Application:
The Inventory For Assessing The Process Of Cultural Competence Among Healthcare Professionals- Revised (IAPCC-R) is a tool 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/students and allied health professions.

Description:
The IAPCC-R© is a pencil/paper self-assessment tool that measures one’s level of cultural competence in healthcare delivery. It consists of 25 items that measure the five cultural constructs of desire, awareness, knowledge, skill and encounters. There are 5 items that address each construct. The IAPCC-R© uses a 4-point likert scale reflecting the response categories of strongly agree, agree, disagree, strongly disagree; very aware, aware, somewhat aware, not aware; very knowledgeable, knowledgeable, somewhat knowledgeable, not knowledgeable; very comfortable, comfortable, somewhat comfortable, not comfortable; and very involved, involved, somewhat involved, not involved. Completion time is approximately 10 -15 minutes. Scores range from 25 -100 and indicate whether a healthcare professional is operating at a level of cultural proficiency, cultural competence, cultural awareness or cultural incompetence. Higher scores depict a higher level of cultural competence. The IAPCC-R has been translated into Swedish, Hebrew, German, Spanish, Korean, Finnish, French, and Japanese.

Development of the Instrument:
The IAPCC-R© was developed by Dr. Campinha-Bacote in 2002. It is a revision of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC). The IAPCC, which is no longer available for use, was developed by Campinha-Bacote in 1997 and is based on her model of cultural competence, The Process of Cultural Competence in the Delivery of Healthcare Services (1998). Cronbach’s alpha of the IAPPC© was established at .81 (Wilson, 2003). The IAPCC only measured four of the five constructs of this model (cultural awareness, cultural knowledge, cultural skill and cultural encounters) and not the fifth construct of cultural desire. In 2002, Campinha-Bacote revised the IAPCC, by adding five additional questions to measure the fifth construct of cultural desire. This revision led to the instrument’s final name, IAPCC-R. Further research was conducted on IAPCC-R© to be used with students and a student version (IAPCC-SV) is currently available (order form).

Obtaining a Copy Of The IAPCC-R For Review Purposes Only:
The IAPCC-R© is available for review by purchasing one hard copy of the tool (order form).  Please attach a formal letter of request along with your payment and order form. There are additional requirements and a fee associated with use of the IAPCC-R© beyond a review of the tool (see Permission To Use IAPCC-R© and Cost of Using IAPCC-R©).

Permission to Use IAPCC-R in A Study/Project:
The IAPCC-R is copyrighted and formal permission and a fee is required before the tool can be used. To obtain permission to use the IAPCC- R, please mail (no fax/email) your request to Dr. Josepha Campinha-Bacote at 11108 Huntwicke Place, Cincinnati; Ohio 45241. In your request, please include the title of your project, purpose, target population, specific time frame of use (specific dates), method of administration (personally hand-administered or non-hand-administered), study design (i.e. one-time testing or pre/post test design) and a money order (US Dollars only) or check (US Dollars and drawn from a US Bank) for fees associated with your method of administration (see Cost of Using IAPCC-R). Dr. Campinha-Bacote will return a letter granting permission to use the tool, articulate specific terms regarding use of the tool and include the number of tools if being used in a hand-administered pencil/paper format or internal/external mailings. Only one copy of the tool will be provided if the request is for online/electronic administration or to be translated. You can utilize this copy for conversion into an electronic format or to translate, if granted permission, into another language for the designated time granted.

Permission to Submit IAPCC-R for A Proposal (I.E., Institutional Review Board, Research Committee, Academic Proposal):
The IAPCC-R is copyrighted and formal permission and a fee is required before the tool can be submitted in a proposal. To obtain permission to use the IAPCC- R, please mail (no fax/email) your request to Dr. Josepha Campinha-Bacote at 11108 Huntwicke Place, Cincinnati; Ohio 45241. In your request, please include the title of your project, specific time frame you plan to submit the tool in the proposal, method of administration (personally hand-delivered to the committee or non-hand-delivered, which includes all other formats; such as electronic submission, internal/external mailings, etc.), and a money order (US Dollars only) or check (US Dollars and drawn from a US Bank) for fees associated with your method of your submission (see Cost of Using IAPCC-R). Dr. Campinha-Bacote will return a letter granting permission to use the tool, articulate specific terms regarding use of the tool and include the number of tools requested. Only one hard copy of the tool will be provided if the request is for online/electronic administration.

Permission to Translate IAPCC-R:
A formal letter of request is required to translate the IAPCC-R into another language, with the understanding that: 1) there will only be one copy of the IAPCC-R that will be sent for translation when permission is granted and the researcher must pay, in advance, for the number of translated copies that will be used in the study; 2) there must be psychometric rigor in translating each of the items on the IAPCC-R to its original meaning; 3) the translated copy must be sent to Dr. Campinha-Bacote; 4) the name of the tool and Dr. Campinha-Bacote’s name as the author of the tool is to be put on all translated versions exactly as it appears on the English version; 5) Dr. Campinha-Bacote will retain the copyright ownership of all translated versions of the IAPCC- R; and 6) the translated version of the IAPCC-R is for a one-time use and any further/future use of the translated version in any studies, publications, presentations or any other use, cannot be done without first seeking and obtaining written permission from Dr. Campinha-Bacote.

