Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)

Heeseung Choi; Eunyoung E. Suh; Chang Park; Jisun Park; Eric Fernandez

doi:10.7469/kjan.2015.27.4.472

Journal List > Korean J Adult Nurs > v.27(4) > 1076346

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Suh, Park, Park, and Fernandez: Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)

Original Article

Korean J Adult Nurs 2015;27(4):472-479.

Published online: NaN August 2015

DOI: https://doi.org/10.7469/kjan.2015.27.4.472

Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)

Heeseung Choi¹, Eunyoung E. Suh¹, Chang Park², Jisun Park³, Eric Fernandez³

^¹College of Nursing, the Research Institute of Nursing Science, Seoul National University, Seoul

^²Research Specialist, University of Illinois at Chicago, College of Nursing, Chicago, U. S. A.

^³College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Suh, Eunyoung, E. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-740-8484, Fax: +82-2-740-8484, E-mail: esuh@snu.ac.kr

Received 13 May 20159 August 2015 Accepted 10 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Few instruments are available to measure nurses’ perceptions of cultural competence in South Korea. Furthermore, the equivalence of factors between original and translated instruments has not been evaluated. The specific aims of this study were to identify the validity and reliability of a Korean version of the Cultural Awareness Scale (K-CAS) and to evaluate the equivalence of factors between the original CAS and the K-CAS. A total of 515 nursing students completed the 26-item K-CAS, 28-item Caffrey Cultural Competence in Healthcare Scale (CCCHS), and eight-item Openness to Diversity and Challenge Scale (ODCS). The K-CAS exhibited good reliability (⍺=.83) and construct validity by correlating with the CCCHS (r=.344, p<.001) and ODCS (r=.394, p<.001). Confirmatory factor analysis results of the K-CAS confirmed the same factor structure as the original CAS. The K-CAS could be a useful tool to assess the concept of cultural competence among nursing students and nurses.

Keywords: Cultural competence, Nursing, Education, Healthcare, Instrumentation, Factor analysis

REFERENCES

1.Ministry of Public Administration and Security. Local government report: statistics on foreign residents [Internet]. Seoul: Ministry of Public Administration and Security;2012. [cited 2014 January 16]. Available from:. http://www.mogaha.go.kr/frt/bbs/type001/commonSelectBoardArticle.do?bbsId=BBSMSTR_000000000014&nttId=42492.

2.Kim JH., Kim CK., Song MR., Han SH., Jang DH. A rural and agricultural vision and tasks by 2030/2050 [Internet]. Seoul: Korea Rural Economic Institute;2010. [cited 2013 September 23]. Available from:. http://www.krei.re.kr/web/www/23?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=2881.

3.Ministry of Health and Welfare. 2012 statistics on foreign patients [Internet]. Seoul: Ministry of Health and Welfare;2013. [cited 2013 September 16]. Available from:. https://stat.mw.go.kr/front/customer/custBoardView.jsp?menuId=28&bbsSeq=15&nttSeq=20866&nPage=1&searchKey=&searchWord=.

4.Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: a model of care. Journal of Transcultural Nursing. 2002. 136:181–4. http://dx.doi.org/10.1177/10459602013003003.

5.Campinha-Bacote J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. OJIN: The Online Journal of Issues in Nursing. 2011. 16(2):): Manuscript 5.http://dx.doi.org/10.3912/OJIN.Vol16No02Man05.

6.Oh WO. Factors influencing cultural sensitivity among nursing students. Child Health Nursing Research. 2013. 17(4):222–9. http://dx.doi.org/10.4094/jkachn.2011.17.4.222.

7.Park SH., Lee JH., Kim EJ. Effects of the multicultural program on the promotion of cultural sensitivity in college students. Korean Journal of Youth Studies. 2011. 18(6):123–45.

8.Kim Y., Lee JY., Cho SH. An explorative study of perceived cultural competency of medical social workers in Korea. Health and Social Welfare Review. 2011. 31(3):251–83.

9.Chae DH., Park YH., Kang KH., Lee TH. A study on factors affecting cultural competency of general hospital nurses. Journal of Korean Academy of Nursing Administration. 2012. 18(1):76–86. http://dx.doi.org/10.11111/jkana.2012.18.1.76.

10.Yang SO., Kwon MS., Lee SH. The factors affecting cultural competency of visiting nurses and community health practitioners. Journal of Korean Academy Community Health Nursing. 2012. 23:286–95. http://dx.doi.org/10.12799/jkachn.2012.23.3.286.

11.Choi HJ. Exploratory study on experience in multiculture and cultural competence of service providers in multicultural settings. Mental Health & Social Work. 2011. 37:405–39.

12.Song Y. The relationship between human rights attitudes, multicultural competence and service quality of multicultural centers'workers. [dissertation]. Seoul: Seoul Christian University;2012.

