Development and psychometric assessment of the healthcare provider cultural competence instrument

Development and Psychometric Testing of the Cultural Bias Scale for Health Professionals: A Methodological Study

INTRODUCTION

Cultural bias can negatively affect processes such as making the correct diagnosis, creating appropriate treatment plans, and ensuring patient satisfaction when providing health care services to individuals. This study aims to develop and conduct the psychometric evaluation of a reliable tool to measure the bias levels of health care professionals.

METHOD

The scale was developed with a pilot study conducted on 50 nurses in Erzurum, Turkey. The scale initially consisted of 53 items, and data collection was performed on 720 participants.

RESULTS

The scale Kaiser-Meyer-Olkin (KMO) value was found to be 0.861. The anti-image value for items was ≥0.5. Bartlett's sphericity tests indicated suitability for factor analysis (χ2 = 2,850.732, df = 210, p < .01). The variance explained by each subscale of the scale was 18.582%, 16.342%, and 14.507%, respectively.

DISCUSSION

Because health care professionals should take a holistic approach to patient care, the scale might be a useful a important instrument for evaluating the cultural biases of health care professionals.

Comparison of Cultural Competence Between Dental House Officers and General Dentists: A Cross-Sectional Study

Background

All patients deserve quality care, regardless of their cultural, ethnic, or linguistic backgrounds. In Pakistan's diverse society, cultural competence in dentistry is crucial for patient-centered care. This study assesses and compares cultural competence levels between dental house officers (DHOs) and general dentists (GDs).

Methods

A cross-sectional, self-reported study was conducted at Altamash Institute of Dental Medicine, Karachi, over 6 months. A validated questionnaire (α = 0.856) on a 4 to 5-point scale assessed five attributes via Google forms. Data were analyzed using SPSS 23. Independent Sample t-test was used to compare DHOs and GDs, while ANOVA evaluated differences in GDs' qualification and practice settings.

Results

A total of 316 participants (response rate: 79%) were included. The mean age was 24.77 ± 2.02 years for DHOs and 31.32 ± 7.49 years for GDs. Females were predominant, and 27% of GDs worked in private practice. Both groups were somewhat culturally competent, with DHOs showing significantly higher self-perception (2.09 ± 0.61 vs. 1.92 ± 0.26, p = 0.001). However, GDs scored slightly higher in patient-centered communication, practice orientation, and cultural competence behaviors. GDs in private practice were more culturally competent than those working only in OPDs (-0.274*, F: 3.542, p = 0.001).

Conclusion

Overall, participants perceived themselves as somewhat culturally competent. DHOs demonstrated greater self-awareness and sensitivity than GDs. GDs in training and private practice exhibited higher cultural competence than those in OPDs alone.

Design and validation of a questionnaire to measure the attitudes of health professionals towards immigrants (AHPI)

Objective

The aim of the article is to describe the validation process of a research tool used to measure the intensity and direction of medical personnel's attitudes towards immigrant patients.

Design

An instrument validation design with a cross-sectional survey was conducted. The validation process was carried out in two phases. In phase 1, the content validity of the tool was analyzed. The competent judges method was used. The reliability of the judges was verified in terms of the consistency of evaluations (the I-CVI index was calculated). In phase 2, the questionnaire was tested among 340 healthcare professionals who have professional contact with immigrants, in terms of its factorial validity (exploratory and confirmatory factor analysis), internal consistency (reliability measured by Cronbach's alpha coefficient) and absolute stability (measured by the test-retest method).

Results

The research results indicate satisfactory content validity of the tool (I-CVI>0.8). The reliability of the tool measured by Cronbach's alpha coefficient was high (0.86). The reliability study based on the test - retest method (after 3 weeks) showed high consistency of measurements (0.75). Exploratory factor analysis allowed extracting 1 factor, which explains 55.7% of the variance. The validity of the one-factor solution was confirmed by confirmatory factor analysis. Satisfactory goodness of fit indices were obtained (RMSEA = 0.038; PCLOSE = 0.624; AGFI = 0.966; GFI = 0.990; CFI = 0.996).