Cost of Using IAPCC-R:
There is a fee of $8.00 per tool when personally hand-administered in a pencil/paper format for research studies, grants, projects or in any onsite pencil/paper distribution to a group of subjects/participants. In this personally hand-administered format the IAPCC-R is to be personally (face-to-face) hand-distributed to each subject/participant and then personally collected immediately following the subjects’/participants’ completion of the IAPCC-R. For example, if you are assessing 20 subjects/participants in a hand-administered format the cost would be $160 plus shipping and handling. Please note that the fee is for the number of tools distributed to complete the study; not necessarily the number of subjects/ participants in the study. Therefore, if you are conducting a pre/post test design with 20 subjects and testing the subjects/participants before and after an intervention, such as an educational program, you will need to double the amount of tools (40 tools) as the number of participants and the cost would be $320 plus shipping and handling. There is a fee of $20 fee per subject access when non-personally hand-administered in all other formats (e.g., electronically; internal or external mailing; online secure format for a training program, in-service educational program, academic course or continuing education offering; an external postal mailing offsite or internal mailing distribution) or any form of administration that is not personally hand-administered to each subject/participant and then personally collected immediately following the subjects’/participants’ completion of the IAPCC-R. Fees associated with this tool are for a one-time use per aggregate distribution in one study and not for unlimited use. Permission is required for further use of the IAPCC-R in any additional projects related or unrelated to its initial use. Please use an order form when purchasing the IAPCC-R (order form).

Noelia Delicado, N. and Wosinski, J. (2014). La perception du niveau de compétence culturelle parmi des infirmières en contexte de soin aux enfants migrants et à leur famill. (2014).
Contact: j.wosinski@ecolelasouce.ch
This study aims to identify factors determining the development of cultural competency of nurses in taking care of migrant children and their families. In order to achieve this, the questionnaire “Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R)” developed by Campinha-Bacote (2014) translated into Swiss French. The questionnaire was submitted to a process of translation and back translation under supervision of the author. The instrument was translated by an inverted method Double (back-to-back) in eight stages (May et al., 2008): 1) translation from French to English by two bilingual caregivers, 2) harmonization of the two versions 3) translation from French to English by two bilingual caregivers, 4) harmonization of the two versions, 5) harmonization of four translations, 6) pilot test (ten pediatric nurses working in other services), 7) adaptation and verification steps, 8) sent to the author for approval. Cronbach’s alpha for all items is 0.68.

Kardong-Edgren, S., Cason, C., Brennan, A., Reifsnider, E., Hummel, F., Mancini, M. and Griffin, C. (2010). Cultural Competency of Graduating BSN Nursing Students.
Contact: sedgren@wsu.edu
The purpose of this study was to evaluate the program outcomes of six undergraduate nursing programs regarding cultural competency. The IAPCC-R was used to assess 515 graduating nurses from six different BSN programs. The IAPCC-R evidenced good reliability across almost all respondents (Cronbach’s alpha = .81).

Köck, S. (2009). Measurement of Cultural Competence in Nursing. Vienna University, Austria.
Contact: sabine.koeck-hodi@univie.ac.at
The study examines existing cultural assessment tool that could be implemented in Austria to measure of healthcare professionals. Out of nine tools examined, the IAPCC-R was selected as a viable tool. The author translated and modified the IAPCC-R into German. This study also describes the in-depth translation process. PDF

Hazan-Hazoref, R. and Uram, L. (2009). The Cultural Competence of Nursing School Educators. Kaplan Academic School of Nursing, Israel.
Contact: lynnuram@netvision.net.il
The study assessed the level of cultural competence of 87 nursing school educators who attended an annual Nurse Educators of Israel conference in the north of Israel. Cultural competence was assessed by using the IAPCC-R that was translated into Hebrew. Cronbach’s alpha of the Hebrew version of the IAPCC-R was .76.

Giles, E. (2008). Application of the Interactional Model of Cultural Diversity to Identify Diversity Climate Factors Associated With Organizational Effectiveness in Accredited U.S. Physical Therapists Education Programs. Old Dominion University, Norfolk, VA.
Contact: egiles@odu.edu
The purpose of this study was to evaluate the effectiveness of the Interactional Model of Cultural Diversity (IMCD, Cox, 1993) as a theoretical framework to identify diversity climate factors associated with organizational effectiveness in accredited U.S. physical therapist education programs. A descriptive, cross-sectional design was used to examine two constructs of the theoretical framework. A total of 151 programs RR=83.9%) participated in the study. Key informants were academic coordinators/directors of clinical education (N=151). Cronbach’s alpha coefficients were .82 for the IAPCC-R (Campinha-Bacote, 2002) and .78 for the perception of diversity climate survey adapted from The Ethnicity Subscale of The Diversity Survey (Brinkman et al, 1992).

Capell, J., Dean, E. and Veenstra, G. (2008). The Relationship Between Cultural Competence and Ethnocentrism of Health Care Professionals. University of British Columbia, Vancouver, BC, Canada.
Contact: jencapell@gmail.com
The study examined the relationship between cultural competence and ethnocentrism among 27 physical therapists, 18 occupational therapists and 26 nurses (N=71). The IAPCC-R and Generalized Ethnocentrism Scale were used resulting in an inverse relational between cultural competence and ethnocentrism. Cronbach’s alpha of IAPCC-R was alpha =.80.

