adaptation), sense of belonging, and satisfaction with university experience of health professions education students (n = 638). Numbers on the arrows represent the estimates of standardized regression weights between the study variables. The error terms (e) inside the small circles reflect the unexplained variance and measurement errors. The interactions were statistically significant at P < .01

Direct effects

The results of the path model (Fig. 2; Table 2) demonstrated significant positive direct effects of Supportive Campus Environment on the two dimensions of sociocultural engagement. The campus environment had direct significant effects on sociocultural interactions and sociocultural adaptation (β = 0.18 and 0.24, P < .001, respectively). Similarly, the quality of student relationships had direct significant effects on sociocultural interactions and sociocultural adaptation (β = 0.29 and 0.26, P < .001, respectively). In addition, there were significant positive direct effects of supportive campus environment and quality of student relationships on students’ sense of belonging (β = 0.35 and 0.41, P < .001, respectively). Furthermore, there was a direct significant effect of the students’ sense of belonging on their satisfaction with the university experience (β = 0.50, P < .001). However, the students’ sense of belonging did not directly affect the sociocultural engagement of students (β = 0.08, P = .07). Similarly, the social engagement of students did not directly affect student satisfaction with the program experience (β = 0.003, P = .91).

Table 2.

Direct, indirect, and total effects of supportive campus environment and quality of student relationships on sociocultural engagement, sense of belonging and students’ satisfaction with university experience of health professions education students (n = 638)

Effect	Direct			Indirect			Total
	β	SE		β	SE		β	SE
Supportive campus environment on:
Sociocultural interactions	0.18*	0.05		0.03	0.02		0.21*	0.05
Sociocultural adaptation	0.24*	0.05		0.03	0.02		0.27*	0.05
Sense of belonging	0.41*	0.04		0.00	0.00		0.41*	0.04
Student satisfaction with university experience	0.00	0.00		0.21*	0.03		0.21*	0.04
Quality of relationships on:
Sociocultural interactions	0.29*	0.05		0.03	0.02		0.32*	0.05
Sociocultural adaptation	0.26*	0.05		0.03	0.02		0.29*	0.04
Sense of belonging	0.35*	0.04		0.00	0.00		0.35*	0.04
Student satisfaction with university experience	0.00	0.00		0.18*	0.03		0.18*	0.03

Indirect effects are mediated through the sense of belonging. * P < .01

Indirect effects

As shown in Table 2, the path analysis results indicated indirect effects between the study variables. Both supportive campus environment and quality of student relationships had significant indirect effects on student satisfaction with university experience (β = 0.21 and β = 0.18, P < .01, respectively). The study results also demonstrated that the sense of belonging mediated the relationships between supportive campus environment, quality of student relationships, and student satisfaction with university experience (β = 0.33, β = 0.26, P < .01, respectively). However, the mediating role of the sense of belonging between the supportive campus environment, quality of student relationships and sociocultural engagement of students was not statistically significant (β = 0.03, β = 0.02, P = .08, respectively).

Discussion

We have demonstrated that a supportive campus environment provided by the university and the quality of relationships among students exert a direct positive influence on students’ sense of belonging and sociocultural engagement. Concurrently, the students’ sense of belonging emerged as a direct determinant of their overall satisfaction with the university experience. Furthermore, the study findings indicated that the sense of belonging played a significant mediating role in the associations between supportive campus environment, quality of student relationships, and overall satisfaction with the university experience.

Wenger’s theory of the Community of Practice (CoP) suggests that students engaged in sociocultural activities develop a sense of community and learn through action and experience. This process shapes their identities within social communities and is facilitated by negotiation and interpretation during diverse contextual interactions [5]. The current study substantiates this theory by demonstrating that students who perceived the university environment as more supportive exhibited enhanced sociocultural engagement. The study also supports the previous student engagement frameworks which postulate that the institutional environment plays an important role in the sociocultural engagement of students [7–9]. To enhance the sociocultural engagement of students, the university should provide students with opportunities to develop their social life and to practice social integration as they learn and grow [10]. A supportive campus environment facilitates diversity in student connections, promotes social involvement and well-being, and provides assistance with non-academic activities. In a university setting, students’ sociocultural engagement takes place within the broader social environment, including social spaces, clubs and societies, the student union, and student housing [14]. The supportive campus environment activities such as school events with student input influence student engagement by enhancing student identity and creating a sense of belongingness to a school community [26].

The finding that the quality of student relationships with peers, faculty, and staff enhanced the engagement of HPE students is supported by previous research [27–29]. Positive interpersonal relationships between students as well as between students and faculty members appear to exert a positive influence on the overall engagement of students in learning communities [27]. In addition, positive peer and faculty relationships enhanced other dimensions of student engagement such as behavioral engagement [28] and agentic engagement [29]. Facilitating interpersonal interactions among medical students fosters social companionship, mitigates their stress levels, and reduces burnout [30]. This conducive atmosphere enhances student engagement by improving the psychological safety of students and enables them to participate in activities without the apprehension of critique or evaluation from either their peers or faculty [31].

