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

Abstract

BackgroundCultural 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.MethodsThe 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.ResultsConstruct 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.ConclusionsThe 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.

Cultural Competence in Public Administration: A Framework and Predictors of Cultural Competence for Graduating Masters Students

“…These findings remain consistent with previous research on cultural competence indirect measurements and social desirability bias (Constantine & Ladany, 2000;Reyes, Hadley, & Davenport, 2013;Bernhard et al, 2015;Worthington, Mobley, & Tan, 2000;). Per Wiggins (1959, "social desirability response style may be defined as a general tendency to endorse personality inventory items that are judged to be socially acceptable by people in general" (p. 419).…”

“…Social Desirability (Constantine & Ladany, 2000;Reyes, Hadley, and Davenport, 2013;Bernhard et al 2015;Worthington, Mobley, & Tan, 2000;and Sodowsky et al,1998) 5-item scale operationalized as an index. 1= lower social desirability bias; 5 = higher social desirability bias (Hays, Hayashi, & Stewart, 1989).…”

Psychosocial work environment and cross‐cultural competence among native and foreign‐born registered nurses

“…Cross‐cultural competence was measured with a validated Finnish version (Hietapakka et al, ) of the Cross‐cultural competence instrument for the health care profession (Bernhard et al, ). The revised Finnish version of the scale has been shown to be an appropriate tool for studies of health care professionals working in Finland (Hietapakka et al, ; Wesołowska et al, ).…”

“…Thus, to improve the situation, it is widely acknowledged that health care professionals, including nurses, need to be equipped with cross‐cultural competence (Cuellar, Brennan, Vito, & de Leon Siantz, ; Douglas et al, ; Truong, Paradies, & Priest, ). Cross‐cultural competence is understood here as a set of skills (cultural adaptability and communicative competence), emotions (empathy, sensitivity, and patience in cross‐cultural encounters), attitudes (tolerance and respect toward cultural diversity), and motivations (a wish to provide culturally responsive care and understand culturally different populations) that enable effective work and communication in a culturally diverse environment (Bernhard et al, ). Given the importance of cross‐cultural competence in health care, it seems crucial to identify factors that may promote or hinder cross‐cultural competence among nurses.…”

Evaluating cultural competence among Japanese clinical nurses: Analyses of a translated scale

“…As with most measurement instruments, further psychometric testing of these instruments is still needed to confirm their reliability and validity among other populations (Shen, ). Also, there are few instruments to validate the impact of education on CC among nurses (Bernhard et al, ). Notably, there were no samples of Japanese nurses using these instruments.…”