Cultural Assessment Tools
■ Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R©) – Developed by Campinha-Bacote (2002), the IAPCC-R© is designed to measure the level of cultural competence among healthcare professionals and graduate students in the allied health fields. It is specifically intended for the following healthcare clinicians, educators and students: physicians, physician assistants, medical students/residents, licensed practical/ vocational nurses, registered nurses, advanced practice nurses, nursing students, health professions’ faculty (medicine, nursing, dentistry, pharmacy), dentists, dental students, clinical pharmacists, pharmacy students, physical therapists and physical therapy students, and occupational therapists. With modifications, the IAPCC-R© can be and has been used with other healthcare professionals and allied health professions. The IAPCC-R is based on Campinha-Bacote’s model of cultural competence, The Process of Cultural Competence in the Delivery of Healthcare Services (1998) and measures the five constructs of this model (cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters). Studies were conducted with a variety of healthcare professionals and reliability scores ranged from a Cronbach’s alpha of 0.72-0.90. This tool has also been translated into several languages and used internationally. Click onto the following link for more details of studies using this tool (link).
■ Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV©) – Developed by Campinha-Bacote (2007), the IAPCC-SV© is designed to measure the level of cultural competence among undergraduate students in the health professions. It is based on the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R©) and also measures the five constructs of this model (cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters). Fitzgerald, Cronin and Campinha-Bacote (2007) conducted a study entitled, Psychometric Testing of a Proposed Student Version of the Tool, “Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised” in which they administered the IAPCC-SV© to 91undergraduate nursing students at Bellarmine University Lansing School of Nursing and Health Sciences to establish reliability of this tool. Reliability testing revealed a Cronbach’s alpha of .783. Click onto the following link for more details of this tool (link).
■ Cultural Competence OSCE (ccOSCE) – Developed by Alexander Green, the ccOSCE is a one-station, performance-based assessment of medical students’ ability to elicit and comprehend the sociocultural causes of health outcomes. It features a middle-aged ethnic minority woman for whom a combination of sociocultural factors, including an inaccurate understanding of hypertension, have led to medication non-adherence and complaints of inability to control her blood pressure. Within a 15-minute time limit, examinees must take a patient history, present the patient’s case orally to an examiner, and answer a short-answer question about the case. Performance is rated using multiple, conceptually founded checklists. The ccOSCE may augment an OSCE that does not assess cultural competence, but its fit to other OSCE stations will require negotiation of implementation procedures and assessment criteria as well as quantitative evaluation to ensure the reliability of the full exam. Scoring guidance is not provided, and initial validation has been conducted qualitatively. Adoption of the ccOSCE may raise awareness of how to assess cultural competence via modifications to extant OSCE stations. Citation: Cianciolo, A. (2013). Critical Synthesis Package: Cultural Competence OSCE (ccOSCE). MedEdPORTAL Publication. https://www.mededportal.org/publication/9428
■ Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD) – Developed by Emami and Safipour, the AAAD assesses healthcare workers’ awareness and acceptance of diversity in the healthcare environment and healthcare delivery. Results of different validity and reliability of the AAAD revealed a Cronbach’s alpha: 0.68 to 0.8 and a Spearman rank correlation coefficient of 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. Citation: Emami, E, and Safipour, J. (2013). Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions. BMC Health Services Research, 13: 145 DOI: 10.1186/1472-6963-13-145 https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-145
■ Meeting the Food Needs of Queensland’s Culturally and Linguistically Diverse Aged Survey – Developed by Millichamp and Gallegos, this online survey relates to ethic aged care, including home and community care (HACC). Two research activities were conducted with HACC aged care service providers in Queensland to develop this survey. The initial activity involved conducting in-depth semi-structured interviews with key informants from a range of HACC aged care services to gain insight into the provision of HACC food services to Culturally and Linguistically Diverse Aged (CALD) clients. This online survey was then developed to ascertain the cultural profiles of service clientele, food service practices, cultural sensitivity of food service practices, perceived barriers and enablers to achieving culturally appropriate food services, client assessment practices, perceived benefits to the service and clientele that would be achieved from offering culturally appropriate food services, and strategies that would likely be of greatest assistance in delivering culturally appropriate food services. Data from this online survey, along with the detailed data obtained in the key stakeholder interviews, can provide themes and patterns to facilitate exploration of barriers and enablers to achieve culturally appropriate food services. Citation: Millichamp, A. and Gallegos, D. (2011). Meeting the Food Needs of Queensland‟s Culturally and Linguistically Diverse (CALD) aged: What do service providers say? Brisbane: Queensland University of Technology. http://diversicare.com.au/wp-content/uploads/Food-Project-Report.pdf
■ Physical Therapy Clinical Performance Instrument (PT CPI) – Developed by the American Physical Therapy Association (APTA) Department of Physical Therapy Education, the PT CPI should only be used after completing the APTA web-based training for the Physical Therapist Clinical Performance Instrument (PT CPI) at www.apta/education. PT CPI is applicable to a broad range of clinical settings and can be used throughout the continuum of clinical learning experiences. Every performance criterion in this instrument is important to the overall assessment of clinical competence, including a section on cultural competence. https://cpi2.amsapps.com/docs/PT_final_revision_11-30-2010.pdf
■ Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD) – Because of a lack of standardized questionnaires in the Swedish context, authors Emami and Safipour developed the AAAD. The AAAD is intended to serve as a tool for obtaining data concerning awareness and acceptance of healthcare providers as they interact with people with diverse backgrounds. This questionnaire aims to assess the entire healthcare institution, i.e., including both care-providing and non-care -providing staff and their relationships with patients and the patients’ significant others. It 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. Psychometric testing reveals a Cronbach’s alpha of 0.68 to 0.8 and Spearman rank correlation coefficient of 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, and 6) Attitude toward interaction between patients and staff. Citation: Emami, A., and Safipour, J. (2013), Constructing a Questionnaire for Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions. BMC Health Services Research, 13:145 PDF
■ Caring Efficacy Scale (CES) – Developed by Coate’s (1997), the CES measures perceived knowledge of caring behaviors. The scale utilizes a 30 items on Likert type scale of measurement (1-very little confidence to 5- quite a lot of confidence) to measure 30 items in the area of caring proficiency. Content validity was verified by expert panel. Internal reliability was measure at a coefficient of Cronbach alpha .97 . Citation: Coates, C.J. (1997). The Caring Efficacy Scale: Nurses’ self – reports of caring in practice settings. Advanced Practice Nursing Quarterly, 3(1): 53-59.
■ Communication Climate Assessment (C-CAT) Toolkit – The C-CAT is an organizational performance assessment toolkit that was developed by the Ethical Force Program® at the American Medical Association (AMA). The C-CAT is now housed at the Center for Bioethics and Humanities at the University of Colorado. C-CAT is designed to assist an organization in meeting the needs of a diverse patient population. The questions are specifically focused on common communication problems, such as culture, language and health literacy gaps. Contact C-CAT staff by phone (303)-724-6997 or CCAT@ucdenver.edu for a list of trained and qualified consultants who can help you. Learn more about this tool by visiting www.coloradobioethics.org/CCAT.
■ Cultural Competence Improvement Tool (CCIT) – The Cultural Competence Improvement Tool was been developed by the National Black Child Development Institute under the supervision of Lauren Hogan, Director of Public Policy and Angele’ Doyne, Child Health Program Coordinator. The CCIT can assist schools, after school providers, and child care providers conduct a review of cultural competence in existing health and nutrition education curricula. This tool can be used in the following ways: 1) It can help providers select a health and nutrition curriculum that meets the particular needs of their learners (i.e., children and family members); 2) It can help providers improve the cultural relevance of an existing health and nutrition curriculum being used in their program; 3) It can be used to compare multiple health and nutrition curricula in order to choose a curriculum that best fits your program needs. PDF
■ Transcultural Humility Simulation Development – This tool, developed by Hamilton (2016) is a researcher-designed educational intervention developed to address the gap in the literature surrounding the use of simulation with cultural competence. The tool is based upon the theoretical framework of Campinha-Bacote’s (2007) model, The Process of Cultural Competence in the Delivery of Healthcare Services, with an emphasis on “becoming” culturally competent, as well as integration of Bloom et al.’s (1956) taxonomy of learning domains, and that of adult learning strategies. The Transcultural Humility Simulation Development activities consist of learning strategies chosen based on the principles of adult learners and Campinha-Bacote’s five constructs of cultural awareness, cultural skill, cultural encounters, cultural knowledge, and cultural desire. Citation: Hamilton, Teresa, “The Influence of Transcultural Humility Simulation Development Activities on the Cultural Competence of Baccalaureate Nursing Students” (2016). Theses and Dissertations. Paper 1270. http://dc.uwm.edu/cgi/viewcontent.cgi?article=2275&context=etd
■ Belief Formation Scale (BFS) – The Belief Formation Scale is a collection of ten items taken from the Actively Open‐Minded Thinking Scale created by Sá, West, and Stanovich (1999). It measures open‐minded thinking. Open-mined thinking is defined as the ability to “evaluate arguments and evidence in a way that is not contaminated by one’s prior beliefs.” The ten items that constitute the BFS were selected to capture several components of rational thought that are deemed essential for open‐mindedness. Citations: Sá, W. C., West, R. F.,& Stanovich, K. E. (1999). The domain specificity and generality of belief bias: Searching for a generalizable critical thinking skill. Journal of Educational Psychology, 91, 497‐510.
■ Actively Open-minded Thinking Scale – Developed by Stanovich and West, this instrument is a 41- item survey which assesses levels of openness to different viewpoints (e.g., “I believe that different ideas of right and wrong that people in other societies have may be valid for them. Citation: Stanovich, K. E., & West, R. F. (1997). Reasoning independently of prior belief and individual differences in actively open‐minded thinking. Journal of Educational Psychology, 89, 342‐357. For a copy of this instrument see, Rodriquez, F. (2011). Do College Students Learn to Critically Evaluate Claims? A Cross-Sectional Study of Freshmen and Senior Psychology Majors. Dissertation, The University of Michigan. http://deepblue.lib.umich.edu/bitstream/handle/2027.42/89614/frodrig_1.pdf?sequence=1, pp. 161-162.
■ Scale of Ethnocultural Empathy (SEE) – Developed by Wang et al., this instrument measures ethnocultural empathy, defined as “empathy directed toward people from racial and ethnic cultural groups who are different from one’s own ethnocultural group.” Citation: Wang, Y.W., Davidson, M.M., Yakushko, O.F., Savoy, H.B., Tan, J.A., Bleier, J.K. (2003). The Scale of Ethnocultural Empathy: Development, validation, and reliability. Journal of Counseling Psychology, 50(2), 221‐234.
■ Sociocultural Thought Process Assessment (STPA) – Produced by James Madison University faculty in 2008 in an attempt to measure the sociocultural domain of general education, the STPA was created to measure the level of reasoning that a student engages in when attempting to understand the behavior/perspective of an individual or a group. Citation: Center for Assessment and Research Studies, James Madison University.
