Cultural Assessment Tools

Annotated Links

■ Campinha-Bacote (2002) developed the tool Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R^©).  This tool is  based on her 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).

■ Campinha-Bacote (2007) developed the tool Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV^©). The IAPCC-SV^© is based on the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R^©).   Vito, Roszkowski, & Wieland (2005) noted in a study of 695 student nurses that the IAPCC-SV^© could be further revised resulting in a higher reliability of this tool.  The IAPCC-SV^© is a result of modifying the response format of the IAPCC-R^© to reflect only responses of strongly agree, agree, disagree, strongly disagree and modifying and deleting selected questions on the IAPCC-R^©.  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).

■ Transcultural C.A.R.E. Associates has conducted an extensive review of the literature regarding organizational assessment tools as well as self-assessment tools for healthcare clinicians and has published an annotated bibliography of this review entitled, Annotated Bibliography for Assessing Cultural Competence in the Healthcare Setting.  This annotated bibliography is available through purchase of the monograph, Readings & Resources in Transcultural Health Care & Mental Health, 2002, 13th Edition (order form).

■ 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.

http://www.vdh.virginia.gov/ohpp/clasact/researchresources.asp

■ The American Institutes of Research prepared a report  for the Office of Minority Heath US Department of Health and Human Resources entitled, Cultural Competency and Nursing: A Review of Current Concepts, Policies and Practices. I n Appendix C-1 there is a chart entitled Measures of Cultural Competence (page 83 ) that lists cultural assessment tools for healthcare professionals.  http://thinkculturalhealth.org/ccnm/documents/CCNMEnvironmentalScanFINAL2004.pdf

■ 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. http://www.nmanet.org/images/uploads/Publications/OC609.pdf

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.  Please visit Dr. Carolyn Tucker's home page at:  http://www.psych.ufl.edu/~tucker/BMED/BMED%20about.htm

■ Program For Multicultural Health has a website that contains a web page entitled, Tools for  Assessing Cultural Competence.  This webpage  can be accessed at: http://www.med.umich.edu/multicultural/ccp/Assessments.doc

This website also has a section devoted to other tools that assess institutional and organizational cultural competency.  This webpage can be accessed at:  http://www.med.umich.edu/multicultural/ccp/iia.htm#HPA

■ Gilbert, J.  (2003).  Resources in Cultural Competence Education For Health Care Professionals.  Woodland Hills: CA: California Endowment. On pages 38-46 of this document, Dr. Gilbert provides  a list of organizational and healthcare professional cultural assessment tools.  This report can be accessed at: 

http://www.calendow.org/reference/publications/pdf/cultural/TCE0218-2003_Resources_in_C.pdf

■ 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. http://www.pico-global.com/Default.aspx?l=2

■ 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.  This report can be accessed   at: http://www.cdha.nshealth.ca/programsandservices/diversityandinclusion/culturalCompetence.pdf

■ 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)

■ The website, SIETAR-Europa, lists an annotated bibliography of over 50 intercultural assessments and instruments. These tools can be found at http://www.sietar.de/SIETARproject/Assessments&instruments.html

■ 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).

■ 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: http://www.aamc.org/meded/tacct/culturalcomped.pdf; http://www.aamc.org/meded/tacct/tacct.xls.  The  article, "Cultural Competence Education for Medical Students: Assessing and Revising Curriculum," describes the tool and its use.  This article can be accessed at http://www.aamc.org/meded/tacct/culturalcomped.pdf.  For more information about the tool contact Dr. Ella Cleveland at ecleveland@aamc.org or (202) 828-0531.

■ 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:

• Organizational Tools  to assess their organization’s level of cultural competence at an administrative level.

• Provider Tools to assess clinicians' cultural competence in working with clients.

• Client Tools to assess clients' experience of the organization and/or clinician’s cultural competence.

  http://www.hogg.utexas.edu/programs_cai_tools.html

■ 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. http://www.bphc.org/director/pdfs/disparities_assess-tool.pdf

■ 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.
http://www.hrsa.gov/culturalcompetence/indicators/default.htm#Assessing

■ 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." http://www.nccccurricula.info/resources_mod2.html#appendixa

■  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. D.1989, revised 2002).

http://www.asha.org/NR/rdonlyres/E7805A1A-CCD2-4A35-B84A-ED889318EFA0/0/personal_reflections.pdf

■ 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).

http://www.asha.org/NR/rdonlyres/07693109-C4F6-48EA-BFC3-58874C8998F9/0/service_delivery.pdf

■ 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 ramon@jimenez.net.

■ 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.  http://www.etsu.edu/oca/Resources.asp. 

■ Cultural Diversity Questionnaire For Nurse Educators.  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.  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: lsealey@selu.edu

http://etd.lsu.edu/docs/available/etd-1112103-133929/unrestricted/Sealey_dis.pdf

■ 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. http://www2.umdnj.edu/fmedweb/chfcd/aetna_foundation.htm.

■ 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. 

http://www.mfh-eu.net/public/experiences_results_tools/cct_eval_instruments.htm  

■ Campinha-Bacote (2005) developed the tool, 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).  Click onto the following link for more details of studies using this tool (link).

■ Lee Cultural Sensitivity Tool: Hispanic Version.  This is a 10-item, researcher-designed instrument. 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.

■  Fantini, A. (2006) developed a list of 87 Assessment Tools of Intercultural Communicative Competence.  http://www.experiment.org/gsi/Appendix%20F.%20ICC%20Assessment%20Tools_87-94_.pdf.
 

■ 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.

■ The Cultural Competence Self Assessment Protocol for Health Care Organizations and Systems, developed by Dennis Andrulis, Thomas Delbanco, Laura Avakian and Yoku Shaw-Taylor, is a tool that 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. http://erc.msh.org/provider/andrulis.pdf

Mental Health Assessment Tools

■ 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?

http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/protocol/CultCompProtocol.pdf

■ Zetzer, H. and Shockley. M.  (2005).  Build the Field and They Will Come: Multicultural Organizational Development for Mental Health Agencies.  This 123-page document is a  Multicultural Access and Treatment Demonstration Project at Antioch University funded by The California Endowment. T 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. http://www.calendow.org/reference/publications/pdf/mental/MHAntioch.pdf

■ The Ohio Department of Mental Health, released the Consolidated Culturalogical Assessment Tool (C-CAT) Tool Kit. The C-CAT 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. http://www.ccattoolkit.org/

■ Cultural Competence Self-Assessment Questionnaire (CCSAQ),  developed by James Mason (1995), a measure 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.

■  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.

http://www.jbcc.harvard.edu/publications.htm

■  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 http://www.socialsciences.uottawa.ca/crcs/pdf/organizational_cultural_competence_21-12-2005.pdf

■  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.

Contact: Valza.Thomas@health.wa.gov.au

■  Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations, is a document 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. http://www.mentalhealth.samhsa.gov/publications/allpubs/SMA03-3828/default.asp

■  The Client Cultural Competency Inventory (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 scholles@pitt.edu.