Chapter 7: Cultural Competency and Assessment

LEARNING OBJECTIVES

After reading this chapter you should be able to

•   Understand assessment in terms of health care.

•   Explain the relevance of measuring attitudes of health professionals, board members, providers, staff and public health practitioners in regard to organizations serving diverse populations.

•   Discuss the importance of establishing reliability and validity of cultural competency assessment tools.

•   Determine the usefulness of data in training and other plans for organizations.

I. Introduction

1. This chapter focuses on assessment and cultural competence in an effort to explain the relevance of measuring attitudes of organizational health care members at every level.

2. Assessment determines the cultural competence preparedness of individuals who work in health service/public health organizations.

3. Emphasis is placed on reliability and validity in terms of assessment tools.

II. Attitudes

1. Attitudes towards the cultures served must be assessed.

2. An approach to measure attitudes is to use a reliable and valid survey instrument specifically focused on cultural competence.

3. A survey will yield useful results that healthcare and public health can use to strengthen any attitudinal weaknesses regarding cultural competence in order to provide better services to all people.

III. Assessment

1. Surveys are an inherently social activity and are generally used to ask respondents about their behaviors, attitudes and beliefs.

Reliability: refers to the stability and equivalence of measures of the same concept over time or across methods of gathering data.

There are several types of reliability including:

Test-Retest: determines whether an instrument will measure what it is purported to measure from time 1 to time 2

Alternative Form: differently worded items to measure the same attribute

Internal Consistency: determination of performance levels of various aspects of the same concept.

Validity: there are four types of validity measures which are:

Face: review of items by untrained survey developers.

Criterion: the sampling adequacy of the items used to measure the subject matter.

Content: provides quantitative evidence of the accuracy of a survey instrument.

Construct: asks the following question:

Does the instrument measure what it is purported to measure?

The two forms of construct validity are:

Convergent: several different methods for obtaining the same information about a given concept produce similar results.

Divergent: comparing a respondent’s answer to a question measuring one concept to the respondent’s answer to a question intended to measure a different concept.

IV. A Cultural Competence Assessment Tool

A cultural competence tool was developed by the author of this text (see Appendices I to III for three forms of the survey).

3 Forms: 1) Board of Directors, Executive Team and Management

2) Providers

3) Staff

Likert Format: Strongly Agree, Agree, Strongly Disagree, Disagree and

Not Applicable

Seven content response categories:

1. Concern for others

2. Self-awareness

3. Patient/client/customer satisfaction

4. Cultural sensitivity

5. Workshops/training

6. Knowledge

7. Communication and language

Reliability and Validity was established.

V. Importance of Reliable and Valid Assessment Tools

· Invalid and unreliable surveys have little or no meaning

· Surveys should be tailored to specifically address the hierarchical level of the organization.

VI. Conclusions

1. Surveys must have established reliability and validity.

2. Survey data can be reviewed with the ensuing development of training sessions to address attitudinal weaknesses relevant to cultural competence for all levels of healthcare and public health organizations.