■ CAHPS® Cultural Competence Item Set (CAHPS CC) – The Cultural Competence Item Set was developed through funding from the Agency for Healthcare Research and Quality (AHRQ) to the CAHPS Consortium. The items address the following five topic areas: Patient-provider (or doctor) communication; Complementary and alternative medicine; Experiences of discrimination due to race/ethnicity, insurance, or language; Experiences leading to trust or distrust, including level of trust, caring, and truth-telling; and Linguistic competency (Access to language services). CAHPS CC is a 26-item set that demonstrates adequate measurement properties and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient’s perspective. CAHPS CC is an outcome of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) project. The CAHPS® project developed a set of standardized survey instruments that can be used to collect reliable information from patients about the care they have received. However, there were concerns that the CAHPS instrument did not fully capture domains of care of particular relevance to diverse populations, such as trust, perceived discrimination, shared decision making, and access to language services. To address this gap, the CAHPS team developed an item set to assess aspects of cultural competency not adequately addressed in the existing CAHPS surveys, which could serve as a supplemental item set to the CAHPS Clinician & Group surveys. The result was the CAHPS CC. Copy of the tool and more information can be retrieved at PDF
■ Knowledge, Efficacy, and Practices Instrument for Oral Health Providers (KEPI-OHP). Developed by Behar-Horenstein, Garvin, Moore, and Catalanotto, the KEPI-OHP is a twenty-item scale that measures the cultural competence of predoctoral dental students. The KEPI-OHP has acceptable internal consistency reliability (0.87). Citation: Behar-Horenstein, Garvan, C., Moore, T., and Catalanotto, F. (2012). The Knowledge, Efficacy, and Practices Instrument for Oral Health Providers: A Validity Study with Dental Students. Journal of Dental Education, 77(8), 998-1005. PDF
■ Cultural Competence Assessment Instrument from the University of Illinois at Chicago (CCAI-UIC) – Authored by Fabricio Balcazar, Y., Taylor-Ritzler, T., Portillo, N., Rodakowsk, J., Garcia-Ramirez, M., and Willis, C. , the CCAI-UCI is an instrument designed to measure cultural competence among rehabilitation practitioners who work with people with disabilities from diverse ethnic backgrounds. The factors identified in the tool were (a) cultural awareness, which was primarily related to developing a critical view of cultural differences, people’s experiences of oppression and marginalization, class differences, discrimination, racism, and becoming aware of ones’ cultural biases; (b) cultural knowledge, which referred to learning about the cultural practices of specific racial or ethnic groups; (c) cultural skills, which focused on developing professional practices and behaviors designed to improve service delivery to diverse populations; and (d) cultural practice, which referred to experiencing other cultures and learning to appreciate diversity in society . A total of 49 items were developed, 24 of which were generated by the authors based on the review of the literature and 25 that were adapted from existing scales. All of the CCAI-UIC survey questions were rated using a four-point scale in which 4 was strongly agree and 1 was strongly disagree. Internal consistency coefficients for all three factors, Awareness, Skills, and Organizational support, were above the .75 threshold criteria . Citation: Fabricio Balcazar, Y., Taylor-Ritzler, T., Portillo, N., Rodakowsk, J., Garcia-Ramirez, M., and Willis, C. (2011). Development and Validation of the Cultural Competence Assessment Instrument: A Factorial Analysis. Journal of Rehabilitation
■ Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) – The SAPLCC, developed by Echeverri et al, (2013), is a modified version of California Brief Multicultural Competence Scale (CBMCS) and the Clinical Cultural Competency Questionnaire (CCCQ). The SAPLCC measures the curriculum standards and the cultural progress of students in pharmacy schools around the country and provides “a non-biased, practical, and cost-effective measure of students’ perception of their cultural competence.” Citation: Echeverri, M., Brookover, C., & Kennedy, K. (2013). Assessing pharmacy students’ self-perception of cultural competence. Journal of Health Care for the Poor and Underserved, 24, 64-92.
■ Implicit Association Test (IAT) – This tool is derived from Project Implicit, a Virtual Laboratory for the social and behavioral sciences designed to facilitate the research of implicit social cognition: cognitions, feelings, and evaluations that are not necessarily available to conscious awareness, conscious control, conscious intention, or self-reflection. The project was initially launched as a demonstration website in 1998 at Yale University, and began to function fully as a research enterprise following a grant from the National Institute of Mental Health in 2003. It is a computer-based test that measures unconscious biases about a number of social and group constructs, including race, ethnicity, gender, obesity, disability and others. Results serve as a trigger for reflection and discussion of unconscious bias Contact: Project Implicit at: https://implicit.harvard.edu/implicit
■ Cultural Competency Assessment Tool for Hospitals (CCATH) – The CCATH, developed by Robert Weech-Maldonado, Janice L. Dreachslin, Julie Brown, Rohit Pradhan, Kelly L. Rubin, Cameron Schiller and Ron D. Hays. is an organizational tool to assess adherence to the U.S. national standards for culturally and linguistically appropriate services (CLAS) in health care provide guidelines on policies and practices aimed at developing culturally competent systems of care. A field test provided support for the reliability and validity of the CCATH.
■ CLAS Assessment Survey – This survey is based on the Cultural and Linguistically Appropriate Services (CLAS) in health care delivery. This online survey assesses how well your organization provides culturally competent care, assesses patient-provider communication and service delivery. After completing the survey, individuals will receive results and recommended actions to address gaps. The survey is offered at no cost. You have the choice to take the full survey or select each of the sections that interest you. (link)
■ Cultural Awareness and Sensitivity Tool (CAST) – Developed by Anjori Pasricha, the CAST is a 25- itemed, self-administered instrument that evaluates undergraduate medical students’ awareness of cross-cultural issues in healthcare and their sensitivity toward them. The CAST includes various themes within cultural competence including awareness, sensitivity, skill, and behavioral interaction. It is based on items from Campinha-Bacote’s tool, IAPCC-R and items from the CCA instrument. All items are scored on a five-point Likert scale, with the following descriptors: strongly disagree, disagree, neutral, agree. The test-retest reliability of CAST is 0.931, and the internal consistency and overall reliability were moderate at 0.756 and 0.721 respectively. Research on the tool is published in the following citation: Pasricha, A. (2012). Developing a Measurement Tool to Assess Medical Students’ Cultural Competency. UOJM, Volume 2, May 2012, pages 44-47.
■ Outcomes of a Culturally Competent Curriculum (OCCC) – A Template for Evaluation. This 44-item curriculum assessment tool was developed by Campinha-Bacote (2008) to measure the existence of cultural concepts taught in nursing schools. It includes five domains (cultural awareness, cultural desire, cultural knowledge, cultural skill, cultural encounters) and components which are based on Campinha-Bacote’s conceptual model of cultural competence.(link) . The tool is currently undergoing rigorous psychometric testing and is not available at this time. Projected release is late 2018.
■ The Diverse Community Questionnaire – This questionnaire, developed by the U.S. Administration on Aging, is a tool that allows agencies, its partners, and stakeholders to have a conversation about what respectful, inclusive, and sensitive services are to a particular community. An agency can use this tool with flexibility, and tailor this questionnaire to meet the particular needs of the communities it serves. http://www.aoa.acl.gov/AoA_Programs/Tools_Resources/DOCS/AoA_DiversityToolkit_full.pdf
■ Cultural Diversity Questionnaire For Nurse Educators (CDQNE) – Developed by Lorinda Sealey (2003), this 55- item tool includes statements developed by this researcher, as well as items adapted from Campinha-Bacote’s tool (IAPCC-R). This tool also consists of items adapted from research conducted by Goode, Mason and Ward. The Cultural Diversity Questionnaire For Nurse Educators is based on Campinha-Bacote’s model of cultural competence and includes items related to cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire (PDF). Research on the tool is published in the following citation: Sealey, L., Burnett, M. and Johnson, G. (2006). Cultural Competence of Baccalaureate Nursing Faculty: Are We Up to the Task? Journal of Cultural Diversity, 13(1), 131-140. Contact: firstname.lastname@example.org.
■ Cultural Diversity Questionnaire for Nurse Educators–Revised (CDQNE–R) – Developed by Yates (2008), this tool is adapted from the CDQNE tool based on Sealey’s (2003) factor analysis. The first section of the CDQNE–R contains 41 items related to cultural confidence and 11 items related to transcultural teaching behaviors. Participants are asked to indicate if they strongly agree, agree, are undecided, disagree, or strongly disagree for each item. The completion time is 10–12 minutes and scores range from 1–5. With the revised CDQNE, Yates found that Cronbach alpha coefficient was higher for the overall Cultural Competence scale and for four of the six subscales. The Cronbach alpha coefficient for each of the subscales was as follows: Teaching Behaviors, 0.84; Cultural Awareness, 0.77; Cultural Knowledge, 0.85; Cultural Skills, 0.77; Cultural Encounters, 0.66; and Cultural Desire, 0.74. Revisions resulted in higher internal consistencies for the first four subscales when compared to Sealey’s earlier study. The last section of the CDQNE–R contained nine demographic and professional characteristics questions. PDF
■ Inventory for Assessing the Process of Cultural Competence in Mentoring (IAPCC-M©) – The IAPCC-M© is designed to measure the level of cultural competence among healthcare professionals as it relates to the mentoring process. It was developed in 2008 by Dr. Campinha-Bacote and is adapted from the IAPCC-R (link) (Campinha-Bacote, 2007). The The IAPCC-M© is based on Campinha-Bacote’s model of cultural competence, The Process of Cultural Competence in the Delivery of Healthcare Services (1998). It is a self-assessment tool consisting of 9 items that measure the five cultural constructs of cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters as it relates to the mentoring process. Scores range from 9 – 36 and indicate whether a faculty mentor is operating at a level of cultural proficiency, cultural competence, cultural awareness or cultural incompetence in their mentoring relationships. Higher scores depict a higher level of cultural competence in mentoring. The IAPCC-M© uses a 4-point likert scale reflecting the response categories of strongly agree, agree, disagree and strongly disagree. (link)
■ Inventory for Assessing a Biblical Worldview of Cultural Competence Among Healthcare Professionals (IABWCC) – Campinha-Bacote (2005) developed the Inventory for Assessing a Biblical Worldview of Cultural Competence Among Healthcare Professionals (IABWCC). This tool is based on her Biblically Based Model of Cultural Competence in the Delivery of Healthcare Services (link to model). The IABWCC is designed to measure the level of cultural competence among healthcare professionals who render care based on biblical principles. Click onto the following link for more details of studies using this tool (link).
■ Blueprint for Integration of Cultural Competence in the Curriculum Questionnaire (BICCCQ) – The 31-item BICCCQ was developed at the University of Pennsylvania, School of Nursing, to measure student reports of components of content on cultural competence taught in undergraduate and graduate nursing programs. BICCCQ items were derived from the Tool for Assessing Cultural Competence Training, which was developed to measure faculty report of components of content on cultural competence in medical school curricula. Cronbach’s alpha ranged from .73 to .94 across factors and was .96 overall. Citation: Tulman, L. and Watts, R. (2008). Development and testing of the Blueprint for Integration of Cultural Competence in the Curriculum Questionnaire. Journal of Professional Nursing, 24(3), 161-166.
■ Cultural Competency Organizational Assessment – 360 (COA360) – The COA360 is an instrument designed to appraise a healthcare organization’s cultural competence. The Office of Minority Health and the Joint Commission have each developed standards for measuring the cultural competency of organizations. The COA360 is designed to assess adherence to both of these sets of standards. Citation: LaVeist, T., Relosa, R. and Sawaya, N. (2008). The COA360: A Tool for Assessing the Cultural Competency of Healthcare Organizations. Journal of Healthcare Management, 53(4):257-66; discussion 266-267.
■ Transcultural and International Nursing Knowledge Inventory (TINKI) – Baldonado et al (1998) developed the TINKI, which is a questionnaire that includes closed and open-ended questions related to participant’s experiences in providing cultural care. Citation: Baldonado, A., Ludwig Beymer, P., Barnes, K., Starsiak, D., Nemivant, E. and Anonas-Ternate A. Transcultural Nursing Practice Described by Registered Nurses and Baccalaureate Nursing Students. Journal of Transcultural Nursing, 9: 15-25.
■ Race Matters: Organizational Self-Assessment – Developed by the Annie E. Casey Foundation, this one-page questionnaire on staff competencies and organizational operations purports to offer a racial equity score followed by a “next steps” analysis. It also suggests tools for improvement.
■ Cross-Cultural Evaluation Tool – The Cross-Cultural Evaluation Tool was developed by Freeman. It is a five-point likert-type scale which measures a student’s ability to make culturally sensitive choices. Hughes & Hood (2007) published an article which presents the psychometric properties of the Cross-Cultural Evaluation Tool that yields a cross-cultural interaction score. Citation: Hughes, K. and Hood, L. (2007). Teaching Methods and an Outcome Tool For Measuring Cultural Sensitivity in Undergraduate Nursing Students. Journal of Transcultural Nursing, 18:57-62.
