Cultural Competence of Healthcare Providers: A Systematic Review of Assessment Instruments.

BACKGROUND: Few articles in the literature identify and describe the instruments that are regularly used by scholars to measure cultural competence in healthcare providers. PURPOSE: This study reviews the psychometric properties of the several instruments that are used regularly to assess the cultural competence of healthcare providers. METHODS: Researchers conducted a systematic review of the relevant articles that were published between 1983 and 2013 and listed on academic and government Web sites or on one or more of the following databases: CINAHL, MEDLINE, ERIC, PsycINFO, Psyc ARTICLES, PubMed, Cochrane, Pro Quest, Google Scholar, CNKI (China), and the National Digital Library of Theses and Dissertations (Taiwan). RESULTS: This study included 57 articles. Ten instruments from these articles were identified and analyzed. These instruments included five that were presented in English and five that were presented in Chinese. All were self-administered and based on respondent perceptions. Five of the 10 instruments were designed to measure cultural competence, two were designed to measure cultural sensitivity, two were designed to measure transcultural self-efficacy, and one was designed to measure cultural awareness. The six cultural dimensions addressed by these instruments were attitudes, knowledge, skills, behaviors, desires, and encounters. An expert panel validated the content of the 10 instruments. The subscales explained 33%-90% of the variance in scores for eight of the instruments. The reliability of the 10 instruments was estimated based on the internal consistency, which ranged from .57 to .97. CONCLUSIONS: This systematic review may assist researchers to choose appropriate instruments to assess the cultural competence of healthcare providers. The findings of this review indicate that no single instrument is adequate to evaluate cultural competence in all contexts.

Coupled dynamics of energy budget and population growth of tilapia in response to pulsed waterborne copper.

The impact of environmentally pulsed metal exposure on population dynamics of aquatic organisms remains poorly understood and highly unpredictable. The purpose of our study was to link a dynamic energy budget model to a toxicokinetic/toxicodynamic (TK/TD). We used the model to investigate tilapia population dynamics in response to pulsed waterborne copper (Cu) assessed with available empirical data. We mechanistically linked the acute and chronic bioassays of pulsed waterborne Cu at the scale of individuals to tilapia populations to capture the interaction between environment and population growth and reproduction. A three-stage matrix population model of larva-juvenile-adult was used to project offspring production through two generations. The estimated median population growth rate (λ) decreased from 1.0419 to 0.9991 under pulsed Cu activities ranging from 1.6 to 2.0 µg L(-1). Our results revealed that the influence on λ was predominately due to changes in the adult survival and larval survival and growth functions. We found that pulsed timing has potential impacts on physiological responses and population abundance. Our study indicated that increasing time intervals between first and second pulses decreased mortality and growth inhibition of tilapia populations, indicating that during long pulsed intervals tilapia may have enough time to recover. Our study concluded that the bioenergetics-based matrix population methodology could be employed in a life-cycle toxicity assessment framework to explore the effect of stage-specific mode-of-actions in population response to pulsed contaminants.