Multicultural Competency Instrumentation: A Review and Analysis of Reliability Generalization

Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students

BACKGROUND

The concept of collaborative practice within health professions is viewed as "best practice." Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities.

OBJECTIVES

This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve.

METHODS

Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results.

RESULTS

Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students.

CONCLUSIONS

This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.

Need for training or already OnTracc? Development and psychometric properties of an online transcultural competence questionnaire among psychotherapists

The prevalence of mental disorders among people with migration experiences is high. Studies have shown that despite the increasing number of patients from different cultures requiring therapy, treating them is still a major challenge. Furthermore, professional training aimed at improving transcultural competence is rare, and psychometric instruments assessing transcultural competence require improvement. Accordingly, this study aimed to develop and evaluate an online transcultural competence questionnaire (OnTracc) to assess transcultural competence among psychotherapists. Based on extensive literature research and expert interviews, 38-self-report statements referring to aspects of transcultural therapy (e.g., skills, knowledge, and awareness) were compiled. In two studies, 306 psychotherapists completed the OnTracc questionnaire. The multicultural counseling inventory (MCI), personality factors (BFI-K), experience in transcultural therapy, and demographic data were assessed as control variables. The exploratory factor analysis (EFA) revealed a 3-factor structure. The reliability of the scale ranged from ω = 0.73 to 0.81. These scales demonstrated substantial convergent and discriminant validity with the BFI-K and MCI subscales. Factorial validity was confirmed through confirmatory factor analysis. This validated inventory is the first to assess transcultural competence in therapeutic settings in the German language. Further analysis of the factorial validity of the different samples is recommended. Given the increasing diversity in the therapeutic landscape, additional development could help close the gap between the evolving treatment demands of culturally diverse patients and the lack of consideration in mental health and education.

Development and Psychometric Evaluation of an Instrument to Assess Cross-Cultural Competence of Healthcare Professionals (CCCHP)

Background

Cultural competence of healthcare professionals (HCPs) is recognized as a strategy to reduce cultural disparities in healthcare. However, standardised, valid and reliable instruments to assess HCPs’ cultural competence are notably lacking. The present study aims to 1) identify the core components of cultural competence from a healthcare perspective, 2) to develop a self-report instrument to assess cultural competence of HCPs and 3) to evaluate the psychometric properties of the new instrument.

Methods

The conceptual model and initial item pool, which were applied to the cross-cultural competence instrument for the healthcare profession (CCCHP), were derived from an expert survey (n = 23), interviews with HCPs (n = 12), and a broad narrative review on assessment instruments and conceptual models of cultural competence. The item pool was reduced systematically, which resulted in a 59-item instrument. A sample of 336 psychologists, in advanced psychotherapeutic training, and 409 medical students participated, in order to evaluate the construct validity and reliability of the CCCHP.

Results

Construct validity was supported by principal component analysis, which led to a 32-item six-component solution with 50% of the total variance explained. The different dimensions of HCPs’ cultural competence are: Cross-Cultural Motivation/Curiosity, Cross-Cultural Attitudes, Cross-Cultural Skills, Cross-Cultural Knowledge/Awareness and Cross-Cultural Emotions/Empathy. For the total instrument, the internal consistency reliability was .87 and the dimension’s Cronbach’s α ranged from .54 to .84. The discriminating power of the CCCHP was indicated by statistically significant mean differences in CCCHP subscale scores between predefined groups.

Conclusions

The 32-item CCCHP exhibits acceptable psychometric properties, particularly content and construct validity to examine HCPs’ cultural competence. The CCCHP with its five dimensions offers a comprehensive assessment of HCPs’ cultural competence, and has the ability to distinguish between groups that are expected to differ in cultural competence. This instrument can foster professional development through systematic self-assessment and thus contributes to improve the quality of patient care.

Factor analysis of a modified version of the California Brief Multicultural Competence Scale with minority pharmacy students

While most of the more frequently used self-report measures of cultural competence in health professionals are targeted to practicing physicians and mental health providers from the majority-white population, no measures have been specifically developed for minority pharmacy students. With the objective to find a suitable tool to be used for curriculum development in cultural competence, this study applied a modified version of the California Brief Multicultural Competence Scale (CBMCS) to 467 pharmacy students at the Xavier University of Louisiana, a Historically Black University. Confirmatory and exploratory factor analyses were conducted to examine if the CBMCS factor structure was replicated using a modified tool and a different population and Cronbach alphas were calculated to determine internal consistency reliability. The CBMCS's original factor structure was not replicated, perhaps because of modifications introduced in the original tool or because of differences between the sample population in this study (minority pharmacy students) and the population used in the original CBMCS study (majority-white mental health providers). However, results show that a modified factor structure fits the data well. The primary difference between the factors found in this study and the CBMCS factors is the appearance of a new factor composed of three items related to interpersonal and racial dynamics, which includes racial discrimination, white privilege, and power imbalance. The significant relationships (p < 0.001) found between respondents' race and these three items suggest that the wording in these items should be modified when the respondents do not belong to the majority population. Results imply that racism, prejudice and bias are not just issues of the majority-white health providers and point to the need for more racially diverse samples. The unique results in this study advance research on racial dynamics and self-assessment of cultural competence of minority health professionals.

Nine constructs of cultural competence for curriculum development

OBJECTIVE

To examine the self-administered Clinical Cultural Competency Questionnaire (CCCQ) and assess the perceived level of cultural competence of students in Xavier University of Louisiana College of Pharmacy to guide curriculum development within the 4-year academic program.

METHODS

The CCCQ was administrated to each class of pharmacy students during spring 2009. Exploratory factor analysis with principal components and varimax rotation was conducted to build the constructs explaining the factors measuring students' self-assessment of cultural competence.

RESULTS

Nine factors, including 46 items extracted from the CCCQ and explaining 79% of the total variance, were found as the best fit to measure students' self-assessment of cultural competence.

CONCLUSIONS

The CCCQ was found to be a practical, valid, and reliable self-assessment instrument to measure the perceived level of pharmacy students' knowledge, skills, attitudes, and encounters in cross-cultural environments. The questionnaire allowed the identification of students' needs for training in cultural competence and the development of a curriculum tailored to satisfy those needs.