■ Cultural Competence Assessment (CCA) – Schim and colleagues developed the CCA instrument, which is designed to measure cultural diversity experience, awareness and sensitivity, and competence behaviors among health care providers and staff. Research on the tool is published in the following citation: Schim, S., Doorenbos, A. , Miller, J. and Benkert, R. (2003). Development of a Cultural Competence Assessment instrument. Journal of Nursing Measurement 11(1):29-40.
■ American Medical Association (AMA), Organizational Assessment Toolkit – The AMA Ethical Force program developed a toolkit goal to help healthcare organizations meet the needs of a diverse patient population by assessing how effectively the organization communicates and improving communication with all patient and focusing on common communication problems, such as culture, language and health literacy gaps. http://www.asha.org/practice/multicultural/self.htm
■ Health Research and Educational Trust Disparities Toolkit (HRET) – The HRET was developed by Hasnain-Wynia, R., Pierce, D., Haque, A., Hedges Greising, C., Prince, V., Reiter, J. (2007). It is a web-based tool that provides hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients. Registration is free. Development of the toolkit included input from a National Advisory Panel. By using this Toolkit, health care organizations can assess their organizational capacity to collect this information and implement a systematic framework designed specifically for obtaining race, ethnicity, and primary language data directly from patients/enrollees or their caregivers in an efficient, effective, and respectful manner. (link)
■ Multicultural Personality Questionnaire – This instrument measures cultural empathy, open-mindedness, emotional stability, orientation to action, adventurousness/curiosity, flexibility and extraversion. Citation: Van der Zee, K. I., & Van Oudenhoven, J. P. (2000). The Multicultural Personality Questionnaire: A multidimensional instrument of multicultural effectiveness. European Journal of Personality, 14, 291-309.
■ Munroe Multicultural Attitude Scale Questionnaire (MASQUE) – This tool measures multicultural knowledge (know), empathy (care), and active experience (act). Reliability of the total MASQUE scale scores was adequate for general research purposes. Citation: Munroe, A., & Pearson, C. (2006). The Munroe Multicultural Attitude Scale Questionnaire: A new instrument for multicultural studies. Educational and Psychological Measurement, 66, 819-834.
■ Intercultural Adjustment Potential Scale (ICAPS) – This tool examined item content from a number of valid and reliable personality inventories assessing psychological constructs related to emotion regulation, critical thinking, openness, flexibility, interpersonal security, emotional commitment to traditional ways of thinking, tolerance of ambiguity, and empathy. Citation: Matsumoto, D., LeRouxa, J., Ratzlaffa, C., Tatania, H., Uchidaa, H., Kima, C.,, Araki, S. et al. (2001). Development and validation of a measure of intercultural adjustment potential in Japanese sojourners: The Intercultural Adjustment Potential Scale (ICAPS). International Journal of Intercultural Relations, 25, 483–510.
■ Lee Cultural Sensitivity Tool: Hispanic Version – This is a 10-item, researcher-designed instrument regarding selected Hispanic health beliefs and practices. Content validity was established through review of the literature with Cronbach’s alpha.60. Limitations of this tool are a small convenience sample size at a single data collection site and lack of vigorous use of the tool. Citation: Lee, C., Anderson, M., & Hill, P. (2006). Cultural sensitivity education for nurses: a pilot study. Journal of Continuing Education in Nursing, 37(3), 137-141.
■ Health Education Latino Cultural Competency Scale – This scale, designed by Rojas-Guyler, Wagner, Chockalingam, and Regha, is based on the seven competencies required of professional health educators as outlined by the National Commission for Health Education The seven items in this scale are designed to assess the comfort level of the health professional in executing their areas of responsibility when working with Latino communities. The items are scored using a five-point Likert scale including 1- very uncomfortable, 2- uncomfortable, 3- neutral, 4- comfortable and 5- very comfortable. A panel of experts established face and content validity. The reliability score is .93. Citation: Rojas-Guyler, Wagner, Chockalingam, and Regha (2006). Latino Cultural Competence Among Health Educators: Professional Preparation Implications. Journal of Health Studies. http://www.thefreelibrary.com/Latino+cultural+competence+among+Health+Educators:+professional…-a0164105568
■ Infant/Toddler Caregiver Cultural Rating Scale (ITCCRS) – Based on Sue’s (1981) tri-dimensional model, the ITCCRS was created to assess 109 child care providers’ cultural competence and the demographic correlates of that competence. Subjects were from 30 randomly selected infant/toddler centers that were licensed to provide child care. The ITCCRS consists of 40-items; 10 items assessing awareness; 19 measuring knowledge, and 11 measuring skills. Citation: Obegi, A. and Ritblat, S. (2005). Cultural Competence in Infant/Toddler Caregivers: Application of a Tri-Dimensional Model. Journal of Research in Childhood Education, 19(3), 199-213.
■ Miville-Guzman Universality-Diversity Scale (M-GUDS) – This is a 45-item questionnaire rated on a 6-point Likert-type scale ranging from strongly agree to strongly disagree. Universality-Diversity Orientation (UDO), is a construct that is defined as an attitude of awareness and acceptance of both the similarities and differences that exist among people. In regard to its psychometric properties, there are significant correlations in theoretically predicted ways with measures of racial identity, empathy, healthy narcissism, feminism, androgyny, homophobia, and dogmatism. Discriminant validity displayed by scale failing to correlate with Scholastic Achievement Test Verbal scores, although mixed results were obtained with social desirability. Internal consistency and retest reliability ranged from .89 to .95. Citation: Miville, M. L., Gelso, C. J., Liu, W., Pannu, R., Touradji, P., Holloway, P., & Fuertes, J. (1999). Appreciating similarities and valuing differences: The Miville-Guzman Universality-Diversity Scale. Journal of Counseling Psychology, 46, 291-307. This scale is based on the theoretical model called the Universal-Diverse Orientation (Fuertes, Miville, Mohr, Sedlaki, & Gretchen, 2000), which emphasizes an ability to tolerate similarities and differences between one’s self and another. The scale’s three subscales are diversity of contact, relativistic appreciation, and comfort with differences. This scale makes the theoretical leap that tolerance of difference is key to intercultural work and cultural competence. Citation: Fuertes, J. N., Miville, M. L., Mohr, J. J., Sedlacek, W. E., & Gretchen, D. (2000). Factor structure and short form of the Miville-Guzman Universality-Diversity Scale. Measurement and Evaluation in Counseling and Development, 33, 157-169.
■ Tailoring Initiatives to Meet the Needs of Diverse Populations: A Self-Assessment Tool – A self-assessment tool is provided in Chapter 8 of One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations to help organizations evaluate the way they currently provide care and services to diverse patient populations. The questions are designed to promote discussion around the need to improve or expand current initiatives to meet patients’ cultural and language (C&L) needs.
■ Cultural Awareness Scale (CAS) – Developed by Rew, Becker, Cookston, Khosropour, & Martinez (2003) to measure the multidimensional nature of cultural awareness in nursing students. The authors identified five key categories of cultural awareness, based on a review of the literature, and developed scale items in each of these categories: (1) general educational experience; (2) cognitive awareness; (3) research issues; (4) behaviors/comfort with interactions; and (5) patient care/clinical issues. Citation: Rew, L., Becker, H., Cookston, J., Khosropour, S., & Martinez, S. (2003). Measuring Cultural Awareness in Nursing Students. Journal of Nursing Education, 42 (6), 249-257.
■ CCATool -Student Version – Cultural Competence in Action Tool (CCAT) was developed by Papadopoulos. The original version, also authored by Papadopoulos, was developed for mental health professionals. The CCATool Student Version consists of a background section and four subsections measuring cultural awareness, cultural knowledge, cultural sensitivity and cultural practice. Each cultural section contains 10 statements in a 4-point Likert -scale (1=completely disagree, 2=disagree, 4=agree, 5=completely agree). Statements are both culture-generic and cultural-specific. The validity was confirmed by using expert panels and reliability was reported in Cronbach’s alphas higher than 0.7.
■ Sociocultural Attitudes in Medicine Inventory (SAMI) – Developed by Tang et al, this 26-item 5-point Likert scale tool measures attitudes toward sociocultural issues in medicine and patient care. Citation: Tang, T., Fantone, J., Bozynski, M. and Adams, B. (2002). Implementation and evaluation of an undergraduate sociocultural medicine program. Acad Med., 77:578-85.
■ Transcultural Self-Efficacy Tool (TSET) – Developed by Jeffreys (2000), this tool is designed to measure the degree of cultural self-efficacy among nursing students. According to the tool’s authors, transcultural self-efficacy refers to perceived confidence in performing or learning transcultural skills. The TSET consists of 83 items, conceptually based on the literature of transcultural nursing, ordered into three subscales: (1) Cognitive (knowledge, consisting of 25 items); (2) Practical (interview, consisting of 28 items); and (3) Affective (Values, attitudes and beliefs, consisting of 30 items).
■ Tucker-Culturally Sensitive Health Care Inventories (T-CSHCI) – Tucker has developed three race/ethnicity-specific forms of the T-CSHCI (one each for African Americans, Hispanics and non-Hispanic whites) to be used by patients at community-based primary care centers to evaluate the level of patient-centered cultural sensitivity perceived in the health care that they experience. The T-CSHCI Patient Form: a) are for patient use by patients; b) assess specific provider and office staff behaviors and attitudes and healthcare center policies and physical characteristics; c) emphasize assessment of cultural-specific interpersonal behaviors; and d) consist of items generated by low-income racial/ethnic minority and majority patients. Citation: Tucker, C., Mirsu-Paun, A., van der Berg, J., Ferdinand, L., Jones, J., Curry, R., Rooks, L., Walker, T., Beato. (2007). Assessments for Measuring Patient- Centered Cultural Sensitivity in Community-Based Primary Care Clinics. Journal of the National Medical Association, 99(6), 609-619. Based on Tucker’s Patient-Center Culturally Sensitive (PC-CS) Health Care Model, she has also developed the T-CSHCI Provider Form and the T-CSHCI Staff Form.
■ Cultural Competence Continuum (CCC) – Based on Cross’s (1989) Cultural Competence Continuum Model of the 6 stages of cultural competence along a continuum, Wong converted this conceptual model (CCC) to an ordinal scale to assess behavior in cultural interactions revealed in reflective student writing. This tool s based on the premise that students’ reflective writing can be analyzed using the CCC to reliably and objectively assess the degree of cultural competence revealed in specific cultural interactions. This behavioral assessment of cultural competence may provide a method for providing feedback aimed at professional development in the area of cultural competence for students, clinicians, faculty, and programs. Christopher Wong is director of physical therapy programs at Touro College, 27 West 23rd Street, New York, NY 10010 (ckwong@touro. edu).
■ Intercultural Development Inventory (IDI) – The IDI was designed by Bennett and Hammer and measures how a person or a group of people tend to think and feel about cultural difference. The IDI is based on Bennett’s Developmental Model of Intercultural Sensitivity. Citation: Hammer, M. R., Bennett, M. J., & Wiseman, R. (2003). Measuring intercultural competence: The Intercultural Development Inventory. International Journal of Intercultural Relations 27(4), 421-443.