Kawashima, A. (2008). Study on Cultural Competency of Japanese Nurses. Dissertation, George Washington University, Fairfax, VA. TN. Contact: asaseri@gmail.com (Study conducted in Japan).
The purposes of this study were: 1) to examine the level of cultural competency reported by Japanese nurses; 2) to examine the level of critical thinking depositions (CTDs) reported by Japanese nurses; 3) to examine the relationship between nurses’ cultural competency and their CTDs; and 4) to examine the relationship between nurses’ cultural competence and selected demographic and personal factors. The study included a sample of 1,035 Japanese nurses. Cultural competency levels were measured by using the Japanese version of Campinha-Bacote’s Inventory for Assessing the Process of Cultural Competency among Healthcare Professionals-Revised (IAPCC-R). To ensure the quality of the IAPCC-R after translation, the forward-backward translation procedure was used. Cronbach’s alpha for the Japanese version of the IAPCC-R was .717. The Japanese version of the California Critical Thinking Disposition Inventory (CCTDI) was employed to measure nurses’ levels of CTDs. The findings indicated that nurses mostly perceived that they were only at a “culturally aware” level according to the IAPCC-R. The findings further indicated that subscales of CCTDI including inquisitiveness, open-mindedness, self-confidence, systematicity, and maturity were predictors of nurses’ cultural competency.

Jirwe, M. (2008). Cultural Competence in Nursing. Karolinska Institutet, Department of Nursing, Sweden. Contact: helen.olt@ki.se

Wilbur, V. (2008). Factors That Influence the Cultural Competence of Nurse Practitioner Students. Dissertation Widener University Chester, PA.
Contact: veronica.f.wilbur@wilmu.edu
The purpose of this descriptive study was to explore the extent to which age, gender, race, number and type of cultural diversity courses, cultural encounters, and perceived level of cultural competence of nurse practitioner students predicted cultural competence. The IAPCC-R was administered to 196 graduate nurse practitioner students from 20 nurse practitioner programs across the United States. Reliability of the IAPCC-R indicated a Cronbach’s alpha of .80

Noble, L. (2007). Effect of a Cultural Competence Educational Intervention on Pediatric Residents. Mount Sinai School of Medicine, Elmhurst Hospital Center, New York.
The purpose of this study was to measure the effectiveness of an educational intervention and testing of a breastfeeding curriculum for the residents to increase general cultural competence of pediatric residents. Twenty five pediatric residents participated in the study, Cronbach Alpha was .82. The residents scores increased significantly from 70+6 to 77+8, p=.009. Posttest scores were higher on cultural knowledge (13+2 vs. 12+2, p=.015), skill (16+3 vs. 14+2, p=.012) and encounters (15+2 vs. 13+1, p=.006), but not on awareness or desire. Recommendation is to incorporate cultural competence educational content into the pediatric residency curriculum.

Morris, I. (2007). Factors Influencing Bachelor of Science in Nursing Students’ Perceptions of Eldercare Cultural Self-Efficacy.
Contact: jencapell@gmail.com
The Eldercare Cultural Self-Efficacy Scale (ECSES) (Shellman, 2003) and the Inventory for Assessing the Process of Cultural Competence-Revised (Campinha-Bacote, 2002) were used to evaluate student self-efficacy. A pre-course demographic questionnaire provided insight to student characteristics and a post-course demographic questionnaire provided information regarding the clinical experiences during a senior level community health course and how these experiences impacted participant perception of self-efficacy. Study reveals validity of the IAPCC-R as compared to the ECSES.

Kardong-Edgren, S. (2007). What Kind of Curricula Produce the Most Culturally Competent BSN Graduates. Washington State University.
Contact: sedgren@wsu.edu
The purpose of this descriptive study was to discover what kind of curriculum produced the most culturally competent new graduate. The IAPCC-R was used as the posttest design to measure and compare the cultural competency of 559 graduating nursing students from six different nursing programs through the United States. Each program employed a different curricula methodology for teaching cultural competency. Across all respondents, the IAPCC-R evidenced good reliability (Cronbach’s alpha of .81).

Olt, H. and Emami, A. (2006). Linguistic and Cultural Translation and Validation of a Cultural Competence Instrument. Karolinska Institutet, Department of Nursing, Sweden.
Contact: helen.olt@ki.se
In order to measure cultural competence among students, lecturers and registered nurses, a translation into Swedish was done of the IAPCC-R. The aim of this study was to describe and analyze the translation process and the validation of this instrument: IAPCC-R. The study was divided into three sub-studies. The results from the validity tests gave contradictory results, which highlighted the need for different types of validity testing. In conclusion, these sub-studies show that the problem appeared to be related to the construction of the original instrument and its content of cultural competence.

