Psychometric evaluation of the Swedish adaptation of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals--Revised (IAPCC-R)

Psychometric properties of the Persian version of the Cultural Competence Scale in Clinical Nurses

AIM

Cultural competence is a crucial component of nursing competency, and a valid and reliable scale is needed to measure it. This study was conducted to investigate the psychometric properties of the Persian version of the Cultural Competence Scale among Iranian clinical nurses.

DESIGN

A methodological design was used.

METHODS

The scale was translated into Persian, and its content, face and construct validity, and reliability were examined.

RESULTS

Two items with a content validity ratio of 0.6 were removed. In the case of the content validity index, one item with a content validity index lower than 0.70 was removed. The mean content validity index for the scale was reported as 0.99. All 31 items with an impact score index higher than 1.5 were approved. The exploratory factor analysis revealed four factors explaining 59.92% of the total variance. Cronbach's alpha and the intraclass correlation coefficient were calculated at 0.95 and 0.94, respectively.

Psychometric properties of instruments used to measure the cultural competence of nurses: A systematic review

BACKGROUND

Cultural competence is a key component of culturally congruent nursing care. In order to reduce healthcare inequalities and to identify potentials for improvement in nursing practice, researchers need to be able to assess cultural competence properly. Although many instruments for the assessment of cultural competence have been developed, their measurement properties have not yet been reviewed systematically. Such an overview of existing instruments, however, would allow researchers to identify the most valid and reliable instrument for nursing practice.

OBJECTIVE

The purpose of conducting this review is to identify and critically appraise the psychometric properties of instruments used to measure the cultural competence of nurses.

METHODS

A systematic literature search was performed in November 2019 in the following electronic databases: Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO and PubMed. Studies that were conducted to assess any measurement property of instruments used to measure the cultural competence of nurses were included. Two reviewers independently screened the articles and assessed the risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The quality of included instruments was assessed on the basis of the updated criteria for good measurement properties, and the quality of the summarised results was graded based on the principles of Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

In total, 44 studies describing 21 instruments were included in this study. We found that most instruments were tested for at least some forms of validity, but seldom for reliability. The quality of the psychometric properties was evaluated using the criteria for good measurement properties for the following: content validity, structural validity, internal consistency, reliability, measurement error and construct validity. No studies were found in which cross-cultural validity, criterion validity, or the responsiveness of the included instruments were evaluated. The Transcultural Self-Efficacy Tool, the Cultural Competence Assessment, and the Cultural Competence Health Practitioner Assessment showed sufficient levels of quality for psychometric properties and can be recommended for the assessment of cultural competence in nurses.

CONCLUSION

Given the broad availability of self-administered instruments to assess cultural competence, the development of new instrument is not recommended. A particular need was identified to conduct further psychometric evaluation studies on existing instruments and to adapt them accordingly, and especially on less frequently evaluated properties, such as reliability, measurement error and responsiveness.

The Spanish version of the Cultural Competence Assessment (CCA-S): Transcultural validation study and proposed refinement

BACKGROUND

Cultural competence (CC) is becoming an essential component of healthcare professionals. There is a gap in the research evaluating CC in order to develop competency-based approach programs. Spain has become a multicultural society and it is necessary to evaluate and promote CC attitudes to reduce the disparity of care for vulnerable and minority groups.

OBJECTIVES

To adapt and validate the Cultural Competence Assessment (CCA) of Schim et al. (2003), to get evidence-based data of CC in Spanish healthcare professionals.

METHOD

A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. An on-line cross-sectional survey questionnaire was used. Statistical and metrical analysis was based in a sample of 568 healthcare professionals who worked daily with patients in a health care institution in South Catalonia in 2018.

RESULTS

The results of the exploratory factorial analysis and subsequent confirmatory analysis showed that the data had an adequate fit for a four-factor model. The reliability analysis results confirm an acceptable consistency for each subscale: active behaviour (0.86), seeking information (0.86), awareness (0,94), and sensitivity (0.69). ANOVA showed no differences between healthcare professionals, age and gender. The scores showed a normal distribution and it was proposed a standardization of scores.

CONCLUSIONS

The translation and transcultural-validation process of the CCA resulted in a Spanish-language for the 25 items, like the original. The psychometric analysis proved that the Spanish version is a reliable and valid instrument. This scale is going to be useful to analyze healthcare professional's attitudes to create effectiveness training programs focused on specific needs. The four-factor model and the standardization of the scores will be useful to achieve future objectives about research in cultural competence in healthcare professionals.

Methodological Challenges in Developing a Youth Questionnaire, Life & Health Young People, for Comparative Studies in Thailand and Sweden: About Bridging the Language Gap Between Two Non-English-Speaking Countries

PURPOSE

To develop a Thai questionnaire ชีวิตและสุขภาพของวัยรุ่นในประเทศไทย (TYQ) to explore girls' and boys' living conditions, lifestyles, and self-reported health with special focus on sexuality, based on a Swedish questionnaire, Liv & Hälsa ung (SYQ). Challenges in developing a youth questionnaire for comparative studies are described.