■ Cross-Cultural Adaptability Inventory (CCAI) – Developed by Kelly and Meyers (1993) to help participants understand the qualities that enhance cross-cultural effectiveness, become self-aware, decide whether to work in a culturally diverse company and whether to live abroad, and to prepare to enter another culture. The CCAI measures the 4 variables of emotional resistance, flexibility and openness, perceptual acuity, and personal autonomy. (Intercultural Press – 1-800-370-2665)
■ Cultural Bases of Health Survey (CBHS) – The CBHS instrument consists of three close-ended and one open-ended demographic questions; 35 close-ended, Likert-scale cultural competency questions; and one open-ended clinical case vignette question. This instrument is a result of the” Seeing the Body Elsewise: Connecting the Pre-Health Sciences and the Humanities grant project of the University of Michigan’s Program in Culture, Health, and Medicine. The aim of this grant was to rethink ways cultural diversity is taught in pre-health education. The project included an interdisciplinary model for teaching pre-health undergraduate students (pre-medicine, pre-nursing, pre-life sciences) about the intersections of race, gender, health, and ethnicity. The CBHS is one of the project’s evaluation activities. For more information contact Dr. Piontek at email@example.com
■ Beliefs, Events, and Values Inventory (BEVI) – The BEVI is a 494-item instrument that is designed to evaluate basic openness, receptivity to different cultures, tendency to stereotype, and self / emotional awareness. The BEVI asks “extensive background and demographic items along with validity and process scales in order to assess variables that may influence or shape both the processes and outcomes of international or multicultural learning.” (link)
■ Personal Intercultural Change Orientation (PICO) – Based on the Deep Culture model of intercultural learning by Shaules, The Personal Intercultural Change Orientation (PICO) instrument was developed. It measures two orientations related to the psychological stresses associated with dealing with new cultural environments: 1) an individual ‘s orientation towards change vs. stability, and 2) whether an individual references decisions internally based on existing knowledge and values or externally, based on the knowledge and values of others. These two measurements are combined to produce four dimensions that represent different intercultural learning orientations: proactive, protective, attentive, and adaptive.
■ Cultural Competence Self Assessment Protocol for Health Care Organizations and Systems – Developed by Dennis Andrulis, Thomas Delbanco, Laura Avakian and Yoku Shaw-Taylor, this tool can be used by health care providers, including hospitals and clinics, to conduct organizational assessments of their cultural competence. The protocol’s questions are organized according to the following four cornerstones of cultural competence:1) health care organization’s relationship with its community; 2) the administration and management’s relationship with staff; 3) inter-staff relationships at all levels; and 4) the patient/enrollee-provider encounter. PDF
■ Culturally and Linguistically Appropriate Health Care Services for Virginians– The Virginia Department of Health’s Culturally and Linguistically Appropriate Health Care Services for Virginians has a site that list seven tools that measure cultural competence. They provide an annotated bibliography of each assessment tool as well as a direct link to obtaining a copy of each tool. (link)
■ Cultural Competence Assessment Instrument from the University of Illinois at Chicago (CAI-UIC). Developed by authors Suarez-Balcazar,Taylor-Ritzler, Pertillo, Rodakowski, Garcia-Ramirez and Willis, the CAI-UIC measures perceived levels of cultural competence based on an extensive literature review, feedback from experts, and a synthesis of prevalent instruments and conceptual models of cultural competence available in the literature. The validation study was conducted with a random sample of 477 practitioners. Both exploratory and confirmatory factor analysis yielded a three-factor model with the following components: cultural awareness/knowledge, cultural skills, and organizational support. The third factor is seldom addressed in the literature- the role of the organization in supporting practitioners’ efforts to engage in culturally appropriate practices. The citation for the psychometric testing of this tools is: Suarez-Balcazar, F., Taylor-Ritzler, T., Pertillo, N., Rodakowski, J., Garcia-Ramirez, M, and Willis, C. (2011). Development and Validation of the Cultural Competence Assessment Instrument: A Factorial Analysis. Journal of Rehabilitation, 77, 4-13. http://www.cespyd.es/procomdi/images/a/a3/Developmentand.pdf
Resources in Cultural Competence Education For Health Care Professionals – In this California Endowment publication (pages 38-46), Dr. Gilbert (2003) provides a list of organizational and healthcare professional cultural assessment tools. This report can be accessed at: http://archive.calendow.org/uploadedfiles/resources_in_cultural_competence.pdf
■ The Perception of Cultural Competency Assessment (POCCA) – POCCA was developed by Nichols-English and Guion, as an instrument to measure the perception of self-efficacy with respect to cultural competency in allied health students. The POCCA demonstrated acceptable internal consistency (a = .92) and 2-week test-retest reliability of (R = .78). Four sub-scales were identified by factor analysis that accounted for 63% of total variance. The subscale a coefficients ranged from .61 to .89, and inter-item correlations varied from (R = .41-53). Citation: Nichols-English, G. and Guion, W. (2008). Evaluation of the Perception of Cultural Competency Assessment Instrument for Allied Health Students Journal of Allied Health, 37(4), 244-254. http://gru.pure.elsevier.com/en/publications/evaluation-of-the-perception-of-cultural-competency-assessment-instrument-for-allied-health-students(9771e41d-d844-4e5c-b3d7-5c1f7477f01e).html
■ Summary Report Cultural Competence in Primary Health Care: Perspectives, Tools and Resources – Janet Rhymes and Darren Brown published a report entitled, Summary Report Cultural Competence in Primary Health Care: Perspectives, Tools and Resources. This report provides a brief overview of the concept of cultural competence with an emphasis on useful tools and resources.
■ Tool for Assessing Cultural Competence Training (TACCT) – Developed by the Association of American Medical Colleges (AAMC ) to help medical schools assess cultural competence training, the Tool for Assessing Cultural Competence Training (TACCT) is a self-administered assessment tool with broad applicability to other health professions disciplines. It is designed to examine all components of a curriculum, including the following areas: where culturally competent care is currently taught, educational elements that have been previously unrecognized, where gaps in the curriculum exist, and planned and unplanned redundancies. It includes specific domains and components and can can be viewed at: https://www.aamc.org/download/54344/data/tacct_pdf.pdf. The article, “Cultural Competence Education for Medical Students: Assessing and Revising Curriculum,” describes the tool and its use. This article can be accessed at https://www.aamc.org/download/54338/data/. For more information about the tool contact Dr. Ella Cleveland at firstname.lastname@example.org or (202) 828-0531.
■ Patient Report Measure of Provider Cultural Competency – Authors Lucas, Michalopoulou, Falzarano, Menon and Cunningham developed a theoretically grounded and patient report measure of provider cultural competency. This tool is based on a study of predominantly African American patients (N = 310) who were recruited from three urban medical clinics to complete a survey about their relationship with their physician. Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician’s cultural knowledge, awareness, and skill. Citation: Lucas, T., Michalopoulou, G., Falzarano, P., Menon, S., and Cunningham, W. (2008). Healthcare Provider Cultural Competency: Development and Initial Validation of a Patient Report Measure. Health Psychology, 27(2), 185-193.
■ The Cultural Diversity Awareness Questionnaire (CDAQ) – The CDAQ was developed, by authors Lazaro & Umphred to assess cultural diversity awareness of physical therapy educators. It was validated for content, analyzed for reliability, and field and pilot tested. Results indicated that the CDAQ has favorable psychometric properties. Citation: Lazaro RT and Umphred DA ( 2007). Improving Cultural Diversity Awareness of Physical Therapy Educators. Journal of Cultural Diversity,14(3) :121-5. email@example.com or RLazaro@samuelmerritt.edu
■ Cultural Competence Tools – Hogg Foundation For Mental Health has complied a resource list entitled, Cultural Competence Tools. This resource list includes some examples of the following types of cultural competence tools: a) Organizational Tools to assess their organization’s level of cultural competence at an administrative level; b) Provider Tools to assess clinicians’ cultural competence in working with clients; and c) Client Tools to assess clients’ experience of the organization and/or clinician’s cultural competence.
■ Cultural Competence Assessment Tool (CCAT) – Sponsored by Blue Cross Blue Shield of Massachusetts Foundation, the Cultural Competence Assessment Tool (CCAT) guides healthcare organizations through an examination of the administrative structures and practices described in the CLAS standards. Denise Dodd, PhD, developed this tool with input from staff at the Boston Public Health Commission.
■ Organizational Cultural Competence Assessment Profile – The Health Resources and Services Administration (HRSA) sponsored a project to develop indicators of cultural competence in healthcare delivery organizations. This project is aimed to contribute to the methodology and state-of-the-art of cultural competence assessment. The product – An Organizational Cultural Competence Assessment Profile – builds upon previous work in the field, such as the National Standards for Culturally and Linguistically Appropriate Services (CLAS), and serves as a future building block that advances the conceptualization and practical understanding of how to assess cultural competence at the organizational level. The project was implemented through a contract with The Lewin Group, Inc. HRSA’s Office of Minority Health and Office of Planning and Evaluation provided both oversight and substantive input to the project.
■ Patient Reported Physician Cultural Competency (PRPCC) Scale – This instrument asks patients of physicians to report physician behaviors previously identified as being important for cultural competency. Briefly, the PRPCC asks patients to report the frequency their physician exhibited each of following 13 behaviors; My doctor asks me why I think I got sick; My doctor talks with me about medications I may use other than the ones he/she prescribes; . My doctor talks with me about traditional healing remedies I may use; My doctor asks if I seek advice from other family members and friends in making decisions about my health care; When discussing diagnosis and treatment related to my condition, my doctor asks if I would like to include family members in the discussion; My doctor takes time to help me understand possible side effects of the medications he or she prescribes for me; My doctor informs me of the resources in my local community where I can find help; My doctor asks if I understand his/her instructions and if not repeats them when necessary; My doctor asks if I have other questions or concerns before I leave the office; My doctor helps me to ask questions about my condition and treatment; My doctor helps me answer the questions he or she asks; My doctor encourages me to stop him or her when I am confused; My doctor helps me make decisions about my treatment. Citation: Thom, D., Tirado, M., Woon, T., and McBride, M. (2006). Development and Validation of a Cultural Competency Training Curriculum. BMC Med Educ., 2006; 6: 38. (link)
■ Cultural Competency Organizational Self-Assessment (OSA) Question Bank – OSA was developed by the Organization Self Assessment subgroup of the AIDS Education and Training Centers (AETC) Cultural Competence Care Workgroup. They reviewed hundreds of questions included in the Office of Minority Health’s guide for implementing the Culturally and Linguistically Appropriate Services (CLAS) in Health Care standards and identified questions most appropriate to AETC work, and chose a relatively small number of questions to include in the final version of the Cultural Competency OSA Question Bank. Questions were grouped into themes that became the six modules in this Question Bank. The Question Bank is comprised of six modular topics also thematically organized: Client and Community Input, Diverse and Culturally Competent Staff, Evaluation and Data Management, Language and Interpreter Services, Organizational Policies and Procedures, and Client and Provider Relations. Thematic categories are intended to reflect AETC foci and activities. Each module contains several questions to elicit a rich description of an organization’s current level of cultural competency and additional needs that AETC can integrate into their education and training planning and programs. (link)
■ Cultural Self-Assessment Resources & Tools for Self-Assessment of Cultural and Linguistic Competence – The National Center For Cultural Competence in Health Care (NCCC) has developed the webpage Curricula Enhancement Module Series, that contains “Cultural Self-Assessment Resources” and “Tools for Self-Assessment of Cultural and Linguistic Competence.”
■ Cultural Sensitivity Personal Reflection Self-Assessment – This tool was developed to heighten awareness of how one views clients from culturally and linguistically diverse populations (Goode, T., 1989; revised 2002).
■ Cultural Sensitivity Service Directory Self-Assessment – This tool was developed to heighten awareness of how one views clients from culturally and linguistically diverse populations (Goode, T. D.1989, revised 2002).
■ Cultural Competency Challenge – The American Academy of Orthopaedic Surgeons (AAOS) has developed the Cultural Competency Challenge to assist in learning or reinforcing one’s individual knowledge of cultural care issues, without the pressure of an actual patient encounter. It is stated to be particularly useful in a residency setting to teach the next generation of orthopaedists. The CD-ROM program was showcased at their 2005 AAOS Annual Meeting and is offered via the AAOS Diversity in Orthopaedics Web site: http://www.aaos.org/diversity. Contact Dr. Ramon at firstname.lastname@example.org.
