Teaching African traditional health knowledge and practices in undergraduate nursing education: a national survey of South African nurse educators

Abstract Background African traditional health knowledge and practices (ATHKPs) remain widely used alongside biomedical services in South Africa. Nurses routinely care for patients whose health beliefs and practices are informed by Indigenous knowledge systems, however, concerns persist regarding the limited preparation of nurses to engage with ATHKPs in a culturally responsive, ethical, and safe manner. Although policy and educational discourse increasingly call for curriculum transformation, there is limited national-level evidence on the extent to which ATHKPs are incorporated into undergraduate nursing education. Methods A quantitative, cross-sectional descriptive survey was conducted among nurse educators employed at accredited public nursing education institutions (NEIs) in South Africa. The study represents Phase 2 of an exploratory sequential mixed-methods design, with Phase 1 informing questionnaire development. Public NEIs were stratified by institutional type (universities, universities of technology, and public nursing colleges), and data were collected from 408 nurse educators from these institutions. The survey assessed curriculum structure, content related to ATHKPs, teaching and assessment approaches, and educators’ perceptions of the importance of ATHKP teaching. Data were analysed using descriptive statistics. Results Most respondents reported that ATHKPs are minimally and inconsistently integrated into undergraduate nursing curricula. More than half indicated that ATHKPs are not taught at any level of the programme, and few reported the presence of dedicated curriculum components. Content relating to foundational ATHKP concepts, values and belief systems, regulation of traditional health practitioners, and professional roles was largely absent. Teaching approaches were predominantly theoretical, with limited use of experiential learning approaches, and formal assessment of ATHKP content was uncommon. Despite this limited curricular inclusion, most nurse educators perceived ATHKP teaching as important and identified the need for educator development, clearer regulatory guidance, and structured curriculum support. Conclusion The study demonstrates a substantial gap between nurse educators’ recognition of the importance of ATHKPs and their meaningful integration into undergraduate nursing education in South Africa. Strengthening curriculum content, pedagogical approaches, educator preparedness, and assessment practices related to ATHKPs may enhance culturally responsive nursing education and better prepare graduates to provide care within pluralistic healthcare systems.