13.Cuevas MC. Cultural competence, cultural awareness and attitudes of social work students. [dissertation]. Austin, Texas: University of Texas at Austin;2002.

14.Lum D. Cultural competent practice: a framework for understanding diverse groups and justice issues. 4th ed.Belmont, CA: Books/Cole, Cengage Learning;2003.

15.Cafferey RA., Neander W., Markle D., Stewart B. Improving the cultural competence of nursing student: results of integrating cultural content in the curriculum and an international immersion experience. Journal of Nursing Education. 2005. 44(5):234–40.

16.Choi SY. A study on the development of cultural competence measures for helping professions. Journal of Community Welfare. 2010. 35:22–53.

17.Nho CR., Kim JH. Development of Korean cultural competency scale for human service workers. Korean Journal of Social Welfare. 2011. 63:207–31.

18.Rew L., Cookston J., Khosropour S., Martinez S. Measuring cultural awareness in nursing students. Journal of Nursing Education. 2003. 42(6):249–57.

19.Krainovich-Miller B., Yost JM., Norman RG., Auerhahn C., Do-bal M., Rosedale M, et al. Measuring cultural awareness of nursing students. Journal of Transcultural Nursing. 2008. 19(3):250–8. http://dx.doi.org/10.1177/1043659608317451.

20.Pascarella E., Edison M., Nora A., Hagedorn LS., Terenzini PT. Influences on students'openness to diversity and challenge in the first year of college. The Journal of Higher Education. 1996. 67(2):174–95. http://dx.doi.org/10.2307/2943979.

21.Sanner S., Baldwin D., Cannella KA., Charles J., Parker L. The impact of cultural diversity forum on students'openness to diversity. Journal of Cultural Diversity. 2010. 17(2):56–61.

22.Barkley A., Boone K., Holloway ZW. Openness to diversity and challenge: assessment of undergraduate attitudes and experiences in the college of agriculture at Kansas state university [Internet]. Paper presented at: The annual meeting of the American Agricultural Economics Association. 2005. ;Providence, RI. [cited 2013 September 23]. Available from:. http://ageconsearch.umn.edu/bitstream/19299/1/sp05ba13.pdf.

23.Floyd FJ., Widaman KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment. 1995. 7(3):286–99. http://dx.doi.org/10.1037/1040-3590.7.3.286.

24.Schmitt TA. Current methodological considerations in exploratory and confirmatory factor analysis. Journal of Psychoeducational Assessment. 2011. 29(4):304–21. http://dx.doi.org/10.1177/0734282911406653.

25.Knafl K., Deatrick J., Gallo A., Holcombe G., Bakitas M., Dixon J, et al. The analysis and interpretation of cognitive interviews for instrument development. Research in Nursing & Health. 2007. 30(2):224–34. http://dx.doi.org/10.1002/nur.20195.

26.Willis GB., Royston P., Bercini D. The use of verbal report methods in the development and testing of survey questionnaires. Applied Cognitive Psychology. 1991. 5:251–67. http://dx.doi.org/10.1002/acp.2350050307.

27.Drennan J. Cognitive interviewing verbal data in the design and pretesting of questionnaires. Journal of Advanced Nursing. 2003. 42(1):57–63. http://dx.doi.org/10.1046/j.1365-2648.2003.02579.x.

28.Wrigley CS., Neuhaus JO. The matching of two sets of factors. American Psychologist. 1955. 10:418–9.

29.Mclntosh CN. Rethinking fit assessment in structural equation modelling: a commentary and elaboration on Barrett on Barrett. Personality and Individual. Personality and Individual Differences. 2007. 42(5):859–67. http://dx.doi.org/10.1016/j.paid.2006.09.020.

30.Kim HY. The prospect and task of policy for multicultural families. Proceedings of the Present and Future of Multicultural Society and Policy Symposium. 2014. September 19; Seoul Korea: Korean Association for Multicultural Society. 2014. 51–71.

31.Oh KS. Exploring changes in Korea's multicultural policy. Proceedings of the Present and Future of Multicultural Society and Policy Symposium. 2014. September 19; Seoul, Korea: Korean Association for Multicultural Society. 2014. 25–39.

32.Choi SY. A study on the antecedent factors affecting helping professions'cultural competence: focusing on social workers, teachers, nurses, and social work civil servants. Korean Journal of Social Welfare. 2012. 64(2):5–29.

Table 1.