■ Color-Blind Racial Attitude Scale (CoBRAS) – The CoBRAS is a 20-item self-report measure. Participants respond utilizing a 6-point Likert-type scale, the scale ranges from 1 (strongly disagree) to 6 (strongly agree). The three subscales which comprise the CoBRAS are Unawareness of Racial Privilege, Unawareness of Institutional Discrimination, and Unawareness of Blatant Racial Issues. Total score which encompasses all three subscales can range from 20 to 120 with higher scores representing more color-blind racial attitudes. Citation: Neville, H. A., Lilly, R. L., Duran, G., Lee, R. M., & Browne, L. (2000). Construction and initial validation of the Color-Blind Racial Attitudes Scale (CoBRAS). Journal of Counseling Psychology, 47, 59-70.
■ Eastern State University’s Office of Cultural Affair – Eastern State University’s Office of Cultural Affair has a comprehensive website on cultural resources that contains a section on “Evaluation.” This section provides information on over 10 cultural assessment tools.
■ Clinical Cultural Competency Questionnaire (CCCQ) – The Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School has developed the Clinical Cultural Competency Questionnaire (CCCQ) for assessing physicians’ knowledge, skills, and attitudes relating to the provision of culturally competent health care to diverse patient populations.
■ Organizational Cultural Competence: Self-Assessment Tools For Community Health and Social Service Organizations – The Centre for Research on Community Services of Centretown Community Health Center at the University of Ottawa produced a report entitled, Organizational Cultural Competence: Self-Assessment Tools For Community Health and Social Service Organizations. The purpose of this report was to identify and review the most relevant assessment tools for the set of organizational cultural competency standards and to make recommendations regarding the future evaluation of organizational cultural competence
■ Clinical Cultural Competency Training Questionnaire (CCCTQ) – Developed by Krajic, Like, Schulze, Strabmayer, Trummer, and Pelikan, the Clinical Cultural Competency Training Questionnaire (CCCTQ) is an adapted version of the CCCQ for a hospital setting. This European Union Migrant Friendly Hospitals initiative tool is translated into 7 languages. (link)
■ The Client Cultural Competency Inventory (CCCI) – The CCCI was developed through a process that incorporated information from focus groups with providers and families, interviews, and a review of relevant research literature. The CCCI is administered via a structured interview. In the field test family members were asked to rate service coordinators by responding to items grouped into four subscales: respect for cultural differences, community and family involvement, appropriateness of assessment and treatment options, and agency services and structure. Results gave evidence of the tool’s usefulness both in assessing cultural competence directly and in providing valuable informational input into a larger process of planning for continuous quality improvement. The research team continues gathering data and refining the CCCI. They are seeking collaborations with communities or organizations that are interested in using the instrument and that are willing to share data so psychometric properties of the scale can be further investigated. For more information, contact Sara Hudson Scholle, Ph.D., Assistant Professor of Psychiatry at the University of Pittsburgh at (412) 624-1703 or email@example.com
■ Health Care Justice Inventory-Provider (HCJI-P) – Developed by Fondacaro et al. (2005), the HCJI-P is an integrated measure of procedural and distributive justice in the health care context. The first portion, Section A, asks participants to describe a visit with their current doctor or other health care provider in the last 12 months in which a decision was made about their health care. Section B asks subjects if the experience they described involved a routine health care visit or an emergency. Section C then includes 28 procedural justice items, which focus on the three facets of procedural justice: Trust, Impartiality, and Participation. Participants would be asked to reflect on the experience they described in Section A while answering these questions. After the procedural justice items, participants were asked to answer eight distributive justice items while focusing on their health care experience. All questions in Section C were rated in a 4-point Likert scale, ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). After the distributive justice items, there were two items asking the participants to rate their satisfaction with their provider using a rating scale ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). Overall, the scale has high internal consistencies, with alphas = .93, .91, and .91 for the subscales Trust, Impartiality, and Participation (Fondacaro et al., 2005). In addition, the scores on each scale range from 0-15. Citation: Fondacaro, M.R., Frogner, B., & Moos, R. (2005). Justice in health care decision-making: Patients’ appraisals of health care providers and health plan representatives. Social Justice Research, 18(1), 63-81.
■ The Global Diversity Survey® – The Global Diversity Survey® is a self-administered, self-scoring tool that prepares you to embark on a journey of self discovery that will help you navigate your way through the diverse global landscape of the 21st Century.
■ The Openness to Diversity and Challenge Scale (ODCS) – The ODCS scale is a seven-item measure assessing an individual’s openness to racial and cultural diversity and the degree to which an individual enjoys being challenged by a variety of perspectives, ideas, and values. The ODCS has internal consistence reliabilities in the present study ranging from .83 to .87. Citation: Pascarella, E., Edison, M., Nora, A., Hagedorn, L. and Terenzini, P. (1996). Influences on students’ Openness to Diversity and Challenge in the First Year of College. Journal of Higher Education, 67(2), 174-195.
■ The Intercultural Conflict Style (ICS) Inventory – A tool for identifying core approaches for resolving conflict across cultural and ethnic differences and is the proprietary instrument of Mitchell R. Hammer Ph.D. (http://www.icsinventory.com/)
■ SIETAR-Europa – The website, SIETAR-Europa, lists an annotated bibliography of over 50 intercultural assessments and instruments.
■ ASK Scale – The ASK scale is a self-evaluation tool to assess cultural competency. Developed by Leung & Cheung, “ASK” (Attitude–Skills–Knowledge) Scale contains 97 items and focuses on assessing three subscales: attitude (A), skill (S), and knowledge (K). A short version of ASK contains 24 items for self-assessment and practice use.Validity and reliability of the ASK instrument were performed by Leung and Cheung . A series of internal consistency reliability tests were performed to examine the reliability. The Cronbach’s alpha of the study was 0.972 suggesting that the items have very high internal consistency. The instrument was validated using factor analyses. Citation: Leung, P., & Cheung, M. (2013). Factor analyzing the “ASK” cultural competency self-assessment scale for child protective services. Children and Youth Services Review, 35, 1993-2002. doi: 10.1016/j.childyouth.2013.09.014
■ Assessment Tools of Intercultural Communicative Competence – Fantini (2006) developed a list of 87 Assessment Tools of Intercultural Communicative Competence. https://cwil.saintmarys.edu/files/cwil/old-content/php/intercultural.learning/documents/feil_appendix_f.pdf
■ Cross-Cultural Diversity Experiences and Attitudes Questionnaire – Developed by Guiton et al. 2007, is a 55-item questionnaire measuring medical students’ background, experiences, and attitudes related to cross-cultural diversity.
■ Quick Discrimination Index (QDI) – Developed by Ponterotto (1995), the QDI is a subject-centered scale that is designed to assess the multidimensional nature of attitudes. The QDI assesses the cognitive component of attitudes directed toward racial minority groups and women and the affective component of attitudes as related to interpersonal comfort in interactions with racially diverse persons. This instrument includes 30 items placed on a 5-point Likert-type scale, in which 1 = strongly disagree, 2 = disagree, 3 = not sure, 4 = agree, and 5 = strongly agree. Citation: Ponterotto, J. G. , Burkard, A. , Reiger, B. P. , Grieger, I. , D’Onofrio, A. , Dubuisson, A., Heenehan, M. , Millistein, B. , Parisi, M. , Rath, J. F. , & Sax, G. (1995). Development and initial validation of the Quick Discrimination Index (QDI). Educational and Psychological Measurement, 55 (6), 1026-1031.
■ Diversity & Cultural Awareness Profile: Online Assessment (CDCAPO) – The CDCAPO, developed by Jon Warner, is a 48 item, online assessment that compares perceptions of the organization’s commitment to cultural diversity against the respondents own commitment to cultural diversity. Both ratings can be compared to a normative “realm of best practice”. Useful from an organization and an individual perspective. Competencies include: Awareness and Climate, Levels of Inclusion, Degree of Empathy, Degree of Adaptation and Change. and Persistence and Commitment. The assessment report also provides coaching tips and development planning templates. (link)
■ The Slope Index of Inequality (SII) – A spreadsheet tool designed to help the user calculate socioeconomic inequalities in health within an area using small area health measures. Based on Low. A. and Low, A. (2004). Measuring the Gap: Quantifying and Comparing Local Health Inequalities. Journal of Public Health Medicine, 26(4):388-396.
■ Intercultural Readiness Check (IRC) – A 60-item questionnaire assessing four key aspects of intercultural competence: intercultural sensitivity, intercultural communication, building commitment and preference for certainty. The IRC has scales for intercultural sensitivity, intercultural communication, intercultural relationship building, conflict management, leadership and tolerance for ambiguity. The instrument has been developed and tested over a period of more than three years. (Van der Zee and Brinkmann, 2004)
■ Intercultural Sensitivity Index (ISI) – Developed by Olson and Kroeger (2001) to measure the global competencies and intercultural sensitivity of individuals and their relationship on individuals’ effectiveness and experience abroad” (Williams, 2005, p.361). The components of this instrument are substantial knowledge, perceptual understanding and intercultural communication.
■ Cultural Assessment Checklist – Developed by Narayan (2003), this assessment tool was written for use by home care nurses to gather the cultural data to impact on a care plan developed for culturally diverse patients. The aim of the assessment is to inform the development of “…a plan of care that is mutually agreeable, culturally acceptable, and potentially capable of producing positive outcomes” (p. 617). Citation: Narayan, M. (2003). Cultural assessment and care planning. Home HealthCare Nurse, 21 (9), 611 – 620.
■ Intercultural Profile – Part of the INCA project, the Intercultural Profile, is a questionnaire containing 21 statements on intercultural situations. It measures tolerance for ambiguity, behavioural flexibility, communicative awareness, knowledge discovery, respect for otherness and empathy. (INCA, 2007).
■ Communication, Curriculum and Culture (C3) Instrument – Developed by Haidet, Adam, and Chou, the purpose of this instrument is to help educators characterize and understand the hidden curriculum at their own institutions. The authors developed survey items to measure three content areas of the hidden curriculum with respect to patient-centered care. These content areas include role modeling, students’ patient-care experiences, and perceived support for students’ own patient-centered behaviors. The survey was distributed to third- and fourth-year students at ten medical schools in the United States. Using factor analysis, the authors selected items for the final version of the C3 Instrument. Citation: Haidet, P., Adam, K. and Chou, C. (2005). Characterizing the Patient-Centeredness of Hidden Curricula in Medical Schools: Development and Validation of a New Measure. Academic Medicine, 80(1), 44-50.
■ Fat Phobia Scale-Short Form (FPS) – Developed by Bacon, Scheltema and Robinson in 2001, this 14-item version of the FPS measures attitudes of prejudice about obese patents. Cronbach’s alpha reliability of 0.91. Citation: Bacon, J., Scheltema, K., and Robinson, B. (2001). Fat Phobia Scale Revised: The Short Form. International Journal of Obesity and Related Metabolic Disorders, 25, 252-257.
■ Prior Cultural Experiences (PCE) – A 24-item summated Likert rating scale piloted in 2012 by Dunagan, Kimble, Gunby and Andrews. Cronbach’s alpha reliability of 0.87. The possible range of scores is 24- 120, with higher scores indicating higher prior cultural experiences Citation: Dunagan, PB, Kimble, LP, Gunby, SS, and Andrews, MM. (2012). Psychometric Evaluation of Tools Measuring Cultural Competence Constructs in Baccalaureate Nursing Students: A Pilot Study. Poster presentation at the Southern Nursing Research Society, New Orleans, L.A.
■ The Cultural Awareness Scale (CAS) – Developed by Rew and others in 2003, this 36-item scale is designed to measure outcomes of a program promoting multicultural awareness. Cronbach’s alpha reliability of 0.91. Citation: Rew, L. Becker, Cookston, J., Khosropour, S. and Martinez, S. (2003). Measuring Cultural Awareness in Nursing Students. Journal of Nursing Education, 42, 249-257.