Conclusion

The presented tool has satisfactory psychometric properties. The AHPI is a tool that can be used for quick assessment of the intensity and direction of attitudes of medical students and healthcare professionals towards immigrant patients, which can help shape educational and training processes.

Development and Psychometric Evaluation of the Clinical Nursing Cultural Competence Scale

Background and Purpose: Cultural competence in clinical nurses can lead to comprehensive care for patients from different cultures. Currently, an appropriate instrument to assess cultural competence in clinical nurses is limited. This study aimed to design and determine the psychometric properties of the clinical nursing cultural competence scale (CNCCS). Methods: This methodological study was conducted in 2018-2019 in two phases. In the first phase, a literature review and semistructured interviews with 18 clinical nurses from Isfahan and Ahvaz were conducted, and the results were used for item generation. In the second phase, the face, content, construct validity, and reliability of the questionnaire were assessed. For construct validity assessment through exploratory factor analysis (EFA), 200 clinical nurses were purposefully recruited to fill out CNCCS. Results: In the first phase, 140 items were produced. In the second phase, the item number was reduced to 40 after the face and content validity assessment. In EFA for construct validity assessment, 13 more items were deleted, and the remaining 27 items were loaded on six factors. The Cronbach's alpha and the test-retest intraclass correlation coefficient were CNCCS 0.86 and 0.93, respectively. Conclusions: The CNCCS had acceptable psychometric characteristics in Iranian nurses and can be used for assessing cultural competence among clinical nurses. The use of this scale can help nursing policymakers and managers develop their understanding of nursing cultural competence and develop strategies for its improvement.

A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education

Objective. To identify and describe validated assessment tools that measure cultural competence and are relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the United States, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The systematic literature and manual search identified 27 tools. Twelve assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no one tool that can effectively assess all aspects of cultural competence in pharmacy students or the Doctor of Pharmacy curriculum. As cultural competence is a priority within the accreditation standards for pharmacy education, PharmD programs are encouraged to develop additional tools that measure observed performance.

Educational Needs of European Intensive Care Nurses with Respect to Multicultural Care: A Mix-Method Study

The aim of the study is the analysis of educational needs of European intensive care nurses (ICNs) with regard to multicultural care. A mixed-method multinational study was performed among 591 ICNs coming from 15 European countries. An online survey was utilised with three research tools: participants’ sociodemographic details, Healthcare Provider Cultural Competence Instrument, and a tool to assess the educational needs of ICU nurses with respect to multicultural care. The highest mean values in self-assessment of preparation of ICU nurses to provide multicultural nursing care and their educational needs in this regard were detected in the case of nurses coming from Southern Europe (M = 4.09; SD = 0.43). With higher age, nurses recorded higher educational needs in the scope of multicultural care (r = 0.138; p = 0.001). In addition, speaking other languages significantly correlated with higher educational needs related to care of patients coming from different cultures (Z = −4.346; p < 0.001) as well as previous education on multicultural nursing care (Z = −2.530; p = 0.011). Experiences of difficult situations when caring for culturally diverse patients in ICU were classified into categories: ‘treatment procedures and general nursing care’, ‘family visiting’, ‘gender issues’, ‘communication challenges’, and ‘consequences of difficult experiences’. The educational needs of intensive care nurses in caring for culturally diverse patients are closely related to experiencing difficult situations when working with such patients and their families.

