Journal List > J Korean Acad Nurs Adm > v.19(1) > 1051702

Chae and Kang: Review of Self-Administered Instruments to Measure Cultural Competence of Nurses-Focused on IAPCC & CCA



As Korean society has rapidly become multicultural in the last few decades, it is essential for nurses to become culturally competent to provide effective care for ethnically and culturally diverse populations. Considering the advantages of standardized instrument, there is a need to evaluate current cultural competence instruments to assess adaptability to Korean nurses.


Using Macdowell's instrument evaluation guideline, a review and evaluation was done of the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals (IAPCC) and Cultural Competence Assessment (CCA), which were both developed based on cultural competence theoretical models and have been commonly used in nursing research. Two other Korean instruments were also evaluated.


The instruments reviewed have limitations in reliability and validity, as well as cultural background and development process, for measurement of cultural competence in Korean nurses.


The results of this study indicate that it is necessary to discuss and agree on a definition of what cultural competence is and to develop instruments to measure cultural competence in Korean nurses.

Figures and Tables

Table 1
Formats for the Reviews
Table 2
Researches Using IAPCC/IAPCC-R Instrument
Table 3
Researches Using CCA Instrument


1. Benkert R, Templin T, Schim SM, Doorenbos AZ, Bell SE. Testing a multi-group model of culturally competent behaviors among underrepresented nurse practitioners. Res Nurs Health. 2011. Wiley Online Library.
2. Bentley R, Ellison KJ. Increasing cultural competence in nursing through international service-learning experiences. Nurse Educ. 2007. 32:207–211.
3. Bernal H, Froman R. The confidence of community health nurses in caring for ethnically diverse populations. Image J Nurs Sch. 1987. 19:201–203.
4. Black M, Soelberg T, Springer P. Cultural competency in nursing education. Acad Exch Q. 2008. 12(2):245–249.
5. Brathwaite AE. Evaluation of a cultural competence course. J Transcult Nurs. 2005. 16(4):361–369.
6. Brown B, Warren NS, Brehm B, Breen P, Bierschbach JL, Smith R, et al. The design and evaluation of an interprofessional elective course with a cultural competence component. J Allied Health. 2008. 37:e316–e337.
7. Caffrey RA, Neander W, Markle D, Stewart B. Improving the cultural competence of nursing students: Results of integrating cultural content in the curriculum and an international immersion experience. J Nurs Educ. 2005. 44:234–240.
8. Campinha-Bacote J. A model and instrument for addressing cultural competence in health care. J Nurs Educ. 1999. 38:203–207.
9. Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: A model of care. J Transcult Nurs. 2002. 13(3):181–184.
10. Capell J, Dean E, Veenstra G. The relationship between cultural competence and ethnocentrism of health care professionals. J Transcult Nurs. 2008. 19:121–125.
11. Chae DH, Park YH, Kang KH, Lee TH. A study on factors affecting cultural competency of general hospital nurses. J Korean Acad Nurs Adm. 2012. 18:76–86.
12. Choi SY. A study on the development of cultural competence measure for helping professions. J Community Welf. 2010. 35:23–53.
13. Doorenbos AZ, Schim SM, Benkert R, Borse NN. Psychometric evaluation of the cultural competence assessment instrument among healthcare providers. Nurs Res. 2005. 54:324–331.
14. Ferketich S. Focus on psychometrics. Internal consistency estimates of reliability. Res Nurs Health. 1990. 13:437–440.
15. Giles EF. Application of the interactional model of cultural diversity to identify diversity climate factors associated with organizational effectiveness in accredited US physical therapist education programs. 2009. Norfolk: Old Dominion University;Unpublished doctoral dissertation.
16. Haack S, Phillips C. Teaching cultural competency through a pharmacy skills and applications course series. Am J Pharm Educ. 2012. 76(2):27.
17. Henriksson M. Cultural competence in Swedish primary care: Are some providers more prone to be culturally competent than others? 2006. Sweden: Vaxjo University;Unpublished master's thesis.
18. Ho MJ, Lee KL. Reliability and validity of three cultural competency measures. Med Educ. 2007. 41(5):519.
19. Hyun JH. The factor affecting cultural capacity of those engaged in social welfare facility. 2011. Gwangju: Honam University;Unpublished master's thesis.
20. Hunter JL. Applying constructivism to nursing education in cultural competence: A course that bears repeating. J Transcult Nurs. 2008. 19(4):354–362.
21. Jang HJ. Theoretical review of measurement and instrument development. Korean J Nurs Query. 2005. 14:73–87.
22. Kardong-Edgren S. Cultural competence of baccalaureate nursing faculty. J Nurs Educ. 2007. 46:360–366.
23. Kardong-Edgren S, Campinha-Bacote J. Cultural competency of graduating US Bachelor of Science nursing students. Contemp Nurse. 2008. 28(1-2):37–44. http://dx.doi:10.5172/conu.673.28.1-2.37.
24. Kardong-Edgren S, Cason CL, Brennan AMW, Reifsnider E, Hummel F, Mancini M, Griffin C. Cultural competency of graduating BSN nursing students. Nurs Educ Perspect. 2010. 31:278–285.
25. Kawashima A. Study on cultural competency of Japanese nurses. 2008. Virginia: George Mason University;Unpublished doctoral dissertation.