■ Faculty Engagement with Underrepresented Minority Nursing Students (EFURMS) – The EFURMS scale is a 10-item scale developed By Moreau (2015) that measures faculty engagement with underrepresented minority nursing students. The Cronbach alpha for the EFURMS scale is .81. Principle component factor analysis with varimax rotation revealed a 3 factor solution that explained 66% of the variance in engagement with underrepresented minority students. The Cronbach alpha for the 3 factors ranged from .72-.78. The EFURM scale did not demonstrate ceiling or floor effects, or social desirability bias. More positive scores (higher EFURMS Scores) were associated with older faculty who had been teaching longer and had more experience teaching underrepresented minority students. Citation: Moreau, P. (2015). Development and Psychometric Testing of the EFURMS Scale: An Instrument to Measure Faculty Engagement with Underrepresented Minority Nursing Students. Dissertation: University of Massachusetts Medical School. Graduate School of Nursing Dissertations. Paper 39. http://escholarship.umassmed.edu/gsn_diss/3
■ The Integration of Cultural Competence in Nursing Education (ICCNE) – Piloted by Dunagan, Kimble, Gunby and Andrews, this questionnaire is a 34-item summated Likert scale that measures how experiences directed toward helping students achieve cultural competence are integrated into the student’s nursing program. Possible scores range from 34-170, with higher score indicating that students perceived greater integration of cultural competence in their nursing program. Cronbach’s alpha reliability of 0.93. Citation: Dunagan, PB, Kimble, LP, Gunby, SS, and Andrews, MM. (2012). Psychometric Evaluation of Tools measuring Cultural Competence Constructs in Baccalaureate Nursing Students: A Pilot Study. Poster presentation at the Southern Nursing Research Society, New Orleans, L.A.
■ The Modified Godfrey-Richman ISMS More Perfect Scale (M-GRISMS-M) – Developed BY Godfrey, Richman, and Withers in 2000, this 40 item tool measures attitudes of prejudice around race, gender, sexual orientation, and religion. Cronbach’s alpha reliability of 0.82. Citation: Godfrey, S., Richman, C., and Withers, T. (2000). Reliability and Validity of a New Scale to Measure Prejudice: The GRISMS. Current Psychology, 19, 3-20.
■ The Social Desirability Scale (SDS) – Developed by Jo, Nelson and Kiecker in 1997, this scale controls social desirability bias, which is important in measuring cultural competence, as the social norm is to have positive views about cultural competence. Citation: Jo, M., Nelson, J. and Kiecker, P. (1997). A Model for Controlling Social Desirability Bias by Direct and Indirect Questioning. Marketing Letters, 8, 429-437.
■ Organizational Cultural Competence: A Review of Assessment Protocols – Authored by Harper, M., Mernandez, M., Nesman, T., Mowery, D., Worthington, J., & Isaacs, M. (2006), is a publication that contributes to understanding how cultural competence is currently operationalized and measured at the organizational level. This monograph compares organizational assessment instruments through the following questions: For what type of organization was the instrument developed? How were the instruments developed? How do the authors define cultural competence? What domains do the authors use as categories of analysis? (link)
■ Nurse Cultural Competence Scale (NCCS) – The NCCS contains 41 items subdivided into four constructs: cultural awareness (items 1 to 10), cultural knowledge (items 11 to 19), cultural sensitivity (items 20 to 27), and cultural skills (items 28 to 41). Each item uses a five-point Likert scale to measure participant’s response: 0 = totally disagree, 1 = 25% agree, 2 = 50% agree, 3 = 75% agree, and 4 = 100% agree. The total score ranges from zero to 164. Higher total NCCS scores indicate a higher level of cultural competence. The reported Cronbach’s α was between 0.78 to 0.96 with a composite reliability between 0.79 to 0.89 (Perng, Lin, & Chuang, 2007). Citation: Perng, S. and Watson, R. (2012). Construct validation of the nurse cultural competence scale: a hierarchy of abilities. J Clin Nurs, 21(11–12),1678–1684.
■ Perceived Nurse Cultural Competence Rating (PNCCR) – The PNCCR is a single item researcher developed instrument based on Benner’s Novice to Expert model. The nurses self-report their perceived level as novice, advanced beginner, competent, or proficient to expert by marking what they believed best described their level of cultural competence in nursing care. This method of using a rating based on the concepts of novice to expert has been successfully used by other researchers.
■ Cultural Capacity Scale – A 20-item self-assessment tool consisting of questions pertaining to cultural knowledge (6 items), cultural sensitivity (2 items), and cultural skill (12 items). Citation: Perng, S., Watson, R. (2012). Construct Validation of the Nurse Cultural Competence Scale: A Hierarchy of Abilities. J Clin Nurs, 21:1678-84.
■ Clinical Cultural Competency Questionnaire (CCCQ) – The CCCQ measures the perceived level of pharmacy students’ knowledge, skills, attitudes, and encounters in cross-cultural environments, This Likert scale self-assessment tool consists of 63 items including questions assessing knowledge (16 items), skills (15 items), attitudes (20 items), and encounters (12 items). Citation: Echeverri, M., Brookover, C. and Kennedy, K. (2010). Nine Constructs of Cultural Competence for Curriculum Development. American Journal of Pharmaceutical Education, 74(10). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058454/
■ Cross-Cultural Care Survey – This self assessment survey assesses residents’ attitudes about cross-cultural care, perceptions of their preparedness to deliver quality care to diverse patient populations, and educational experiences and educational climate regarding cross-cultural training. Items include questions regarding training, preparedness in cross-cultural experiences, skillfulness, resources, specialty preparedness and demographics. Citation: Weissman JS, Betancourt J, Campbell EG, et al. (2005). Resident Physicians’ Preparedness to Provide Cross-Cultural Care. JAMA, 294(9), 1058-67.
■ Multicultural Assessment Questionnaire – This Likert scale evaluates achievement of stage 4 of Bennett’s model (acceptance, importance). There are 16 items in this self-assessment tool: knowledge (6 items), skills (6 items), and attitude (4 items). Citation: Crandall, S., George, G., Marion, G, and Davis, S. (2003). Applying Theory to the Design of Cultural Competency Training for Medical Students: A Case Study. Acad Med, 78:588-94.
■ New York Center of Excellence in Cultural Competence: Review of Cultural Assessment Tools – Published in 2010 by the New York Center of Excellence in Cultural Competence at the New York State Psychiatric Institute in 2010, this report consists of several cultural assessment tool to assist organizations and providers in evaluating their level of cultural competence. Cultural assessment tools were only included if the reliability and validity had been evaluated and reported in a peer review publication. https://saidnazulfiqar.files.wordpress.com/2008/04/nyspi-cecc_culturalcompetenceassessment.pdf
Mental Health Assessment Tools
■ Assessment Guidelines and Tools – Developed by the Transcultural Mental Health Centre, this web page lists several cultural assessment tools for mental healthcare professionals. http://www.dhi.health.nsw.gov.au/Transcultural-Mental-Health-Centre/Programs-and-Campaigns/GPs/Cultural-Resource-Kit/Assessment-Guidelines-and-Tools/default.aspx
■ Toolkit for Assessing Cultural Competence in Peer-Run Mental Health Organizations – Working collaboratively with the National Alliance on Mental illness (NAMI) Support Technical Assistance and Resource (STAR) Center, the University of Illinois at Chicago Center developed a cultural competency guidebook and assessment tool for use by mental health peer-run programs and self-help groups nationwide. The guidebook and tool also have applicability for traditional mental health and rehabilitation programs. The project involved the following components: 1)comprehensive review of existing tools for assessing cultural competency in human services organizations; 2) web-based survey of peer-run programs to determine their current needs and practices in delivering culturally competent services and supports; 3) Focus groups and interviews with individuals from diverse backgrounds who attend or staff peer-run organization; 4) Creation of an organizational assessment and accompanying guide for administering the assessment; 5) Formation of a multi-stakeholder, external expert review team to provide feedback on the assessment and administration guide; and 5) Pilot testing the assessment at 9 peer-run organizations to determine the usability of the cultural competency assessment. PDF
■ Bibliography of Cultural and Linguistic Competence Self-Assessment Tools and Supporting Information – This 2009 bibliography was complied by the National Evaluation of Comprehensive Mental Health Services for Children and Their Families Program and is divided into three sections regarding tools/inventories for; 1) clinical and personal assessment; 2) cultural competence of organizations and systems; and 3) cultural competence of training and curricula.
■ Consumer-Based Cultural Competency Inventory Cultural Competency – Rather than a crosscultural measure, this tool was developed for use among subcultures (e.g., Native Americans, Asian Americans) within the American culture. It relies upon third-party (consumer) assessment of the cultural competency of mental health providers. Subscales include: Language fluency, Understanding, indigenous practices, Acceptance of cultural differences, Awareness of patient’s culture, Respectful behaviors, Patient-provider interactions, Consumer involvement and Consumer outreach. Construct validity was evaluated by examining the correlations between each of the 8 subscales as well as by factor analysis. Reliability was assessed using Cronbach‘s alpha for all 52 items (alpha = .91, eta square = .13). Citation: Cornelius, L. J., Booker, N. C., Arthur, T. E., Reeves, I., & Morgan, O. (2004). The validity and reliability testing of a Consumer-Based Cultural Competency Inventory. Research on Social Work Practice, 14, 201-209.
■ Making Children’s Mental Health Successful: Organizational Cultural Competence: A Review of Assessment Protocols – This monograph presents the findings from a review of cultural competence assessment tools designed for the use at the organizational level that focused on health or mental health. The search for assessment tools meeting criteria yielded 45 instruments. A final selection of 17 organizational assessment instruments was examined in this report. Citation: Harper, M., Hernandez, M., Nesman, T., Mowery, D., Worthington, J., & Isaacs, M. (2006). Organizational cultural competence: A review of assessment protocols, FMHI pub. no. 240-2). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children’s Mental Health.
■ Cultural Competence Self-Assessment Questionnaire (CCSAQ) – Developed by James Mason (1995), the CCSAQ is designed to assist service agencies working with children with disabilities and their families in self-evaluation of their cross-cultural competence. The measure is based on the Child and Adolescent Service System Program Cultural Competence Model. This model describes cultural competency in terms of four dimensions: attitude, practice, policy, and structure. This instrument is intended to help service providers and staff at child and family serving agencies to assess their cross-cultural strengths and weaknesses in order to design specific training activities or interventions that promote greater competence across cultures. The Cultural Competence Self-Assessment Questionnaire (CCSAQ) was designed for use in child and adolescent mental health systems.
■ CAMHS CCATool – The Children and Adolescent Mental Health Services (CAMHS) Cultural Competence in Action Tool (CCATool) is a tool that measures the cultural competence of individuals working with children and adolescent mental health services. It is based on the Papadopoulos, Tilki and Taylor’s model of cultural competence. Citation. Papadopoulos, R., Tilki, M. and Ayling, S. (2008). Cultural Competence in Action for CAMHS: Development of a Cultural Assessment Tool and Training. Contemporary Nurse, 28(2), 129-140. Advances in Contemporary Transcultural Nursing 2nd edition.
■ Counseling Self-Estimate Inventory (COSE) – Developed by Larsen et al. (1992) the COSE is designed to measure counselor’s trainee’s expectancy for success in counseling. The COSE defines self-efficacy as one’s belief’s or judgments about his or her capabilities to successfully counsel a client in the near future. This instrument contains 37 items and uses a likert-type 6-point scale of agree-disagree format. The internal consistent is reported at .93. This tool was administered to 213 students enrolled in master’s level counseling courses and the author performed a factor analysis on the resulting responses. Five factors resulted from the analysis. Microskills items refer to course content related to basic counseling and communication skills training. Process items describe an integration of counselor responses when working with a client. The sum of the Difficult Client Behaviors items indicates high self efficacy for dealing with silent or unmotivated clients. Cultural Competence items refer to behaving competently with clients of different ethnic or cultural groups. Awareness of Values items assess counselors’ tendency to impose their values and biases on the client. Citation: Larson, L. M., Suzuki, L. A., Gillespie, K.N., Potenza , M.T., Bechtel, M. A., & Toulouse , A. L.(1992). Development and validation of the Counseling Self-Estimate. Journal of Counseling Psychology, 39(1), 105-120.