Raija Huttunen, R. (2006). The Cultural Competence of Health Care Workers Who Take Gynaecological Samples. University of Kuopio, Finland.
The purposes of this study were: (1) to describe the experiences and the ideas of cultural competence of the health care workers who take gynaecological samples from immigrant women by using Campinha-Bacote’s model of cultural competence; (2) to give account of the competence and knowledge level of health care workers by using the IAPCC-R; (3) to conduct a pilot study on the translated version of the IAPCC-R into Finnish. The data were collected by interviewing a group of ten (n=10) health care workers in the capital region of Helsinki. The data were analyzed by using both qualitative content analysis and statistical analysis method. According to the results cultural competence in gynaecology is consist of ten levels of competence; professional, ethnical, theoretical, communication, cultural, social support and “soft” competence and by using ones own personality in the customer service. The knowledge and competence level was measured with the IAPCC-R revealing a score of 57 points which means the level of cultural awareness. The IAPCC-R was translated into Finnish and yielded a Cronbach’s alpha of .64. Considering the small sample size of 10, more testing is recommended on a larger sample to assess a more accurate reliability of the Finnish version of the IAPCC-R.

Ndiwane, A. (2006). Modification and Evaluation of the Inventory to Access the Process of Cultural Competency (IAPCC-R) for Certified Nursing Assistants in long term care facilities. UMass Worcester’s Graduate School of Nursing. University of Massachusetts Worchester.
Contact: Abraham.Ndiwane@umassmed.edu
This study was a two-phase study to modify and evaluate a measure of cultural competency, the IAPCC-R, for Certified Nursing Assistants (CNAs) who work in long term care facilities. Phase I of the study included two focus group interviews of 10 CNAs to discuss and explore constructs of cultural competency for conceptual clarity. For each interview subjects were given a copy of the IAPCC-R and encouraged to complete the instrument and comment in the margins, questions that go through their minds as they complete the instrument. They then were asked item by item to share their opinions about readability, interpretability, and content relevance. Phase two of the study was to test reliability and validity of the modified instrument. The focus group interview data including responses to the items on the questionnaires were too scanty, thus, could not be coded for reliability & validity (i.e., Phase II). There was significant difficulty in reading and understanding the constructs of cultural competency. Based on this findings, it was concluded that the IAPCC-R is not appropriate for this (CNAs) population. Analysis is pending.

Lippy, R. (2006). A Self-Assessment of Cultural Competency in Military Primary Care Providers. Dissertation – Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD.
Contact: RDLippy@bethesda.med.navy.mil
The purpose of this study was to conduct a baseline assessment of cultural competency levels of military primary care providers and to determine modifiable (e.g., training, level of immersion) and non-modifiable (e.g., age, gender, ethnicity) predictors of cultural competency in military primary care providers. The study population consisted of 178 active duty Army, Navy, Air Force, and U.S. Public Health Service primary care (152 Family Medicine, 3 Internal Medicine, 22 Pediatrics) physicians (129 males, 49 females), (141 White, 31 ethnic minority). The IAPCC-R was used as the main outcome variable. Intraclass Correlation Coefficient of the IAPCC-R = 0.82, 95%CI: 0.77-0.85 (p<.001).

Anderson-Worts, P. (2006). Evaluation of Cultural Competence of First Year Osteopathic Medical Students. Nova Southeastern University College of Osteopathic Medicine, Department of Family Medicine. Fort Lauderdale-Davie, FL.
Contact: paulal@nova.edu
The purpose of this study was to measure the level of change in cultural competency of osteopathic medical students after taking an 8 hour cultural competency seminar. The study involved 605 osteopathic medical students during their first year of medical school from 2003 – 2005. The IAPCC-R was given to the students as a pre-test and repeated as a post-test following an 8-hour lecture series. In each year the medical students’ overall scores increased on the IAPCC-R post-test following the 8-hour seminar, when compared to the IAPCC-R pre-test. The reliability of the IAPCC-R was assessed on each test for every testing period using Cronbach’s alpha. Estimates were stable with pretest measures ranging from .87 to .93 and post-test measures ranging from .74 to .85. The average pre-test alpha was .90 and the average post-tests alpha .81.

Bowen, D., Haras, M. and Holman, P. (2006). Cultural Competence in a Convenience Sample of Registered Nurses in NJ. Kean University, NJ.
The purpose if this study was to measure the level of cultural competence of registered nurses studying at Kean University in Union, NJ. A convenience sample of 95 participants were surveyed. The IAPCC-R was used to assess the level of cultural competence. Reliability of the IAPCC-R indicated a Cronbach’s alpha of .817.

Noble, A. and Noble, L. (2006). Cultural Competence of Healthcare Professionals Caring for Breastfeeding Mothers in Urban Areas. Henrietta Szold/Hadassah – Hebrew University School of Nursing, Jerusalem, Israel and Jacobi Medical Center, Bronx, NY.
Contact: anoble@hadassah.org.il
The purpose of the study was to measure the general cultural competence of healthcare professionals caring for breastfeeding mothers in urban areas. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals – Revised (IAPCC-R) and a demographic instrument were utilized. Group testing was performed at a breastfeeding seminar. 128 out of 141 healthcare professionals caring for breastfeeding mothers in New York City participated in the study that included 69 nurses, 18 physicians and 41 allied health professionals. The Cronbach’s alpha for the IAPCC-R was 0.84.