DESIGN

A multistep translation, sociocultural adaptation procedure, and a mixed-method validation test were performed using English as a common language within the research group. Three versions of SYQ were used as a pool of questions to develop the questionnaire.

FINDINGS

From a field test, unclear questions were identified and minor adjustments made. Life & Health Young People in a Thai version was successfully developed. The English version was used to bridge the language gap.

CONCLUSION

This unique multistep methodology, including mixed-method validation procedure, can be used by researchers in countries where English is not the main language.

Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional Study

BACKGROUND

Cultural competency is now a core requirement for maternal health providers working in multicultural society. However, it has not yet received due attention in Ethiopia. This study aimed to determine the level of cultural competence and its associated factors among maternal health care providers in Bahir Dar City Administration, Northwest Ethiopia.

METHODS

Institution based cross-sectional study was carried out using both quantitative and qualitative methods. Maternal health care providers from all health facilities were our study participants. Structured Questionnaire with some modification of Campinha Bacote's tool was used to collect quantitative data from health workers and semi structured guide line was used for qualitative data among women. While quantitative data analysis was done using SPSS, qualitative data was analyzed using open code software. P-value of less than 0.05 was taken to determine statistical significance. Cronbach's alpha was used to test internal reliability and a factor loading of 0.3 or greater was the criterion used to retain items.

RESULT

Two hundred seventy four health workers and seven women were involved in the study. The overall competency level was 57.3 % thought vary in different subscales or stages. Of the cultural competent health workers near to three fourth (73.0 %) were in awareness stage which is the earliest stage of competence in which individuals were aware only their own culture but not the world view of their clients. The voices of mothers in the qualitative assessment also showed discordance in cultural competence with their healthcare providers. Female health workers almost six times [AOR,5.5; 2.71, 11.30] more competent than male providers and those who got in-service training related to maternal care provided services more culturally competent than their counter parts with [AOR,3.5; 1.4, 8.64]. Reliability Cronbach's α coefficient value of cultural competence subscales showed 0.672,0 .719, 0.658, 0.714, and 0.631 for cultural awareness, knowledge, skill, encounter and desire, respectively.

CONCLUSIONS

The overall competence level of health workers was low and the mean competence level falls in awareness stage in the continuum of culturally incompetent, culturally aware, culturally competent, and culturally proficient indicated that the providers were aware of only their own culture but not the world view of their clients. The voices of mothers also showed that they were dissatisfied for the services they got and the interactions they had with health care providers. Hence, we recommend on job training of health workers and incorporation of cultural components in the curriculum of health workers as it would be the key to provide culturally acceptable services.

Obtaining Validity Evidence by Cognitive Interviewing to Interpret Psychometric Results

The latest edition of the Standards for Educational and Psychological Testing ( APA, 1999 ) promotes the analysis of respondents’ response processes in order to obtain evidence about the fit between the intended construct and the response process produced. The aim of this paper was twofold. First, we assess whether cognitive interviewing can be used to gather such validity evidence, and secondly, to analyze the usefulness of the evidence provided for interpreting the results from traditional psychometric analysis. The usefulness of the Cognitive Interviewing Reporting Framework ( Boeije & Willis, 2013 ) for reporting the cognitive interviewing findings was also evaluated. As an empirical example, we tested the (Spanish language) APGAR family function scale. A total of 21 pretest cognitive interviews were conducted, and psychometric analyzes were conducted of data from 28,371 respondents who were administered the APGAR scale. Results and utility of CIRF as a reporting framework are discussed.

Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions

Background

To develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it’s important to map out and assess caregivers’ awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short).

Method

The questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments.

Results

Results of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach’s alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff.

Conclusion

This study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers’ awareness and acceptance of diversity in the healthcare environment and healthcare delivery.

European Higher Health Care Education Curriculum

This article concerns the European Curriculum in Cultural Care Project (2005-2009), which aimed at developing a curriculum framework for the enhancement of cultural competence in European health care education. The project was initiated and supported by the Consortium of Institutes in Higher Education in Health and Rehabilitation, whose goal is to nurture educational development and networking among member institutions. The framework is the result of a collaborative endeavor by nine nurse educators from five different European countries. The production of the framework will be described in accordance with the following tenets: developing cultural competence is a continuing process, cultural competence is based on sensitivity toward others, and cultural competence is a process of progressive inquiry. Critique concerning the framework will be presented.

Teaching cultural competency through a pharmacy skills and applications course series

OBJECTIVE

To incorporate cultural competency in a Pharmacy Skills and Application course series and assess the level of cultural competency in students who did and did not complete the courses.

DESIGN

The course series focused on cultural competency throughout the PharmD curriculum and included such activities as self-reflection, lecture, diversity service-learning, case studies, and discussion.

ASSESSMENT

The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) was used to measure cultural competence in 2 cohorts: the last class preceding implementation of the new course series and the first class after its implementation. Overall scores between the 2 cohorts were not significantly different; however, 2 subscale scores were significantly higher among students who completed the course series: cultural skills (p = 0.021) and cultural encounters (p = 0.048).

CONCLUSIONS

The Pharmacy Skills and Application course series appears to improve some aspects of cultural competence in pharmacy students, but may not be sufficient to elicit change in all areas.