Cultural Competence and Cultural Intelligence of Healthcare Professionals Providing Emergency Medical Services

Background: There are more and more foreigners in Poland who become clients of the Polish healthcare system. They use, among others, emergency medical services provided by healthcare professionals: doctors, nurses, and paramedics. Skillful care for culturally different patients requires cultural competencies and cultural intelligence to ensure good quality of care and cultural safety. The study aimed to measure and assess the cultural competencies and cultural intelligence of medical professionals working in hospital emergency departments (HEDs) and hospital emergency rooms (HERs) in Małopolska, a region in southern Poland. Methods: The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI), the Cultural Intelligence Scale (CQS), and Questionnaire on Attitudes Towards Culturally Divergent People. In total, 709 medical professionals participated in the study, including 363 nurses, 223 paramedics, and 123 doctors. Results: Cultural intelligence—the overall score and the scores on the metacognitive, cognitive, motivational, and behavioral subscales were significantly higher among HED and HER doctors. Cultural competencies—the overall score and the score on the cultural adaptation subscale were also significantly higher among HED and HER doctors. The CCCI and CQS scores were influenced by selected variables: taking care of and close interactions with representatives of other cultural circles; staying outside Poland for more than a month. Doctors were the group of medical professionals that were most tolerant and most positive towards people from other cultures. Conclusions: The research results confirm the positive impact of contact of medical professionals with people from other cultures on their cultural competencies and cultural intelligence. They indicate the need for training in acquiring cultural competencies and developing cultural intelligence, especially among nurses. They demonstrate the need to raise awareness among HED and HER medical professionals about issues in intercultural care and to increase diversity efforts, especially among nurses.

Evaluating the Effectiveness of Cultural Education Training: Cultural Competence and Cultural Intelligence Development among Nursing Students

BACKGROUND

Since 2012, education standards in medical faculties in Poland have allowed medical universities to introduce content related to multiculturalism. On the one hand, this creates a necessity to introduce new strategies, forms, and techniques of education aimed at the development of knowledge, skills, and attitudes in terms of multiculturalism. On the other hand, there is a need to evaluate their effects. The main goal of this study was to evaluate the cultural competence and cultural intelligence of master's degree nursing students before the commencement of and two months after cultural education training in the form of the intercultural communication workshops included in the study program.

METHODS

The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI) and the Cultural Intelligence Scale (CQS). Two consecutive classes (2019 and 2020) of master's nursing students were tested twice (pre-test, post-test). The study was conducted at a leading medical university that educates nurses at a master's level in Poland. In total, 130 master's nursing students took part in this evaluative study: 64 individuals in 2019 (study 1) and 66 individuals in 2020 (study 2).

RESULTS

In comparison to the pre-test, the post-test showed that the surveyed students in both study 1 and study 2 obtained significantly higher overall results in terms of cultural intelligence (p = 0.001; p = 0.004, respectively) as well as in the behavioral (p = 0.001; p = 0.002) and cognitive (p = 0.001; p = 0.008, respectively) subscales. The cultural competence results were also higher overall, but the difference was insignificant.

CONCLUSIONS

The study shows the efficiency of training/workshops in the development of culturally specific knowledge and cultural intervention skills. At the same time, it postulates the need to plan and organize cultural education programs in a form that aims to improve the development of culturally sensitive attitudes.

Cultural competence of Australian dental students

BACKGROUND

Australia possesses a highly multicultural demographic, and thus dental practitioners are likely to regularly encounter culturally and linguistically diverse individuals. It is important for dental practitioners to be culturally competent, however, cultural competency education is highly variable in the curricula of dentistry and oral health courses in Australia, and research is largely limited to dentistry students. This study aims to investigate and compare perceived attitudes, beliefs and practices of cultural competence amongst first and final year Doctor of Dental Surgery (DDS) and Bachelor of Oral Health (BOH) students at the University of Melbourne Dental School.

METHODS

Following ethics approval, anonymous questionnaires were completed by 213 participants. The questionnaire was adapted from Schwarz's Healthcare Provider Cultural Competence Instrument and consisted of five scales. Data was analysed using SPSS V 24.0 software.

RESULTS

A total of 213 students participated in this study (response rate = 88%) The majority of participants were female (n = 114, 53.5%) and the mean age of 23.5 years (range 18-40). The majority of participants were Australian born (n = 110) with 74.6% (n = 159) first generation Australians. Participants who identified as Australian represented 35.7% (n = 76) with 66.1% (n = 141) identified as partly Australian. Multivariate analysis indicated that, after controlling for other independent variables in the model, those who had the highest cultural competence score were female, who self-identify as "Australian", who were in the final year. Furthermore, those who were in the final BOH year scored significatively higher than final year DDS students.