Kattner, M. (2006). Creating an Educational Template to Enhance Cultural Competence. Buntain School of Nursing, Northwest University, Kirkland, WA.
Contact: melba.kattner@northwestu.edu
The objective of the study was to evaluate the level of cultural competence of senior nursing students at Buntain School of Nursing at Northwest University before and after a month-long immersion clinical course. Both the IAPCC-R and the IABWCC (Inventory for Assessing the Biblical Worldview of Cultural Competence Among Healthcare Professionals) were used in this study. Based on standardized items the reliability of the IAPCC-R revealed a Cronbach’s alpha of .888 (Time 2); the IABWCC Cronbach’s alpha was calculated at .877 (Time 2).

Stephen, J. (2006). The Effect of a Multi-Cultural Panel Discussion on Cultural Competence of Health System Employees. Cooks Children’s Medical Center, Forth Worth, Texas.
The purpose of this study was to determine the effect of a particular educational method, a multi-cultural panel discussion, on the level of cultural competence of healthcare providers. Fifty-two healthcare providers from Texas completed the IAPCC-R prior and after the panel discussion, and again at 2 months and 6 months after the event. Reliability of the IAPCC-R revealed Cronbach’s alpha of .72 (pretest) to .87 (6 month posttest).

Crandall, S. (2006). Cultural Competency Training for Medical Students. Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
Contact: crandall@wfubmc.edu
The purpose if this study was to determine the effect of a culturally competent curriculum for medical students. The IAPCC-R was used to assess the level of cultural competence. Preliminary results indicates reliability of IAPCC-R of a Cronbach’s alpha of .85.

Mabunda, G. T. and White, K.W. (2006). Assessment of the Cultural Competence Level of Faculty and Nursing Students at a Midwestern University. Southern Illinois University Edwardsville, School of Nursing.
Contact: gmabund@siue.edu
The purpose of this study was to assess the cultural competence level of faculty, undergraduate and graduate nursing students at a Midwestern University. The target populations were current faculty and students. Using survey research methods, data were collected from a convenience sample of 32 faculty, 101 graduate students and 228 undergraduate students (N=361). The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC-R) was used to collect data. Data were analyzed using SPSS, and included computation of descriptive statistics, item analysis, cultural competence scores, t-test and internal validity. Internal validity of the IAPCC-R was confirmed using Guttman Split-half (.76) and Spearman-Brown (.76).

Ho, Ming- Jung. (2006). Reliability and Validity of Three Cultural competency Measures. National Taiwan University.
Contact: mjho@ntu.edu.tw
The purpose of the study is to examine the psychometrics of three cultural competency measures tested in a Taiwanese medical school. 237/ 262 of the 3rd- and 4th-year medical students filled out a survey containing the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) and two other tools. SAS 9.1 was used to analyze the data. The values of Cronbach’s α for internal consistency coefficient ranged from.06 to .57 in the IAPCC-R subscales. Exploratory factor analysis showed that the IAPCC-R did not have an identifiable factor structure.

de Beer, J. (2006). Are Critical Care Nurses Culturally Congruent in the Private Sector in KwaZulu Natal South Africa. University of Kwazulu-Natal, South Africa?
The purpose of the study was to identify and describe the current practices of critical care nurses in relation to provide culturally congruent nursing care. The subjects consisted of 100 critical care nurses working in 9 intensive care units in 5 private hospitals in KwaZulu Natal, Durban South Africa and the tool used was the IAPCC-R. Most of the respondent were females and between the ages of 30-40 years. Scale statistics in SPSS revealed 0.09 which questions the IAPCC-R’s internal consistency within the cultural context of this population.

Hendriksson, M. (2006). Cultural Competence in Swedish Primary Care: Are Some Providers More Prone To Be Competent Than Others? Vaxjo Universite, Sweden.
Contact: malin.henriksson@drivhuset.se Cited: PDF
The aim of this study was to investigate the degree of cultural competence in primary care in Sweden and to examine if the degree of cultural competence had a relation to the providers’ personality, gender age, ethnicity, and educational level. A Swedish version of the IAPCC-R was used to measure the level of cultural competence; the Big Five Inventory (BFI) was used to measure the participants’ personality; and the Social Desirability Scale of Marlow-Crowne was used to rule out the possibility that the participants would answer what they thought was the “right” answer on the IAPCC-R. In analyzing the data, the IAPCC-R revealed a Reliability Coefficient Cronbach’s alpha of .73.

Vito, K., Roszkowski, M and Wieland, D. (2005). Measuring Cultural Competence as a Curriculum Outcome: What We Learned From Our Experiences with Two Instruments. LaSalle University, Philadelphia, PA.
Contact: wieland@lasalle.edu
This study investigated the psychometric properties of the IAPCC-R based on 695 cases (student nurses). Cronbach’s alpha was calculated at .77. Authors found that items #1, #3, #11, #17 and #21 of the 25 items on the IAPCC-R correlated below .3 and when these items were deleted Cronbach’s alpha was increased to .82. Some recommendations to increase reliability of IAPCC-R were to drop items that correlate less than .3; re-phrase items in the positive; and to make all items into statements.

