*Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R^©)

"Courage is not the absence of despair; it is rather,

the capacity to move ahead in spite of despair."

Rollo May

ABOUT THE IAPCC-R^©

Application:

The IAPCC-R^© is designed to measure the level of cultural competence among healthcare professionals.  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.

Development of the Instrument:

The IAPCC-R^© 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  IAPCC^© 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 (link).

Obtaining the IAPCC-R^©:

The IAPCC-R^© is available for review and personal use only by purchasing the book, “The Process of Cultural Competence in the Delivery of Healthcare Services, 5^th Edition (2007), authored by Campinha-Bacote (order form).   There are additional requirements and a fee associated with use of the IAPCC-R^© beyond a personal self-assessment (see Permission To Use IAPCC-R^© and Cost of Using IAPCC-R^©).

Permission To Use IAPCC-R^©

The IAPCC-R^© is copyrighted and formal permission and a fee is required before the tool can be used in a format other than for personal/individual use.  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, method of administration, 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 an onsite pencil/paper format or internal/external mailings. Only one copy of the tool will be provided if the request is for online/electronic administration.  You can utilize this copy for conversion into an electronic format for the designated time granted.

Cost of Using IAPCC-R^©

There is a fee of $8.00 per tool when administered onsite 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 onsite administration format the IAPCC-R^© is to be 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 an onsite administration 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 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 administered offsite in such formats as an online secure format for a training program, in-service educational program, academic course or continuing education offering, an external or internal postal mailing distribution or any form of administration that is not hand-distributed 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). 

REPORTED RELIABILITY & VALIDITY OF THE IAPCC-R^©

Reliability (Nationally Within the United States): Although the IAPCC-R^© has been used throughout the USA, unfortunately, several researchers have chosen not to report the reliability.  Following are researches from Minnesota, Texas, Nebraska, Pennsylvania, Missouri, New York, Maryland, Washington, New Jersey, North Carolina, Florida, and Massachusetts who have kindly reported the reliability of the IAPCC-R^© when used in their study.

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 alpha of IAPCC-R was alpha =.80.

Noble, L. (2007).  Effect of a Cultural Competence Educational Intervention on Pediatric Residents. Mount Sinai School of Medicine, Elmhurst Hospital Center, New York. Contact: noblela@nychhc.org

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.

Kardong-Edgren, S. (2007). What Kind of Curricula Produce the Most Culturally Compete 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 Untied 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). 

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.  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.  Contact: emeraldsixty@optonline.net; dawnette@bowensweb.com; or mharar@sbhcs.com

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.

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.  Contact: jennifes@cookchildrens.org

The purpose if 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 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.

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 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.

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 Alpha of .85 and a Guttman Split Half Coefficient of .83.

Reliability (Internationally): Although the IAPCC-R^© has been translated and tested globally in such countries as Portugal, Japan, Finland, Italy, Denmark, Guam, Thailand, Puerto Rico, New Zealand, Ireland, China, Australia, Turkey, England, and South Korea, unfortunately, several researchers have chosen not to report the reliability.  Following are researches from Israel, Sweden, South Africa, Taiwan, and Canada, who have kindly reported the reliability of the IAPCC-R^© when used in their study.

Kawashima, A. (2008). Study on Cultural Competency of Japanese Nurses.  Dissertation, George Washington University, Fairfax, VA. TN.  Contact: asaseri@gmail.com

Cited: http://mars.gmu.edu/dspace/bitstream/1920/3072/5/Kawashima_Asako_final.pdf 

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 findings indicated that nurses mostly perceived that they were only at a “culturally aware” level according to the IAPCC-R.

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.  Contact: noble@013.net

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 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.

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 Coefficient alpha for the IAPCC-R was 0.84.

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: http://www.diva-portal.org/diva/getDocument?urn_nbn_se_vxu_diva-864-2__fulltext.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 alpha of .73.

Ho, Ming- Jung.  (2006). Reliability and Validity of Three Cultural competency Measures.  National Taiwan University.  Contact email: 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?  Contact: ccdebeer@telkomsa.net or jchipps@telkomsa.net

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.                        

Validity (Nationally & Internationally):

Internal Validity

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 the 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.

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).

 

Construct Validity was addressed, in that the IAPCC-R^© is based on the five constructs of 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].  In addition, construct validity was addressed by Capell et. al, (2008), in that the IAPCC-R was related to the construct of ethnocentrism.  It was noted in this study that there was 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].

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

PUBLICATIONS USING THE IAPCC-R^©

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.

          A three credit course was offered on "Health Promotion and Health Literacy," in which portions of this course was

          structured around Campinha-Bacote's model of cultural competence. The IAPCC-R was used as a pre/post test of    

          measurement of cultural competence.

Kardong-Edgren, S. and Campinha-Bacote, J.  (2008).  Cultural Competency of Graduating US Bachelor of Science Nursing Students. Contemporary Nurse, 28(2), Advances in Contemporary Transcultural Nursing 2nd edition.  