General Characteristics of the Participants (N=515)

Variables	Categories	n (%)
Type of program	Undergraduate	364 (70.7)
	Master's	116 (22.5)
	Doctorate	35 (6.8)
Gender	Male	20 (3.9)
Gender	Female	495 (96.1)
Religion	Christian	146 (28.3)
	Roman catholic	86 (16.7)
	Buddhism	40 (7.8)
	Others	6 (1.2)
	None	237 (46.0)
Have you stayed in a foreign country for over three months?	Yes	83 (16.1)
	No	432 (83.9)

Have you taken college courses that are related to foreign studies?	Yes	61 (11.8)
	No	453 (88.0)
	Missing	1 (1.9)
Do you have contact with patients or clients from different cultural backgrounds?	Often	24 (4.7)
	Sometimes	302 (58.6)
	None	185 (35.9)
	Missing	4 (0.8)
Do you have contact with other health care professionals from different cultural backgrounds?	Often	7 (1.4)
	Sometimes	165 (32.0)
	None	340 (66.0)
	Missing	3 (0.6)

Have you worked as a nurse?	Yes	149 (28.9)
	No	363 (70.5)
	Missing	3 (0.6)

Table 2.

Confirmatory Factor Analysis of the Korean Version of the Cultural Awareness Scale

Factors (Subscales)	Item	Coefficient	SE	z	95% CI
E(General educational experiences)	1. The instructors at this nursing school adequately address multicultural	.761	0.023	33.01	0.715~0.806
	issues in nursing.
	2. This nursing school provides opportunities for activities related to multicultural affairs.	.638	0.030	21.40	0.574~0.694
	3. Since entering this nursing school, my understanding of multicultural issues	.763	0.023	32.62	0.722~0.814
	has increased.
	4. My experiences at this nursing school have helped me become	.691	0.027	25.39	0.635~0.743
	knowledgeable about the health problems associated with various racial
	and cultural groups.
	15. My instructors at this nursing school seem comfortable discussing cultural	.552	0.035	15.98	0.482~0.620
	issues in the classroom.
	17. I believe the classroom experiences at this nursing school help students	.489	0.037	13.13	0.403~0.552
	become more comfortable interacting with people from different cultures.
	19. My clinical courses at this nursing school have helped me become more	.477	0.038	12.46	0.397~0.548
	comfortable interacting with people from different cultures.
	20. The instructors at this nursing school model behaviors that are sensitive to	.737	0.025	29.36	0.685~0.785
	multicultural issues.
	21. The instructors at this nursing school use examples and/or case studies that	.664	0.029	22.81	0.605~0.721
	incorporate information from various cultural and ethnic groups.
C(Cognitive awareness)	5. I think my beliefs and attitudes are influenced by my culture.	.654^†	0.031	20.89	0.600~0.722
	6. I think my behaviors are influenced by my culture.	.659^†	0.031	21.23	0.607~0.727
	7. I often reflect on how culture affects beliefs, attitudes, and behaviors.	.474^†	0.039	11.98	0.413~0.566
	11. I believe nurses' own cultural beliefs influence their nursing care decisions.	.658	0.031	21.24	0.591~0.714
	13. I think students' cultural values influence their classroom behaviors (e.g.,	.567	0.035	16.10	0.496~0.635
	asking questions, participating in groups, offering comments).
	14. I think it is the nursing instructor's responsibility to accommodate students'	.620	0.033	18.92	0.555~0.684
	diverse learning needs.
	16. I think the cultural values of the nursing instructors influence their	.690	0.029	23.54	0.631~0.747
	behaviors in the clinical setting.
B(Behaviors/ Comfort with interaction)	8. When I have an opportunity to help someone, I offer assistance less	.503	0.042	11.96	0.436~0.598
	frequently to individuals of certain cultural backgrounds.
	9. I am less patient with individuals of certain cultural backgrounds.	.590	0.038	15.51	0.541~0.685
	10. I feel comfortable working with patients of all ethnic groups.	.498	0.041	12.07	0.415~0.577
	12. I typically feel somewhat uncomfortable when I am in the company of	.722	0.033	21.73	0.668~0.793
	people from cultural or ethnic backgrounds different from my own.
	26. I feel somewhat uncomfortable working with the families of patients from	.683	0.034	19.96	0.632~0.762
	cultural backgrounds different than my own.
P(Patient care/ Clinical issues)	18. I feel comfortable discussing cultural issues in the classroom.	.409^‡	0.042	9.80	0.339~0.503
	22. I respect the decisions of my patients when they are influenced by their culture, even if I disagree.	.637	0.032	20.15	0.573~0.698
	23. If I need more information about a patient's culture, I would use resources	.802	0.024	33.68	0.747~0.843
	available onsite (e.g., books, videotapes).
	24. If I need more information about a patient's culture, I would feel	.758	0.026	29.30	0.695~0.800
	comfortable asking people I work with.
	25. If I need more information about a patient's culture, I would feel	.629	0.033	18.91	0.557~0.690
	comfortable asking the patient or family member.

^† Standardized coefficients for the bold values were lower than those in the original scale;

^‡ Standardized coefficient for the bold value was higher than that in the original scale.

TOOLS

Similar articles