Gulas, C. (2005) Establishing the Reliability of Using The Inventory For Assessing The Process of Cultural Competence Among Healthcare Professionals With Physical Therapy Students. Dissertation, Saint Louis University, Saint Louis, MO.
Contact: cgulas@maryville.edu
Gulas conducted a study to measure reliability of the IAPCC-R when used with physical therapy students. A sample of convenience of 238 students enrolled in the Maryville University Physical Therapy Program. Two hundred and eighteen (92%) of the students volunteered to participate and completed the IAPCC-R. Two internal consistency estimates of reliability were computed for the results on the IAPCC-R: Cronbach’s alpha coefficient and a split half coefficient expressed as a Guttman Split Half Coefficient. Findings revealed Cronbach’s alpha of .78 and a Guttman Split Half of .77. These tests of reliability demonstrated good to excellent reliability and support the hypothesis that the IAPCC-R is reliable when used with physical therapy students.

McCoy, A. (2005). Cultural Competence Among Nursing Students and Faculty. Master Thesis, Nebraska Methodist College, Omaha, NE.
Contact: ammemc@cox.net
McCoy conducted a study to describe and examine cultural competence between freshman level nursing students, junior level nursing students and nursing faculty. Data was collected using IAPCC-R. The convenient sample in this study consisted of 111 participants at a private Midwest college. Cronbach’s alpha for the IAPCC-R was calculated at .81.

Kardong-Edgren, S. (2004) Cultural Competency of Nursing and Health Education Faculty. Dissertation, Texas Woman’s University, Denton, TX.
Contact: sedgren@uta.edu
Kardong-Edgren conducted a study in which the IAPCC-R was mailed to 748 health education and nursing faculty in the United States. Fifty-eight surveys were dropped from the analysis for incomplete answers on the IAPCC-R, leaving 313 usable surveys for analysis. Cronbach’s alpha for the total sample was .869.

Noble, A. (2004). An Examination of Cultural Competence and Ethnic Attitudes of Israeli Midwives Concerning Orthodox Jewish Couples in Labor and Delivery. Dissertation, University of Tennessee, Memphis, TN. (Study conducted in Israel).
Noble conducted a study of midwives working in the Labor and Delivery units at the two division hospitals of the major medical center in Jerusalem, Israel. Cultural competence was assessed by using the IAPCC-R that was translated into Hebrew. The Reliability Coefficient Cronbach’s alpha was .77 in which 20 respondents answered all questions on the IAPCC-R.

Spencer, W and Cooper-Brathwaite, A. (2003). Reliability Analysis of the IAPCC-R. University of Toronto, Faculty of Nursing.
Contact: angela.cooperbrathwaite@utoronto.ca
Spencer & Cooper-Brathwaite conducted a stratified sample of 50 public health registered nurses from four regions in Toronto, Canada using the IAPCC-R. This study yielded a Cronbach’s alpha of .90.

Koempel, V. (2003). Cultural Competence of Certified Nurse Practitioners. Masters Thesis. Minnesota State University, Mankato, MN.
Contact: norma.krumwiede@mnsu.edu (faculty member on the thesis)
Koempel conducted a study with 275 certified nurse practitioners in the state of Minnesota using the IAPCC-R and calculate the Reliability Coefficient Cronbach’s alpha of .85 and a Guttman Split Half Coefficient of .83.

Construct Validity
Construct validity of the IAPCC-R© is based on Campinha-Bacote’s theoretical model of cultural competence in healthcare delivery [Citations: Cooper-Brathwaite, A. (2005). Evaluation of a Cultural Competence Course. Journal of Transcultural Nursing, 16 (4)361-369; Campinha-Bacote, J. {1999}. A Model and Instrument for Addressing Cultural Competence in Health Care. Journal of Nursing Education, 38(5), 203-207].

Construct validity was addressed by Capell et. al, (2008), in that findings revealed an inverse relationship between cultural competence (as measured by the IAPCC-R) and ethnocentrism (as measured by the Ethnocentrism Scale) [Citation: Capell, J., Dean, E. and Veenstra, G. 2008. The Relationship Between Cultural Competence and Ethnocentrism of Health Care Professionals. Journal of Transcultural Nursing, 19(2),12–125].

Construct validity was addressed by Mesler (2013), in that the there was a direct relationship between a student’s level of cultural competence (as measured by the IAPCC-R) and their level of confidence in performing general transcultural skills (as measured by the Transcultural Self-Efficacy Tool – TSET) [Citation: Mesler, D. 2013. A Comparative Study of Cultural Competence Curricula in Baccalaureate Nursing Programs. Dissertation. Seton Hall University, NJ. Contact Donna.Mesler@shu.edu.

Content Validity
Content Validity was established, in that the items on the IAPCC-R clearly reflect the review of the literature of cultural competence in healthcare delivery that identifies awareness/attitudes, skill and knowledge as domains of cultural competence. In addition, the IAPCC-R was reviewed by experts in the field of transcultural healthcare (Citations: Kattner, M. 2006. Creating an Educational Template to Enhance Cultural Competence. Buntain School of Nursing, Northwest University, Kirkland, WA. Unpublished study. Reported that content validity was established by experts at Northwest University. Contact: melba.kattner@northwestu.edu.

Face Validity
Face Validity was established by reviews of national experts in the field of transcultural healthcare.

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Matthews, N. et al. (2023). Registered Nurses' Cultural Competence and South Asian Culture Knowledge: A Quantitative Study.  Association of Black Nurse Faculty Journal, 2(3), 14-24.