This study confirms that a supportive university environment enhances the sense of belonging among HPE students. It does so by promoting interpersonal interactions among students from diverse backgrounds and encouraging social involvement through campus activities and events. Consequently, the findings support the view that a sense of belonging is relational, shaped by the quality of student relationships with both peers and faculty [32]. This sense of belonging emerges as students develop their identities and establish connections with the university community [26, 33]. A previous study on first year business management students identified the sense of belonging as an important mediator between university interventions and their academic engagement in learning [34]. Additionally, research conducted across four universities in the Netherlands demonstrated that a supportive learning environment promotes positive interactions with both teachers and peers [35]. Alternatively, the positive student relationships could be attributed to an improved sense of belonging to the university community [16]. These studies demonstrate the critical role of fostering a supportive and inclusive university environment in enhancing students’ sense of belonging, which, in turn, contributes to their academic engagement and social integration.

The current study fails to substantiate a direct or indirect influence of the sense of belonging on sociocultural engagement of students. These findings may seemingly contradict previously published models of engagement that underscore the significance of students’ sense of belonging in fostering student engagement [6–8, 36]. However, other studies have demonstrated that the sense of belonging is associated with emotional engagement [37] and behavioral engagement of university students [36, 37]. Consequently, it is plausible that the observed disparities between the present study and prior research could be attributed to variations in the mediating role of the sense of belonging across different dimensions of student engagement. Further studies will be required to examine the role of sense of belonging on the cognitive and agentic dimensions of student engagement.

This study demonstrates that a student’s sense of belonging directly influences and mediates their satisfaction with the university experience. Previous research has shown that a sense of belonging is inversely correlated with burnout and positively associated with academic achievement among medical students [17]. Moreover, the relationship between student satisfaction and university retention has been empirically established [14]. On the other hand, students considering leaving the university tend to report lower satisfaction levels and reduced engagement with peers and the institution [14]. Conversely, greater satisfaction with the university experience is linked to a stronger sense of belonging [38]. Unexpectedly, we found that sociocultural engagement does not significantly impact student satisfaction, contrasting with earlier research. A previous study suggests that sociocultural adaptation, including factors such as religious freedom, cultural acceptance, and supportive environments, positively influences student satisfaction [39]. The differing findings may reflect variations in the study contexts, cultural factors, and the characteristics of the student populations studied.

Despite the rigorous design of this study, several limitations should be noted. First, the cross-sectional, survey-based approach prevents us from establishing cause-and-effect relationships between the study variables. Additionally, the use of convenience sampling within a single institution limits the generalizability of the findings and may introduce sampling biases. Specifically, the university’s geographic location may have influenced the sample, with a predominance of students from Asia and the Middle East and an overrepresentation of female participants. Another limitation is the potential bias in student responses, as the use of self-reported questionnaires measures perceptions rather than actual engagement, sense of belonging, or university support. To address these limitations, future research should consider longitudinal or experimental designs to validate and expand on these findings. Additionally, expanding the study to multiple institutions and more diverse populations would enhance the representativeness and robustness of the conclusions.

Conclusions

This study demonstrated that the perceived quality of a university supportive environment and student relationships directly increased students’ sociocultural engagement and sense of belonging. Moreover, the sense of belonging not only directly influences students’ satisfaction with their university experience but also serves as an indirect mediator in the relationship between university support and student satisfaction. However, the sense of belonging does not appear to mediate the relationships between the university environment and sociocultural engagement of students. The findings of this study carry implications for shaping institutional strategies aimed at enhancing the sociocultural engagement of health professions education students and, consequently, elevating their satisfaction with the overall quality of the university experience.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

SEK initiated the idea of the research article. RR collected, entered, and coded all the data related to the study. Both HH and HGS helped in developing the first draft of the manuscript. HGS conducted the confirmatory factor analysis. All authors contributed to the revision, editing, and finalizing the manuscript.

Funding

No funding.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The research protocol was approved by the Research Ethics Committee (REC) at Gulf Medical University (# IRB-COM-FAC-16-SEPT-2023). In accordance with the Declaration of Helsinki, each student signed a written informed consent and a detailed information sheet explaining the purpose of the research, potential benefits and ensuring that participation is voluntary and the right to refuse participation or to withdraw without any reasons and without any negative consequences. Confidentiality was ensured by keeping the questionnaire anonymous and avoiding mentioning any identifying features of the participants. Finally, one of the author’s contact pieces of information was available for the participants to provide any needed clarification.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.