CONCLUSION

The findings of this study suggest that there is a significant difference in students self-reported cultural competence at different stages of their education. This may be attributed to differences in cultural competence education, scope of practice and the type of patient encounters and role modelling that students may experience. Future research should involve follow up to create longitudinal data, as well as research at other dental schools in Australia and overseas.

Nurse Cultural Competence-cultural adaptation and validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results

Introduction

Measuring nurses’ cultural competence is an important aspect in monitoring the acceptable quality in multicultural populations, and is a means for efficient modification of the educational process of nurses based on this assessment.

Purpose

The goal of this article is to offer a preliminary assessment of the cultural competence of nurses based on a Polish-language and -culture version of the Nurse Cultural Competence Scale (NCCS).

Research method

An adaptive and diagnostic cross-disciplinary concept was used in the research. Two hundred thirty-eight professionally active nurses in the southeast region of Poland took part in this study. The NCCS-Polish version (NCCS-P) questionnaire was used after linguistic adaptation and analysis of psychometric properties.

Results

Moderate levels of competence in the Cultural Knowledge Subscale (M = 3.42) were found in the group of nurses studied. The results indicate lowest competency levels in the Cultural Skill Subscale (M = 3.14). The highest values were obtained for the Cultural Awareness Subscale (M = 3.98) and the Cultural Sensitivity Subscale (M = 3.72). The Cronbach's alpha reliability coefficient for the NCCS-P scale was 0.94, with the subscale values ranging from 0.72 to 0.95. Factor validity analysis of the Polish adaptation of the NCCS-P scale pointed to its four-factor structure. The Kaiser-Mayer-Olkin sampling adequacy test was 0.905, and the Bartlett test of sphericity result was χ2 = 5755.107; df = 820; p<0.001. The four-factor structure is affirmed by the Kaiser criterion and the scree test result.

Conclusions

The NCCS-P psychometric properties were highly reliable and significant because of the opportunity for using them for research in Poland.

Practical implications

The scale can be used in intercultural research for comparing cultural competence of nurses, including Polish ones. This scale facilitates the precise monitoring of cultural competence among nurses and nurse managers, which may help in developing nursing policies geared toward a commitment to expanding cultural competence.

Targeting of Enrollment Assistance Resources in Health Insurance Television Advertising: A Comparison of Spanish- Vs. English-Language Ads

Latinx adults, especially immigrants, face higher uninsurance and lower awareness of the Affordable Care Act's (ACA) provisions and resources compared to other racial/ethnic groups. Television advertising of ACA health plans has directed many consumers to application assistance and enrollment, but little is known about how ads targeted Latinx consumers. We used Kantar Media/CMAG data from the Wesleyan Media Project to assess Spanish- vs. English-language ad targeting strategies and to assess which enrollment assistance resources (in person/telephone vs. online) were emphasized across three Open Enrollment Periods (OEP) (2013-14, 2014-15, 2015-16). We examined differences in advertisement sponsorship and volume of Spanish- versus English-language ads across the three OEPs. State-based Marketplaces sponsored 47% of Spanish-language airings; insurance companies sponsored 55% of English-language airings. The proportion of Spanish-language airings increased over time (8.8% in OEP1, 11.1% in OEP2, 12.0% in OEP3, p <.001). Spanish-language airings had 49% lower (95%CI: 0.50,0.53) and 2.20 times higher odds (95%CI: 2.17,2.24) of mentioning online and telephone/in-person enrollment assistance resources, respectively. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings, these mentions increased significantly in Spanish-language airings. Future research should examine the impact of the drastic federal cuts to ACA outreach and marketing.

