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.

Career and Retirement Theories: Relevance for Older Workers Across Cultures

This paper reviews selected career development theories as well as theories specifically focused on retirement, with an emphasis on their application to retirement decisions and vocational behavior in multicultural populations. Theories are evaluated based on whether: (a) retirement was considered a stage of working life, (b) work satisfaction, motivation, and other work variables at retirement age were addressed, (c) work choices at retirement age were included, and (d) cultural and other minority status issues were either directly considered in the work/retirement decision or if the model could be reasonably applied to retirement across cultures. We provide specific recommendations for research and practice with the aim of helping practitioners and scholars conceptualize the current concerns older adults face in their working lives and during retirement planning.

Teaching Social Justice in Counseling Psychology

Recent years have witnessed increased calls from counseling psychology to include social justice competencies in the training of future practitioners. Integration of social justice awareness, advocacy skills, and opportunities for social change action are needed extensions of the field’s commitment to multicultural competency. Classroom teaching is a key component of transforming counseling psychology curricula and of developing students’ awareness of the value of social justice perspectives, yet pedagogical applications are rarely present in the literature. This article provides a case example of the integration of social justice and multicultural consciousness across the curriculum of one counseling psychology program. It highlights examples of innovative pedagogical techniques within a variety of core courses. We present specific examples of readings and nontraditional teaching approaches to promote social justice consciousness, including experiential exercises, self-reflection opportunities, use of video and online discussions, and assignments.

Broadening sources of Diginity and Affirmation in Work and Relationship

This article builds on assertions in Richardson's (2012, this issue) Major Contribution on counseling for work and relationship. In this reaction, I expand on the relevance and potential of the counseling for work and relationship perspective to enrich the field of counseling psychology. My comments focus on three considerations to further extend the cultural relevance of Richardson's work and relationship perspective: (1) broadening sources of dignity, (2) centering knowledge of marginalized communities, and (3) promoting psychologists' critical consciousness. Richardson's perspective holds great promise for being a guiding heuristic to inform counseling psychology research, theory, and practice.

Beyond Microskills

Heeding the call to the profession, the authors present both a definition and model of counseling competence. Undergirding the model are 15 foundational principles. The authors conceptualize counseling competence as more complex and nuanced than do traditional microskills models and include cognitive, affective, and behavioral components. The model consists of 4 superordinate competencies—determining therapeutic outcomes, facilitating therapeutic outcomes, evaluating therapeutic outcomes, and sustaining therapeutic outcomes—and 12 subordinate competencies: self-appraisal/self-evaluating, structuring the therapy, building a therapeutic alliance, applying a conceptual map of therapeutic change, using therapeutic techniques, self-correcting, surmounting obstacles, leveraging opportunities, managing special situations, working with other systems of care, consulting other sources, and terminating therapy. Integral to the model is the integrated deep structure, which consists of 5 metacognitions: purposefulness, motivation, selection, sequencing, and timing.

Avaliação do processo de aconselhamento vocacional: revisão da literatura

As questões acerca do processo de intervenção têm sido cada vez mais alvo de atenção e estudo na Psicologia. Este artigo apresenta uma revisão da literatura acerca da panorâmica atual do processo de aconselhamento vocacional. Deste modo, são abordados, uma descrição do processo de aconselhamento vocacional e das variáveis comuns ao aconselhamento psicológico pessoal e vocacional, seguindo-se uma breve caracterização das investigações sobre o processo da intervenção psicológica vocacional. Por último, apresenta-se um conjunto de sugestões para futuras pesquisas.

Relational Processes in Career Transition: Extending Theory, Research, and Practice

A growing body of work in relational theory and career decision making explores how relational processes, not just people’s relationships but more broadly their connections to self, others, and society, inform career development and counseling. This article presents the results of a qualitative research study of midlife women in career transition that contributes to building an empirical foundation for relational perspectives in career development. Feminist relational psychology, specifically relational cultural theory, frames the study, focusing attention on gender and culture in the context of relational influences. It extends the current research by focusing on career transition for midcareer, midlife women. Findings presented here illustrate the ways participants’ connections across a range of relationships enhanced and supported the process of career change and how their disconnections hindered, and sometimes halted, their movement through the transition. Implications for research and practice are offered.

The Vocational Significance of Black Identity: Cultural Formulation Approach to Career Assessment and Career Counseling

Scholarship is emerging on intervention models that purposefully attend to cultural variables throughout the career assessment and career counseling process (Swanson & Fouad, in press). One heuristic model that offers promise to advance culturally-relevant vocational practice with African Americans is the Outline for Cultural Formulation (American Psychiatric Association, 1994). This article explicates the Outline for Cultural Formulation in career assessment and career counseling with African Americans integrating the concept of cultural identity into the entire model. The article concludes with an illustration of the Outline for Cultural Formulation model with an African American career client.

Ethnic Identity and Career Development Among First-Year College Students

The current study explored the relation of ethnic identity achievement and career development progress among a sample of 2,432 first-year college students who completed the Career Decision Profile and Phinney's Multigroup Ethnic Identity Measure. Among students of color, correlational analyses revealed a series of statistically significant, but small positive correlations between higher levels of ethnic identity achievement and career decidedness, choice comfort, indecisiveness, and choice importance. Additionally, racial group was found to moderate the relation between ethnic identity achievement and career decidedness. For Black and Asian American students, those with higher levels of ethnic identity achievement were found to have significantly higher levels of career decidedness, whereas ethnic identity achievement had no significant relation with the decidedness of White and Latina/o students. It is suggested that for first-year students of color, ethnic identity achievement may play a meaningful, but limited role in being decided in one's career decisions. Research and practice implications are discussed.