■ Build the Field and They Will Come: Multicultural Organizational Development for Mental Health Agencies – Authored by Zetzer and Shockley (2005), this 123-page document is a Multicultural Access and Treatment Demonstration Project at Antioch University funded by The California Endowment. It contains an excellent compilation of strategies to enhance cultural competence in mental health agencies. Pages 8-14 of this document provides readers with an annotated bibliography of several organizational cultural assessment tools. In addition, pages 31-33 consists of an annotated bibliography of several individual cultural assessment tools.
■ Multicultural Personality Questionnaire (MPQ) – The MPQ is a personality questionnaire that measures multicultural effectiveness, with scales on cultural empathy, open-mindedness, social initiative, emotional stability and flexibility (Van Oudenhoven and Van der Zee, 2002).
■ Consolidated Culturalogical Assessment Tool (C-CAT) Tool Kit – The Ohio Department of Mental Health, released the C-CAT, which is a set of dynamic measurement instruments that allow systems and organizations to assess their cultural competence from the perspective of an array of raters. The C-CAT Tool Kit includes the C-CAT instruments, a stand-alone database, and training and promotional materials. The C-CAT Tool Kit was developed in conjunction with mental health consumers, family members, service planners and providers, and the Outcomes Management Group, a Columbus-based management consulting firm. For more information: Multiethnic Advocates for Cultural Competence, Columbus, OH 43215; Phone: (614) 221-7841
■ A Practical Guide for the Assessment of Cultural Competence in Children’s Mental Health Organizations – With support from a federal grant from Child Mental Health Services of the Department of Health and Human Services, the Technical Assistance Center of Judge Baker Children’s Center developed a manual with a list of cultural assessment tools. This manual, A Practical Guide for the Assessment of Cultural Competence in Children’s Mental Health Organizations, authored by Dr. Monica Roizner, is a guide to planning and implementing cultural competence assessments, with brief reviews of 14 assessment tools, resources for post-assessment cultural competence, and contact information. It is useful to agency and program administrators, providers, and human resource personnel, cultural competence trainers, and family members.
■ Culturally Competent Program Annual Self-Evaluation (CC-PAS) – The CC-PAS tool was developed by San Diego County Mental Health to be used by programs to rate themselves as to their current capability for providing culturally competent services. The CC-PAS Protocol is based on expectations and standards recommended by the Cultural Competence Resource Team (CCRT) and endorsed by the Quality Review Council (QRC). PDF
■ The California Brief Multicultural Competency Scale (CBMCS) – The CBMCS can be used by an agency to identify the training needs of the agency staff. It has its own training program that “flows” from the scale. The CBMCS is a likert scale consisting of 21 items representing 4 factors: Multicultural Knowledge: Issues of acculturation, racial/ethnic identity, language, etc.; Awareness of Cultural Barriers: Challenges people of color experience accessing mental health services; Sensitivity to Consumers: What does it mean to be a person of color AND a mental health consumer of services; and Sociocultural Diversities: formerly (Nonethnic Ability) Issues of gender, sexuality, aging, social class, and disability. Cronbach’s Alpha of internal consistency ranges from .90 to .75. Citation: Gamst, G., Dana, R., Der-Karabetian, A., Aragon, M., Arellano, L., Morrow, G. & Martenson, L. (2004). Cultural Competency Revised: The California Brief Multicultural Competency Scale. Measurement and Evaluation in Counseling and Development, 37(3),163-187. (link)
■ Compendium of Culturally-Sensitive Assessment Tools and Inventories – The West Australian Transcultural Mental Health Centre took part in a project that developed the Compendium of Culturally-Sensitive Assessment Tools and Inventories. This project aims to assist clinicians in assessing the mental health of people from culturally and linguistically diverse backgrounds.
■ Consumer Based Cultural Competency Inventory – Cornelius and colleagues developed a 52-item consumer assessment instrument of the cultural competency of mental health providers. Following a 2-year, community-driven instrument development process, this consumer assessment tool was administered to 238 African American, Latino, and Vietnamese American mental health consumers across the state of Maryland. The overall instrument had a Cronbach’s alpha of .92. Research on the tool is published in the following citation: Cornelius, L., Booker, N., Arthur, T., Reeves, I. and Morgan, O. (2004). The validity and reliability testing of a consumer-based cultural competency inventory. Research on Social Work Practice, 14(3):201-9.
■ Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations – This document is written by Drs. Athey and Moody-Williams. This guide includes two sections and six appendices. Section One explores the nature of culture and disaster and discusses cultural competence in the context of disaster mental health services. Section One also presents the Cultural Competence Continuum and a list of questions to address in a disaster mental health plan. Section Two sets forth nine guiding principles for culturally competent disaster mental health services and related recommendations for developing these services. The appendices provide an annotated bibliography of cultural competence resources and tools as well as a Cultural Competence Checklist for Disaster Crisis Counseling Programs.
■ State Mental Health Agency Cultural Competence Activities Assessment – This assessment was developed by the National Association of State Mental Health Program Directors and the National Technical Assistance Center for State Mental Health Planning based on discussion at two expert meetings. The assessment consists of questions appropriate for state mental health agencies in ten areas of cultural competency. The categories include the Commissioner’s Personal Leadership, Staff and Stakeholder Commitment, Responsibility for Cultural Competence, Cultural Competence Advisory Committee, Organizational Self-Assessment, Data Analysis, Cultural Competence Plan, Linguistic Competence, Standards and Contractual Requirements, and Resources.
■ Cross-cultural Counseling Inventory – Revised (CCCI-R) – CCCI-R was originally created as an 18-item scale used by learners to rate the behavior of a counselor in a short video of a counseling session. The developers of the instrument suggest that it is best used for providing feedback during training – by faculty, peers, and clients – during simulated or actual counseling sessions, and as a self-assessment tool. This instrument has been cited in more than 75 scientific articles. Citation: LaFromboise, T. D., Coleman, H. L. K., & Hernandez, A. (1991). Development and factor structure of the Cross-cultural Counseling Inventory – Revised. Professional Psychology: Research and Practice, 22(5): 380-88.
■ Cultural Competence Checklists – The American Speech-Language-Hearing Association (ASHA) developed a series of checklists to heighten one’s awareness of providing services to culturally/linguistically diverse (CLD) populations. These checklists include: 1) Personal Reflection; 2) Policies & Procedures; and 3) Service Delivery.
■ Multicultural Counseling Awareness Scale (MCAS) – The MCAS, a revision of the MCAS: B, is a 32-item self-report measure that assesses respondents’ knowledge and awareness of multicultural competency. The instrument was developed for use by counselors and has been tested on both professional and trainee populations. Citation: Ponterotto, J. G., Gretchen D., Utsey, S. O., Rieger, B. P., & Austin, R. (2002). Revision of the Multicultural Counseling Awareness Scale. Journal of Multicultural Counseling and Development, 30: 153-80.
■ Multicultural Awareness-Knowledge-and Skills Survey – Counselor Edition- Revised (MAKSS-CE-R) – The MAKSS-CE-R is a self-assessment instrument that is based on the MAKSS instrument, developed in 1990 which consisted of 60 self-report items on three subscales of knowledge, skills and awareness. The MAKSS-CE-R was revised in 2003 to assess the impact of training on learners’ multicultural counseling competence. The MAKSS-CE-R now consists 33 items (10 items each for the Awareness and Skills subscales and 13 items for the Knowledge subscale) Citation: Kim, B. S. K., Cartwright, B. Y., Asay, P. A., & D’Andrea, M. J. (2003). A revision of the Multicultural Awareness, Knowledge, and Skills Survey-Counselor Edition. Measurement and Evaluation in Counseling and Development, 36: 161-80.
■ Multicultural Counseling Competence and Training Survey (MCCTS) – Developed by authors Holcomb-McCoy & Myers in 1999, the MCCTS is a self-report instrument containing 32 behaviorally stated items and 29 items that require participants to provide information regarding their entry-level counseling training experiences and demographics such as gender, age, race, and year of graduation. These authors assert that there were five factors underlying the multicultural counseling competence items of the MCCTS: Multicultural Knowledge, Multicultural Awareness, Multicultural Terminology, Knowledge of Racial Identity Development Theories, and Multicultural Skills. In the calculation of internal consistency reliability coefficients (Cronbach’s alpha) for the instrument, alphas of .92, .92, .79, .66, and .91 were derived for the Multicultural Knowledge, Multicultural Awareness, Multicultural Terminology, Racial Identity, and Multicultural Skills subscales, respectively (the somewhat lower reliability coefficient for the Racial Identity subscale.
■ MHA/MHP/CCAG – The Mental Hygiene Administration/Maryland Health Partners (MHA/MHP) Cultural Competency Advisory Group (CCAG) developed a 52-item scale (still in progress) to assess clients’ perceptions of the Public Mental Health System. Statistical analysis identified four core domains assessed by the instrument: as 1) the ability to tune into psycho-social, medical, and spiritual needs; 2) the accessibility of services and the willingness to negotiate on priorities for care; 3) efforts to reach out to racially diverse communities; and 4) the willingness to listen to and respect people in recovery from various cultures. Citation: T. E., Reeves, I., Morgan, et al. (2005). Developing a Cultural Competence Assessment Tool for People in Recovery From Racial, Ethnic and Cultural Backgrounds: The Journey, Challenges, and Lessons Learned. Psychiatric Rehabilitation Journal, 28(3): 243-50.
■ Personal Cultural Perspective Profile (PCPP) – Developed by Ramsey (1994), is a 14 item cultural continua which emphasizes the concept of personal culture in a way that helps counselors recognize personal biases and potential areas of conflict in cross-cultural interactions. Additionally, the purpose of this tool is to help counselors recognize that culture is not external to themselves, and helps to combat cultural group stereotyping (p. 283).Citation: Ramsey, M. (1994). Use of a Personal Cultural Perspective Profile (PCPP) in developing counselor multicultural competence. International Journal for the Advancement of Counseling, 77(4), 283-290.
■ The Cultural Competency Standards and Audit Tool (the Tool) – The Tool was developed and produced by the Multicultural Forum for Mental Health Practitioners. This Western Australia based group of mental health clinicians was a policy and advisory group to the state’s mental health directorate on issues concerning service development and provisions for Western Australia’s Culturally and Linguistically Diverse (CALD) mental health consumers. The central objective of the Tool is to ensure that the organizational culture and practice of mental health services effectively accommodates Western Australia’s growing multicultural population. The Performance Measures in the Tool were designed to have three functions: to measure the extent to which services can achieve the Cultural Competency Standards; to guide services in how to strive for best practice and quality-assured service provisions to CALD communities; and to assist services in implementing cultural competency initiatives at all levels. Copies of the Cultural Competency Standards and Self-Assessment Audit Tool may be obtained from the Mental Health Division, Department of Health, Western Australia – 08 9222 4222.
■ Multicultural Counseling Inventory (MCI) – The MCI consists of 43 self-report items that assesses multicultural competencies on a 4-point Likert scale (1 = very inaccurate; 4 = very accurate) asking the respondent to indicate the degree to which the scale items describe their work as counselors/trainers. The MCI is based on a conceptual framework from Sue et al. (1982) on multicultural counseling competencies on the following four subscales: Awareness (ten items measure multicultural sensitivity, interactions, and advocacy in general life experiences and professional activities); Knowledge (eleven items measure treatment planning, case conceptualization, and multicultural research); Skills (fourteen items measure general and specific multicultural skills); and Relationship (eight items measure the interaction process with the minority patient e.g., comfort level, world view, and trustworthiness). Citation: Sodowsky, G., Taffe, C., Gutkin, T. & Wise, S. (1994). Development of the Multicultural Counseling Inventory (MCI): A self-report measure of multicultural competencies. Journal of Counseling Psychology, 41, 137-148.