Supportive Clinical Practice Environments Associated With Patient-Centered Care

A lack of organizational supports in clinical settings may prevent nurse practitioners from providing patient centered care. Using a cross sectional survey design, data were collected from NPs in 1,571 practices across four states to investigate clinical practice environments and the extent to which they are associated with NP integration of patient preferences. Three-quarters of NPs reported frequent integration of patient preferences into clinical care. Overall, 371 practices (23.6%) were classified as good practice environments; the remaining 76.3% were mixed or poor environments. NPs in good environments were significantly more likely to integrate patient preferences (O.R. = 2.3, p <.001).

Structural Stress and Otherness: How Do They Influence Psychological Stress?

Background: This study represents the initial steps in researching the cultural distress model and explores the cumulative layering of stressors that place the patient at risk for cultural distress, including structural stress and otherness. Method: A cross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) on psychological stress. Participants were also asked to define the word culture. Results: Results indicated that structural stressors did not significantly influence on psychological stress but were associated with perception of discrimination. The experience of otherness significantly influenced psychological stress. Discussion: Given the association between structural stress and perceived discrimination, additional research and tool development is needed to better understand how structural stressors influence psychological stress. Participant definitions of culture fell into two primary themes: Collectiveness and Individualness, indicating that the way we live is influenced by shared experiences, yet also a product of individual choices.

Factor Structure of the Cultural Competence Items in the National Home and Hospice Care Survey

BACKGROUND

There is a need for validated measures of cultural competency practices in home health and hospice care (HHHC).

OBJECTIVE

To establish the factor structure of the cultural competency items included in the agency-component of the 2007 public-use National Home and Hospice Care Survey file.

DATA SOURCE

We used weighted survey data from 1036 HHHC agencies.

RESEARCH DESIGN AND PARTICIPANTS

We used exploratory factor analyses to identify a preliminary factor structure, and then performed confirmatory factor analysis to provide further support for identified factor structure.

MEASURES

We examined 9 cultural competency items.

RESULTS

Exploratory factor analyses suggested an interpretable 2-factor solution: (1) the provision of mandatory cultural competency training; and (2) the provision of cultural competency communication practices. Each factor consisted of 3 items. The remaining 3 items did not load well on these factors. A similar, but more restrictive, confirmatory factor analysis model without cross-loadings supported the 2-factor model: (Equation is included in full-text article.)=9.50, P=0.30, root mean square error of approximation (RMSEA)=0.01, comparative fit index (CFI)=0.99, Tucker-Lewis Index (TLI)=0.99.

CONCLUSIONS

Two constructs with 3 items each appeared to be internally valid measures of cultural competency in this nationally representative survey of HHHC agencies: cultural competency training and cultural competency communication practices. These measures could be used by HHHC managers in quality improvement efforts and by policy makers in monitoring cultural competency practices.

Cultural competence skills in a dental curriculum: A review

This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne.

METHODS

The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses.

RESULTS

Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours).

CONCLUSION

The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.

Contextualizing Competence: Language and LGBT-Based Competency in Health Care

Changes in the language and terminology used to refer to individuals identifying as lesbian, gay, bisexual, and transgender (LGBT), as well as how best to discuss issues of sexual and gender identity, can prove challenging for health care providers due to (1) lack of training; (2) interdisciplinary issues; and (3) prejudices on personal and institutional levels. Given the importance of language in the relationship between health care provider and patient as well as the myriad ways in which language can reflect knowledge, skills, and attitudes, we contend that language is both a facilitator and inhibitor of competence. In this article, we discuss language as a means of exhibiting cultural competence as well as the barriers to facilitating this degree of competence. Communicative competence, a concept traditionally used in linguistics, is discussed as a framework for contextualizing LGBT-specific cultural competence in health care. Ideally, a professional will be considered competent once they (1) acquire a foundation in issues associated with LGBT individuals, as well as a basic understanding of appropriate vocabulary' (2) reconcile personal beliefs with their professional role; (3) create an inclusive healthcare environment such that the influence of personal biases does not negatively impact care; and (4) use identifiers suggested by the patient.