This article discusses a study aimed at evaluating the effectiveness of four different nursing program curricula in developing culturally competent new graduates. Four methodologically and geographically diverse groups of 212 graduating BSN students in the United States were given the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) prior to graduation and after completion of course work. A variety of curricular methods for achieving cultural competency were included. Two programs utilized a theory or a model developed by recognized transcultural expert nurses, one program utilized an integrated approach employing no specific model, and one program utilized a free-standing two credit culture course within the curriculum, taught by nursing faculty with strong cultural preparation. Results indicate that these 212 graduating nursing students scored only in the culturally aware range, as measured by the IAPCC-R, regardless of what program model they attended. Contact e-mail: sedgren@wsu.edu

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.

In this article the authors examined the relationship between cultural competence and ethnocentrism among 71 healthcare professionals from three hospitals in Vancouver, British Columbia, Canada. The survey questionnaire incorporated the IAPCC-R and the Generalized Ethnocentrism Scale (GENE).  Cultural competence scores and ethnocentrism scores were inversely related.  Findings suggest that cultural competence may not be entirely distinct from ethnocentrism.  Contact email: jencapell@gmail.com.

Seright, T. (2007).  Perspectives of Registered Nurse Cultural Competencies in a Rural State - Part I & II.  Online Journal of Rural Nursing and Health Care, 7(1), 47-68.

In this article the author described the outcomes of a self-assessment survey completed by registered nurses in a homogenous rural state. The purpose of this study was to determine the relationship between cultural competence and educational preparation. It was hypothesized that the North Dakota nurses who reported participation in cultural competency educational programs would rank themselves higher on the IAPCC-R than those who had not reported participation in such programs. A voluntary sample of registered nurses from urban and rural hospitals in the state of North Dakota were surveyed using the Inventory for Assessing the Process of Cultural Competence –Revised version (IAPCC-R) and a demographic survey tool. The data analysis was accomplished through correlational statistics. Results of this research indicate that a majority (>80%) of the participants did not consider themselves culturally competent. While higher self rating scores did correlate to participation in educational activities, the quality and frequency of those activities varies. The author offered suggestions for improved rate and quality of cultural competence education as well as suggestions for further research. Department of Nursing, Minot State University.  Contact e-mail: teresa.seright@minotstateu.edu  

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 http://www.nursingcenter.com/pdf.asp

The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program. The Cronbach's alpha reliability coefficient was established using the sample of this study. Cronbach's alpha coefficient for internal consistency was conducted for the IAPCC-R using the total sample of the pretest and posttest groups. The standardized alpha for the IAPCC-R was .74 for pretest assessment and .83 for the posttest assessment. Frances Payne Bolton School of Nursing, Case Western Reserve University. 

Contact email:  joyce.fitzpatrick@case.edu

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

Education, 41(5), 519.        

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

Using the IAPCC-R (adapted by removing the “I phrases”), Cooper-Brathwaite conducted a one-group repeated measures design to evaluate the effectiveness of a course to increase 76 public health nurses’ level of cultural competence.  Subjects completed the IAPCC-R four times, twice before the intervention and twice after the intervention.  The time between initial (T1) completion of the IAPCC-R and the second (T2) completion was two months.  The time between (T2) and the immediate post intervention (T3) completion of the IAPCC-R by participants was one week.  The Cronbach’s Alpha Coefficient was .78 and .75 at baseline and pretest, respectively, and .90 and .93 at posttest (immediate posttest and 3-month follow-up, respectively). Durham Regional Health Department, Canada. Contact email: angela.cooperbrathwaite@utotonto.ca

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), p. 441. 

The article gives an account of a descriptive intra-cultural study to measure Israeli midwives' general cultural competence, ethnic attitudes concerning Orthodox Jewish couples in labor and delivery, and the relationship of background data with cultural competence and ethnic attitudes. Thirty Israeli midwives employed in the labor and delivery units at a major hospital system in Jerusalem, and who identified themselves as Secular, Traditional or Religious Jews, comprised the sample. Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R), Rooda's Ethnic Attitude Scale (EAS), adapted for this study with 4 Israeli Jewish scenarios, and a Midwifery Demographic Survey were used to collect data. Midwives were "culturally aware" on the IAPCC-R with results consistent with previous research of groups with no cultural education courses. Although not differing by groups based on extent of religious observance, midwives differed significantly among Secular, Traditional, Religious, and Ultra-Orthodox scenarios demonstrating the most negative attitudes and highest bias scores toward the Ultra-Orthodox religious scenario. Contact email: anoble@hadassah.org.il

*Duplication/Copying of IAPCC-R^©: Transcultural C.A.R.E. Associates has a policy preventing unauthorized use of tools.

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  Last Updated: August, 2008