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Bjelica, M. and Nauser, J. (2018). End of Life Care for the Hmong Population: A Cultural Competency Educational Program for Hospice Nurses. Hmong Studies Journal, 19(2), 1-18.

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Roller, M and Ballestas, H. (2017). Cultural Competency: Measuring the Sustainability Following an Immersion Program for Undergraduate Students. Journal of the New York State Nurses Association, 45(1), 21-28.

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Govere, L., Fioravanti, M., and Tuite, P. (2016). Increasing the Cultural Competence Levels of Undergraduate Nursing Students. Journal of Nursing Education, 55(3), 155-159.

Roller, M., and Ballestas, H. (2016). Culturally competency: Measuring the Sustainability Following an Immersion Program for Undergraduate Students. The Journal of the New York State Nurses Association, 45(1), 21-27.

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Gleditsch, R., Hahn, E., Molapo, T. and Hunter, C. (2016).  Intercultural Competency in Social Studies Education Methods. Journal of Natural Inquiry and Reflective Practice 29:2, pp.105-120.

Paparella-Pitzel, S., Eubanks, R. and Kaplan, S. (2016). Comparison of Teaching Strategies for Cultural Humility in Physical Therapy. Journal of Allied Health, 45(2), 139-146(8).

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Diaz, C., Clarke, P. and Gatua, M. (2015). Cultural Competence in Rural Nursing Education: Are We There Yet? Nursing Education Perspective, 36(1), 22-26.

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Bauer, K., and Baib, Y. (2015). Innovative Educational Activities Using a Model to Improve Cultural Competency among Graduate Students Procedia - Social and Behavioral Sciences, 174, 705- 710.

Steinke, M., Riner, M., and Shieh, C. (2015). The Impact of Cultural Competence Education on Short Term Medical Mission Groups: A Pilot Study. Journal of Transcultural Nursing, 26(4), 428-435.

Messler, D. (2014). A Comparative Study of Cultural Competence Curricula in Baccalaureate Nursing Programs. Nurse Educator, 39(4), 193-198.

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de Beer, J and Chipps, J. (2014). A Survey of Cultural Competence of Critical Care Nurses in KwaZulu-Natal. South Africa, Journal of Critical Care (SAJCC), 30(2), 50-54.

Sood, D., Cepa, D., Dsouza, A., Saha, S., Aikat, R., and Tuuk, A. (2014). Impact of International Collaborative Project on Cultural Competence among Occupational Therapy Students. The Open Journal of Occupational Therapy, 2(3) Article 7. Available at: http://scholarworks.wmich.edu/ojot/vol2/iss3/7/

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Volberding, J. (2014). Relationship Between Cultural Competence and Athletic Training Students’ Confidence in Providing Culturally Competent Care. Athletic Training & Sports Health Care. 6(1), 31-36.

Grady, A. (2014). ) Enhancing Cultural Competency in Home Care Nurses Caring for Hispanic/Latino Patients. Home Health Nurse, 32(1), 24-30.

Noble, A., Nuszen, E., Rom, E. and Noble, L. (2014). The Effect of a Cultural Competence Educational Intervention for First-Year Nursing Students in Israel. Journal of Transcultural Nursing, 25(1), 87-94.

Chae, D. and Kang, K. (2013). Review of Self-Administered Instruments to Measure Cultural Competence of Nurses-Focused on IAPCC & CCA . J. Korean Acad Nurs Adm, 19(1), 48-62.

Delgado, D., Ness, S., Ferguson, K., Engstrom, P., Gannon, T., and Gillett, G. (2013). Cultural Competence Training for Clinical Staff: Measuring the Effect of a One-Hour Class on Cultural Competence. Journal of Transcultural Nursing, 24, (2), 204-213.

Ballestas, H. and Roller, M. (2013). The Effectiveness of a Study Abroad Program for Increasing Students’ Cultural Competence. Journal of Nursing Education and Practice, 3(6),125-133.

Olt, H. (2013). Healthcare Providers’ Perceptions of Diversity and Cultural Competence. Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden https://openarchive.ki.se/xmlui/bitstream/handle/10616/41780/1.1%20Kappa.pdf?sequence=1&isAllowed=y

Riley, D., Smyer, T. and York, N. (2012). Cultural Competence of Practicing Nurses Entering an RN-BSN Program. Nursing Education Perspectives, 33(6), 381-385.

Field, S., and Bell, S. (2012). Cultural Competence Education for Rural Clinic Nurses: A Comparison of Methods. Clinical Scholars Review, 5(2), 91-97.

Lee, A., Litwin, B., Cheng, S., and Harada, N. (2012). Social Responsibility and Cultural Competence Among Physical Therapists With International Experience. Journal of Physical Therapy Education, 26(3), 67-73.

Haack, S. and Phillips, C. (2012). Teaching Cultural Competency Through a Pharmacy Skills and Applications Course Series. Am J Pharm Educ, 76(2), 1-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305936/

Tuck, I,. Moon, M., and Allocca, P. (2010). An Integrative Approach to Cultural Competence Education for Advanced Practice Nurses. Journal of Transcultural Nursing, 21(4), 402-409.