26. Lampley TM, Little KE, Beck-Little R, Xu Y. Cultural competence of North Carolina nurses: A journey from novice to expert. Home Health Care Manag Pract. 2008. 20:454–461.
27. Lee EH. A method for development and validation of an instrument. Korean J Nurs Query. 2005. 14:73–87.
28. Lee EJ, Kim YK, Lee HK. A study on the cultural competence of community health practitioners. J Korean Acad Community Health Nurs. 2012. 23:179–188.
29. Lee JI. A study on relationship between cultural competency and empathy of nurses. 2011. Chuncheon, Korea: Hallym Universty;Unpublished master's thesis.
30. Lum D. Cultural competent practice: A framework for understanding diverse groups and justice issues. 2003. Pacific Grove, CA: Brooks/Cole Cengage Learning.
31. Luquis R, Pérez MA. Cultural competency among school health educators. J Cult Divers. 2006. 13:217–222.
32. Mahabeer SA. A descriptive study of the cultural competence of hemodialysis nurses. CANNT J. 2009. 19(4):30–33.
33. Marra J, Covassin T, Shingles R, Canady RB, Mackowiak T. Assessment of certified athletic trainers' levels of cultural competence in the delivery of health care. J Athl Train. 2010. 45:380–385.
34. McDowell I. Measuring health: a guide to rating scales and questionnaires. 2006. 3rd ed. New York, NY: Oxford University Press.
35. Morris A. Factors influencing bachelor of science in nursing students' perception of elder care cultural self-efficacy. 2007. Alabama: Auburn University;Unpublished doctoral dissertation.
36. Musolino GM, Babitz M, Burkhalter ST, Thompson C, Harris R, Ward RS, Chase-Cantarini S. Mutual respect in healthcare: assessing cultural competence for the University of Utah Interdisciplinary Health Sciences. J Allied Health. 2009. 38(2):e54–e62.
37. Noble LM, Noble A, Hand IL. Cultural competence of healthcare professionals caring for breastfeeding mothers in urban areas. Breastfeed Med. 2009. 4:221–224.
38. Nho CR, Kim JH. Development of Korean cultural competency scale for human service workers. Korean J Soc Welf. 2011. 63:207–231.
39. Nokes KM, Nickitas DM, Keida R, Neville S. Does service-learning increase cultural competency, critical thinking, and civic engagement? J Nurs Educ. 2005. 44(2):65–70.
40. Nunnally JC. Psychometric theory. 1978. New York, NY: McGraw-Hill.
41. Nunnally JC, Bernstein IH. Psychometric theory. 1994. New York, NY: McGraw-Hill.
42. Ohm R, Rosen L. Psychometric evaluation of the perceived prejudice in health care scale-modified (PPHC-M) among baccalaureate student nurses. J Transcult Nurs. 2011. 22:282–289.
43. Olt H, Jirwe M, Gustavsson P, Emami A. Psychometric evaluation of the Swedish adaptation of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R). J Transcult Nurs. 2010. 21:55–64.
44. Park JS. Study on cultural competence nurses working in general hospital. 2011. Daegu, Korea: Keimyung University;Unpublished master's thesis.
45. Poirier TI, Butler LM, Devraj R, Gupchup GV, Santanello C, Lynch JC. A cultural competency course for pharmacy students. Am J Pharm Educ. 2009. 73(5):81.
46. Riley DM. Cultural competence of RN to BSN students. 2010. Las Vegas, USA: University of Nevada;Unpublished master's thesis.
47. Rooda L. Knowledge and attitudes of nurses toward culturally different patients: Implications for nursing education. J Nurs Educ. 1993. 32:209–213.
48. Salman A, McCabe D, Easter T, Callahan B, Goldstein D, Smith TD, et al. Cultural competence among staff nurses who participated in a family-centered geriatric care program. J Nurses Staff Dev. 2007. 23(3):103–111.
49. Sargent SE, Sedlak CA, Martsolf DS. Cultural competence among nursing students and faculty. Nurse Educ Today. 2005. 25:214–221.
50. Schim SM, Miller A. Cultural competence program core components. Presented at The Henry Ford Health System/Oakland University Center for Academic Nursing. 1999. Detroit:
51. Schim SM, Doorenbos AZ, Borse NN. Cultural competence among Ontario and Michigan healthcare providers. J Nurs Scholarsh. 2005. 37:354–360.
52. Schim SM, Doorenbos AZ, Borse NN. Cultural competence among hospice nurses. J Hosp Palliat Nurs. 2006a. 8:302–307.
53. Schim SM, Doorenbos AZ, Borse NN. Enhancing cultural competence among hospice staff. Am J Hosp Palliat Care. 2006b. 23:404–411.
54. Schim SM, Doorenbos AZ, Miller J, Benkert R. Development of a cultural competence assessment instrument. J Nurs Meas. 2003. 11:29–40.
55. Seright T. Perspectives of Registered Nurse Cultural Competence in a Rural State-Part II. Online J Rural Nurs Health Care. 2012. 7:57–69.
56. Song K, Jang E. Cultural Competence and Measurements in Social Work Practice. 2010. Gwangju: Institute for Humanities and Social Sciences.
57. Starr S, Wallace DC. Self-reported cultural competence of public health nurses in a Southeastern US Public Health Department. Public Health Nurs. 2009. 26:48–57.
58. Starr S, Wallace DC. Client perceptions of cultural competence of community-based nurses. J Community Health Nurs. 2011. 28(2):57–69.
59. Transcultural C.A.R.E. Associates. The process of cultural competence in the delivery of healthcare services. 2012. Retrieved October 8, 2012. from
60. Wayne State University. Faulty & Research. 2012. Retrieved October 8, 2012. from
61. Yang SO, Kwon MS, Lee SH. The factors affecting cultural competency of visiting nurses and community health practitioners. J Korean Acad Community Health Nurs. 2012. 23:286–295.
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