The efficacy of compassion and self-compassion training programs for healthcare university students: a systematic review and meta-analysis

Abstract

Background: University healthcare students are exposed to significant levels of stress. The training is highly complex as it requires academic excellence, the development of clinical competencies and strong interpersonal skills. Compassion and self-compassion are considered protective factors against stress in the healthcare context. Objective: The aim of this study was to analyse the effectiveness of programs aimed at cultivating compassion on the variables of self-compassion and compassion in university healthcare students. Methods: The PubMed, CINAHL, WOS and PsycINFO databases were searched for studies with interventions based on the cultivation of compassion or self-compassion in university healthcare students. A meta-analysis was conducted using a random-effects model for the variable of self-compassion and compassion, calculating the effect size and heterogeneity of the studies. For the self-compassion variable, subgroup analyses were performed for participant characteristics, type of control group, and duration of intervention. Results: For the self-compassion variable, a total of 23 articles were included (N = 1552), of which 11 were used for the meta-analysis. With regard to the qualitative synthesis, most of the studies showed a significant increase in selfcompassion, as well as improvements in other dimensions of the instrument used. Six studies measured compassion, two of which identified a significant increase in this variable post-intervention. The meta-analysis revealed a moderate and significant overall effect of self-compassion interventions (d = 0.52; 95% CI [0.27, 0.78]; p < 0.001), with higher post-intervention scores in experimental groups. Despite moderate heterogeneity (I2 = 60.29%) and some evidence of publication bias (Egger´s test p = 0.0273), the findings remained robust across sensitivity analysis. Regarding the compassion variable, despite the limited evidence (n = 6), a meta-analysis (n = 5) was performed. A medium effect size was obtained with marginal statistical significance (d = 0.43, 95% CI [-0.09, 0.95]; p = 0.10). This indicated that, although the trend is positive and clinically relevant, the extremely high variability (I2 = 79%) prevents a statistically conclusive statement of efficacy. Conclusions: This is the first meta-analysis to investigate the effectiveness of interventions based on compassion/self-compassion in university healthcare students. Given that compassion and self-compassion are essential skills for future professionals, and considering the potential benefits of interventions, it is suggested that these programs be tested in undergraduate and postgraduate health education.