Kardong-Edgren, S., Cason, C., Brennan, A., Reifsnider, E., Hummel, F., Mancini, M. and Griffin, C. (2010). Cultural Competency of Graduating BSN Nursing Students. Nursing Education Perspectives, 31(5), 278.

Wilson, A., Sanner, S. and McCallister, L. (2010). A Longitudinal Study of Cultural Competence Among Health Science Faculty. Journal of Cultural Diversity, 17(2):68-72.

Kardong-Edgren, S., Cason, C., Walsh-Brennan, A., Reifsnider, E.,  Hummel, F., Mancini, M. and Griffin, C. (2010). Cultural competency of graduating BSN nursing students. Nursing Education Perspectives (NEP), 31(5), 210-217.

Hunter, J. and Krantz, S. (2010). Constructivism in Cultural Competence Education. Journal of Nursing Education, 49(4), 207-214.

Musolino, G., Burkhalter, S., Crookston, B., Ward, R., Harris, R., Chase-Cantarini, S. and Babitz, M. (2010). Underrating and Eliminating Disparities in Health Care Development and Assessment of Cultural Competence for Interdisciplinary Health Professionals at the University of Utah – A 3 Year Investigation. Journal of Physical Therapy Education, 24(1), 25-36.

Olt, H., Jirwe, M., Gustavsson, P, and Emami Z. (2010). Psychometric Evaluation of the Swedish Adaptation of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R). Journal of Transcultural Nursing, 21(1), 55-64.

Taylor, S. (2009- 2010). Cultural Competency of RN to BSN Students at the University of Nevada, Las Vegas School of Nursing. UNLV McNair Research Journal 2009-2010, 82-87.

Mahabeer, S. (2009). A Descriptive Study of the Cultural Competence of Hemodialysis Nurses. CANNT Journal, 19(4), 30-33.

Noble, L., Noble, A. and Hand, I. (2009). Cultural Competence of Healthcare Professionals Caring for Breastfeeding Mothers in Urban Areas. Breastfeeding Medicine, 4(4), 221-224.

Noble, A., Engelhardt, K., Newsome-Wicks, M. and Woloski-Wruble, A. (2009). Cultural Competence and Ethnic Attitudes of Midwives Concerning Orthodox Jewish Couples. Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN), 38(5),544-555.

Poirier, T., Butler, L., Devraj, R., Gupchup. G., Santanello, C. and Lynch. J. (2009), A Cultural Competency Course for Pharmacy Students. Am J Pharm Educ., 73(5):81.

Kopecky, R. and Castro, M. (2009). Communicating for Patient Safety: Team Communication. Nurturing Cultural Competence in Nursing, p. 12.

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Poirier, T., Devraj, R., Gupchup, G., Lynch, C., Treloar, K. and Butler, L. (2008). Development in Cultural Competency of Pharmacy Students. American Journal of Pharmaceutical Education, 72(3), 35.

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Capell, D., Dean, E. and Veenstra, G. (2008). The Relationship Between Cultural Competence and Ethnocentrism of Health Care Professionals. Journal of Transcultural Nursing, 19(2),121-125.

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Salman, A., McCabe, D., Easter, T., Callahan, B., Goldstein, D., Smith, T., White, M., and Fitzpatrick, J (2007). Cultural Competence Among Staff Nurses Who Participated in a Family-Centered Geriatric Care Program. Journal for Nurses in Staff Development, 23(3),103-111.

Ming-Jung. Ho, and Keng-Lin, Lee. (2007). Reliability and Validity of Three Cultural Competency Measures. Medical Education, 41(5), 519.

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Kardong-Edgren, S. (2007) Cultural Competency of Baccalaureate Nursing Faculty. Journal of Nursing Education, 46(8), 360-366.

Dandanu, D., Chenjing, L. and Huang, W. (2007). Survey on the Demands for Knowledge of Humanistic and Cultural Competence in College Nursing Students. Journal of Nursing Science, 22(12).

Denial, A., Hoppe, E., and Carlson, N. (2006). Assessing Cultural Competency in Optometric Faculty. Optometric Education, 31(3), 92-95.

Brathwaite, A. (2006). Influence of Nurse Characteristics on the Acquisition of Cultural Competence. International Journal of Nursing Scholarship, 3(1), 1-16.

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Cooper-Brathwaite, A. (2005). Evaluation of a Cultural Competence Course. Journal of Transcultural Nursing, 16(4), 361-369.

Nokes, K., Nickitas, D., Keida, R. and Neville, S. (2005). Does Service-learning Increase Cultural Competency, Critical Thinking, and Civic Engagement? Journal of Nursing Education, 44(2), 65-70.

Noble, A., Engelhardt, K., Newsome-Wicks, M. and Woloski-Wruble, A. (2005). Cultural Competence and Ethnic Attitudes of Israeli Midwives Concerning Orthodox Jewish Couples in Labor and Delivery. Journal of Midwifery & Women’s Health, 50 (5), 441.

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*Duplication/Copying Of IAPCC-R: The IAPCC-R is copyrighted and therefore cannot be duplicated/copied without written permission from the author, Dr. Josepha Campinha-Bacote, or her designee. Transcultural C.A.R.E. Associates has a policy regarding the unauthorized use of this copyrighted tool.