■ Client Cultural Competence Inventory – Developed by Switzer (1998), this author asserts that prior efforts to assess cultural competence of mental health services have focused exclusively on agency providers and individual mental health professionals rather than on clients’ perceptions of care. Therefore, he introduced the Client Cultural Competence Inventory, which has several advantages over other cultural competence measures including its (a) lower susceptibility to social desirability bias, (b) ability to assess attitudes concerning a broader range of therapists, providers and plans, and (c) focus on clients rather than the psychiatric community as the central force in determining cultural competence. Preliminary psychometric analyses of the inventory are presented from data gathered in a group of parents with children who are severely emotionally disturbed. Citation: Switzer. G., Scholle, S., Johnson, B. and Kelleher, K. (1998). The Client Cultural Competence Inventory: An Instrument for Assessing Cultural Competence in Behavioral Managed Care Organizations. Journal of Child and Family Studies, 7(4). Contact: firstname.lastname@example.org
■ Siegel, C., Chambers, E. D., Haugland, G., Bank, R., Aponte, C., McCombs, H. (2000). Performance measures of cultural competency in mental health organizations. Administration and Policy in Mental Health, 28(2), 91-106.
The authors utilized numerous documents created by advisory groups, expert panels and multicultural focus groups to develop performance measures for assessing the cultural competency of mental health systems. To provide a national perspective, the focus groups–a total of 134 consumers, family members, advocates and providers–met in locations across the country: New York, Florida, South Carolina, South Dakota, and California. Competency was measured within three levels of organizational structure: administrative, provider network, and individual caregiver. Indicators, measures and data sources for needs assessment, information exchange, services, human resources, plans and policies, and outcomes were identified. Procedures for selection and implementation of the most critical measures are suggested. The products of this project are broadly applicable to the concerns of all cultural groups.
■ Siegel, C., Haugland, G., Chambers, E.D. (2003). Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery. Administration and Policy in Mental Health, 31(2), 141-170.
These benchmarks were developed in response to a concern among consumers of mental health services that the services offered by behavioral healthcare organizations may not be responsive to the special needs of multicultural populations. It describes a two-phase project to recommend and benchmark performance measures that could make these concerns specific and to measure organizational responses. The project focused on the articulated concerns of the four major racial/ethnic groups in the United States: African American, Hispanic American, Asian American, and American Indian.
■ Multicultural Counseling Self-Efficacy Scale – Racial Diversity (MCSE-RD) – Developed and validated by Hung-bin (2005), the MCSE-RD is designed to assess the helping professional’s perceived abilities in providing individual counseling to racially diverse clients. Data were collected from 181 graduate students in counseling-related programs. Results of an exploratory factor analysis retained 37 items and indicated that the MCSE-RD consists of three underlying factors. The MCSE-RD subscale and total scores showed adequate internal consistency and test-retest reliabilities. Also, convergent and discriminant validity was initially supported by differential relations of MCSE-RD scores to general counseling self-efficacy, multicultural counseling competency, and social desirability. Finally, the MCSE-RD scores correlated significantly with demographic variables and educational/training backgrounds. In conclusion, psychometric properties of the MCSE-RD were initially supported by findings of the study This research can be found at: http://drum.lib.umd.edu/bitstream/handle/1903/2337/umi-umd-2186.pdf;jsessionid=A653FDC86A5A794E1CF922D19420399F?sequence=1
Review Articles On Cultural Assessment Tools
■ Cultural Competence of Healthcare Providers: A Systematic Review of Assessment Instruments. This study reviews the psychometric properties of the several instruments that are used regularly to assess the cultural competence of healthcare providers. Researchers conducted a systematic review of the relevant articles that were published between 1983 and 2013 and ten instruments from these articles were identified and analyzed. The six cultural dimensions addressed by these instruments were attitudes, knowledge, skills, behaviors, desires, and encounters. The subscales explained 33%-90% of the variance in scores for eight of the instruments. The reliability of the 10 instruments was estimated based on the internal consistency, which ranged from .57 to .97. The findings of this review indicate that no single instrument is adequate to evaluate cultural competence in all contexts. Citation: Lin, Chia-Jung, L., Chia-Kuei, L., and Mei-Chih, H. (2017). Cultural Competence of Healthcare Providers: A Systematic Review of Assessment Instruments. Journal of Nursing Research, 25(30, 174-186. Available from: https://www.researchgate.net/publication/304009290_Cultural_Competence_of_Healthcare_Providers_A_Systematic_Review_of_Assessment_Instruments
■ Translation, Adaptation and Validation of Instruments or Scales for use in Cross-Cultural Health Care Research: A Clear and User-Friendly Guideline –These authors assert that researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. Citation: Sousa, V. D., .& Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, 17, 268-274.
■ Cultural Competence Models and Cultural Competence Assessment Instruments in Nursing A Literature Review – In this article, the author reviews cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982. Both models and instruments were examined in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation. Most models were not empirically tested; only a few models developed model-based instruments. About half of the instruments were tested with varying levels of psychometric properties. Other related issues were discussed, including the definition of cultural competence and its significance in model and instrument development, limitations of existing models and instruments, impact of cultural competence on health disparities, and further work in cultural competence research and practice. Citation: Shen, Z. (2015).Cultural Competence Models and Cultural Competence Assessment Instruments in Nursing A Literature Review. Journal of Transcultural Nursing, 26(3), 308-321.
■ Index of Health Professions Education Assessments Professionalism Competency 5.5: Demonstrate sensitivity and responsiveness to diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation – Authors Palladino, Halbert, Blake, and Davies, in 2012, published an extensive review of the literature on assessment tools that look at the broad concept of cultural competence, which includes diverse patient population, as well as diversity in other areas–such as diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Citation: Palladino, C., Halbert, J., Blake, L., and Davies, K. (2013). Professionalism Competency 5.5: Demonstrate sensitivity and responsiveness to diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation A collaborative project of the Medical College of Georgia at Georgia Regents University Educational Innovation Institute, the University of Texas System Transformation in Medical Education (TIME) initiative. https://www.mededportal.org/download/359092/data/5.5.pdf
■ Studies of Diversity & Multiculturalism –Compiled by Dr. Dena Pastor of James Madison University (JMU), this 2009 document summarizes studies conducted by faculty and graduate students in the Center for Assessment and Research Studies for the purposes of exploring: (a) the attitudes, feelings, behaviors, beliefs, and thought process of JMU students as they relate to diversity and multiculturalism and (b) the psychometric properties of instruments used to measure such characteristics. Citation: Pastor, D. (2009). Studies of Diversity and Multiculturalism. James Madison University, The Center For Assessment and Research Studies. http://chbs.jmu.edu/documents/JMU%20Studies%20of%20Diversity%20%20%20Multiculturalism%20CARS.pdf
■ Maryland Cultural, Linguistic and Health Literacy Competency Strategies: A Policy Framework for 2013-2020 – This document is a result of a cultural competency workgroup report co-chaired by Lisa Cooper, James Fries, and Marcos Perquera in 2013, which includes a review of organizational assessment tools and/or bibliographies of tools. Citation: Cooper, L. and Fries, J. (2013). Maryland Cultural, Linguistic and Health Literacy Competency Strategies: A Policy Framework for 2013-2020. http://msa.maryland.gov/megafile/msa/speccol/sc5300/sc5339/000113/019000/019542/unrestricted/20140637e.pdf
■ Measures of Cultural Competence in Nursing: An Integrative Review – This article presents an integrative review of instruments used to measure cultural competence in nursing students and nursing professionals. Citation: Loftin, C., Hartin, V., Branson, M., and Reyes, H. (2013). Measures of Cultural Competence in Nursing: An Integrative Review. The Scientific World Journal. http://www.hindawi.com/journals/tswj/2013/289101/
■ Identification of Nursing Assessment Models/Tools Validated in Clinical Practice For Use With Diverse Ethno-Cultural Groups: An Integrative Review of the Literature – This article discusses an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care. Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized. Citation: Higginbottom, G., Richter, M., Mogale, R., Ortiz, L., Young, S., and Mollel, O. (2011). Identification of Nursing Assessment Models/Tools Validated in Clinical Practice For Use With Diverse Ethno-Cultural Groups: An Integrative Review of the Literature. BMC Nursing 2011, 10:16.
■ The Need for a Standardized Evaluation Method to Assess Efficacy of Cultural Competence Initiatives in Medical Education and Residency Programs – This article authored by Chun and Takanishi (2009) maintain the need for valid, uniform evaluation methods for assessing cultural competency in healthcare delivery. This article discusses existing evaluation efforts and makes suggestions regarding future development of such tools. Citation: Chun, M. and Takanishi, D. (2009). The Need for a Standardized Evaluation Method to Assess Efficacy of Cultural Competence Initiatives in Medical Education and Residency Programs. Hawaii Medical Journal, 68 (1).
■ Review of Multidisciplinary Measures of Cultural Competence for Use in Social Work Education – Krentzman, A. and Townsend, A. (2008) sought measures of cultural competence from as many sources as possible and found a total of 19 measures/ instruments that met the inclusion criteria for this analysis. The tools were developed between 1986 and 2005. They come from various disciplines including social work, counseling psychology, college student affairs, pharmacy, nursing, medicine, applied health, allied health sciences, and education. All were written in the United States except for one developed in the United Kingdom. This article provides an excellent review of these tools. Citation: Krentzman, A. and Townsend, A. (2008). Review of Multidisciplinary Measures of Cultural Competence for Use in Social Work Education. Journal of Social Work Education, 44(7), 7-31.
■ Cultural Competence Education Resource Toolkit – Developed by Dr. Marianne R. Jeffreys, this toolkit features: 23 distinct tools, resources for academic settings, resources for health care institutions, and resources for professional associations. Information available at http://www.mariannejeffreys.com/culturalcompetence/newtoolkit.php
■ Measures of Cultural Competence: Examining Hidden Assumption – This article, authored by Kumas-Tan et. al (2007), critically examines the quantitative measures of cultural competence most commonly used in medicine and in the health professions and identifies underlying assumptions about what constitutes competent practice across social and cultural diversity. Citation: Kumas-Tan, Z., Beagan, B., Loppie, C., MacLeod, A. and Frank, B. (2007). Measures of Cultural Competence: Examining Hidden Assumptions. Academic Medicine. 82(6), 548-557.
■ Self-Administered Instruments to Measure Cultural Competence of Health Professionals: A Systematic Review – Gozu (2007) and colleagues systematically reviewed articles published from 1980 through June 2003 that evaluated the effectiveness of cultural competence curricula targeted at health professionals by using at least one self-administered tool. They included 45 articles in their review comprising a total of 45 unique instruments (32 learner self-assessments, 13 written exams) that were used in the 45 articles. They concluded that most studies of cultural competence training used self-administered tools that have not been validated. Citation: Gozu, A., Bass, E., Powe, N., Cooper, L., Beach, M., Price, E., Gary, T., Robinson, K., Palacio, A., Smarth, C., Jenckes, M. and Feuerstein, C. (2007). Self-Administered Instruments to Measure Cultural Competence of Health Professionals: A Systematic Review. Teaching and Learning in Medicine, 19(2), 180-190.
■ Multicultural Competency Instrumentation: A Review and Analysis of Reliability Generalization – This article critiques 800 multicultural articles in order to identify multicultural competency instruments mainly related to mental health and counseling. Citation: Dunn, T., Smith, T. and Montoya, J. (2006). Multicultural Competency Instrumentation: A Review and Analysis of Reliability Generalization. Journal of Counseling & Development, 84, 471-482.