Technical assistance (TA) has been a ubiquitous part of the implementation of policies, programs, and services across public and private enterprise for decades. There have been few attempts to identify critical components of TA and evaluate its effectiveness. Qualitative analysis of interviews with experienced TA providers suggested a continuum of practice anchored at each end by approaches termed content-driven and relationship-based. Content-driven approaches focus on information transfer and referral whereas relationship-based approaches center on the facilitation of behavior and systems change. TA is almost always a mix of these approaches. Fitting the right approach to each situation is the key to success. The structure of TA is conceptualized as a three-phase set of activities (decision-making, implementation, and evaluation) supported by an effective partnership and informed by the overarching context. The strategies for effective TA are consistent with major theories of behavior change but need to be further evaluated and refined.

The objective of this study was to create a psychometrically sound measure of family-centered care, the Family-Centered Care Assessment (FCCA), developed through a process led by families in collaboration with maternal and child health leaders. The items for the FCCA scale were initially developed by families of children and youth with special needs in partnership with pediatric providers and researchers. Using an Institutional Review Board-approved research protocol, the questions were revised based on input from focus groups of diverse parents in three states. Parental responses (N = 790) to the revised 59-item survey were collected online from families in 49 states. Item distributions uniformly showed excellent spread. A principal axes factor analysis confirmed the existence of a single factor. Rasch modeling item analyses identified a reduced subset of 24 items that demonstrated excellent psychometric properties. All items met the criteria for a linear Rasch scale. Empirical evidence in support of the construct validity of the 24-item measure was derived: all items had a positive and substantial item–total correlation; person alpha scale reliability was >0.80 and the item reliability was >0.90; both separation indices were >2.0; infit and outfit statistics were within 0.5–1.5; and item difficulties ranged between −2 and +2 logits. Strong rank-ordered associations and large effect sizes were observed for six indicators of quality of care. This study’s family-led process produced a tool, the FCCA, to measure families’ experience of care with excellent psychometric properties.

Background Few valid and reliable measures exist for health care professionals interested in determining their levels of cultural and linguistic competence. Objective To evaluate the measurement properties of the Cultural Competence Health Practitioner Assessment (CCHPA-129). Methods The CCHPA-129 is a 129-item web-based instrument, developed by the National Center for Cultural Competence (NCCC). Responses on the CCHPA -129 were examined using factor analysis; Rasch modeling; and Differential Item Functioning (DIF) across race, ethnicity, gender, and profession. Subjects 2504 practitioners, including 1864 nurses (RN/LPN,/BSN); 341 clinicians (PA/NP); and 299 physicians (MD/DO), who completed the CCHPA-129 online between 2005 and 2008. Results Three factors representing domains of knowledge, adapting practice, and promoting health for culturally and linguistically diverse populations accounted for 46% of the variance. Among Knowledge factor items, 53% (23/43) fit the Rasch model, item difficulties ranged from −1.01 logits (least difficult) to +1.11 logits (most difficult), separation index (SI) 13.82, and Cronbach’s α 0.92. Forty-seven percent (21/44) Adapting Practice factor items fit the model, item difficulties −0.07 to +1.11 logits, SI 11.59, Cronbach’s α 0.88; and 58% (23/39). Promoting Health factor items fit the model, item difficulties −1.01 to +1.38 logits, SI 22.64, Cronbach’s α 0.92. Early evidence of validity was established by known groups having statistically different scores. Conclusion The 67-item CCHPA-67 is psychometrically sound. This shorted instrument can be used to establish associations between practitioners’ cultural and linguistic competence and health outcomes as well as to evaluate interventions to increase practitioners’ cultural and linguistic competence.

Parents and providers can support children's genetic health literacy and psychosocial adjustment to hereditary breast/ovarian cancer (HBOC) risk information through open family communication.Policy: Public health benefits from genetic testing for HBOC mutations may only be realized when all high-risk relatives of individual mutation carriers are informed of their family's status, including children, so that appropriate risk-reducing steps can be considered at different life stages.Research: Future research is needed to examine the integration of family communication and psychosocial support tools into cancer genetic counseling and testing protocols.

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