CV

2

Test Item Development, Expert Rating, and CVI Calculation

Chidinma Ogundu

Touro University

Test Construction

Purpose

The purpose of this document is to assess the healthcare professionals’ level of cultural competence regarding the African immigrant group. The information in the document will be used as guidance in the implementation of the health care professionals’ cultural competence training program for African immigrants and when handing out a resources toolkit for African immigrant patients.

Objectives

To assess understating of the participants regarding the basics of cultural competence.

To evaluate the participant’s knowledge on the effects of cultural incompetence when attending to African immigrants.

To examine the participant’s understanding on the basic resources needed by African immigrants as related to health care.

To evaluate the participant’s understanding regarding the challenges faced by African immigrants as they relate to health care.

To determine the participant’s understanding of the solutions to these challenges faced by African immigrants.

Population

The population is made up of healthcare professionals attending to African immigrants who visit the clinic for primary care services.

Length of the Test

The test has a maximum of 10 questions.

Difficulty and Discrimination Levels of Test Items

The test contains questions ranging from low-level to moderate level of difficulty.

Scoring Procedures to be Used

The aim is to use a separate answer sheet which can then be used in developing a computer-generated item analysis report.

Item Format

The test is in the form of a selected response multiple choice format.

Test Blueprint

Content	Level of Cognitive Skill
	K	C	AP	AN	Total
Basics of cultural competence	1	1		1
Effects of Cultural Incompetence			1	1
Basic resources for African immigrants				1
Healthcare-related challenges faced by African immigrants			1	1
Solutions to the challenges		1		1
Total	1	2	2	5	10

General Directions for the Test

(Please answer all the questions to the best of your ability. Please circle the most appropriate answer. Kindly note that your responses are strictly confidential and will only be seen by the appropriate leader(s) of the project. Your participation is highly valued. Thank you!)

Questions

1. What is cultural competence in healthcare?

A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage.

B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact.

C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.

D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.

Answer: C. Knowledge- Basics of Cultural Competence

Rationale: All the definitions above are related to important terms in cultural issues of healthcare but the definition in option C is the meaning of cultural competence in healthcare (Allison et al., 2016). Option A defines Cultural sensitivity, Option B defines Cultural diversity, and Option D defines Cultural humility. Even though the terms are inter-related, understanding the correct definition of cultural competence is the first step to ensuring that all the other terms are understood appropriately (Allison et al., 2016).

2. A healthcare professional will know that he/she is culturally competent when

A. He/ she has successfully completed a cultural competence program.

B. He/she is able to obtain knowledge of a patient's individualized culturally-influenced worldview and how their culture affects their physical and mental health.

C. He/she is able to answer key cultural competence questions regarding a particular cultural group.

D. He/she is able to treat a patient belonging to a different culture.

Answer: B Comprehension- Basics of Cultural Competence

Rationale: The only way to measure the cultural competence of a healthcare professional is by assessing their ability to look at healthcare needs and experience from the view of the patient (Allison et al., 2016). Completing a cultural competence program and answering cultural questions are only the first way to sharpening one’s cultural competence skills. Treating a patient from a different culture does not indicate cultural competence because the quality of the care the patient’s healthcare experience have not been discussed (Allison et al., 2016).

3. Which of the following would not be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient?

A. Difficulty understanding medical instructions.

B. Problem with the reliability of information.

C. Possible medical errors.

D. Increased readmission for the patient.

Answer: D Application-Effects of Cultural Incompetence

Rationale: While increased readmissions of patient may be a possible effect of language barrier between a healthcare professional and a patient, it is not immediate. All the other three options are likely to emerge during the communication session. The readmission effect may be noticed after a period of time (about 30 days). Additionally, the immediate effects can be resolved through ways such as interpretation hence improving the healthcare outcome and preventing the readmission (Allison et al., 2016).

4. Which of the following is not a basic resource needed by African immigrants as they seek healthcare services?

A. Legal Resources

B. Housing Resources

C. Food Assistance Resources

D. Finance Aid Resources

Answer: A Analysis- Basic resources for African immigrants

Rationale: Apart from legal resources, all the other resources have a direct impact on an African immigrant seeking healthcare services (Chikanda & Morris, 2021). For example, poor housing may result in poor health through ways like increased allergens and risk for cardiovascular diseases. Lack of food and poor nutrition can cause certain diseases and negatively affect the mental health, energy levels, and general well-being. Lack of finance and poverty limit the resources that the African immigrants can use to avoid health risks and implement healthy behaviors (Chikanda & Morris, 2021.

5. The main reason for cultural competence in healthcare is

A. Delivering quality care.

B. Improving cultural awareness.

C. Demographic change

D. Changing policies.

Answer: C Analysis- Basics of cultural competence

Rationale: The main reason for cultural competence in healthcare is the demographic shifts which exert pressure on health systems and demand for new directions to be applied in the delivery of care (Chikanda & Morris, 2021). All the other listed options (A, B, D) are ways of adapting to the newer forms of delivering quality care for everyone (Chikanda & Morris, 2021).

6. What is the relationship between poverty and quality care among African immigrants?

A. African immigrants are barred from accessing healthcare when needed.

B. African immigrants are not able to purchase those things that are needed for good health.

C. B only.

D. A and B.

Answer: D Analysis- Healthcare-related challenges faced by African immigrants

Rationale: The relationship between poverty and quality care among African immigrants is financial (Omenka et al., 2020). They are not able to purchase those things that are needed for good health and this prevents them from accessing quality care when needed (Omenka et al., 2020).

7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ?

A. Failing to understand the social determinants of the health of the patient.

B. Failing to communicate in the patient’s language.

C. Involving a third party (e.g. translator) to help in the communication process.

D. All of the above.

Answer: A Application- Effects of cultural incompetence

Rationale: African immigrants have unfavorable social determinants of health which contribute to their lack of quality healthcare (Chikanda & Morris, 2021). A healthcare provider is culturally incompetent if he/she cannot understand these social determinants of health because the lack of understanding will lead to poor attendance to the patient and a subsequent poor health experience (Omenka et al., 2020).

8. African immigrants may fear seeking health care services due to the following reasons except :

A. Fear of racial discrimination.

B. Difference in culture and beliefs.

C. Fear of new environments.

D. Inability to pay for the services.

Answer: C A pplication- Healthcare-related challenges faced by African immigrants

Rationale:

By agreeing to move into a newer country, the African immigrants show that they have made peace with the idea of newer environments and may be focused on how to adapt rather than the fear of the environments (Chikanda & Morris, 2021). However, all the other three are reported to be leading causes of African immigrants failing to seek healthcare services (Chikanda & Morris, 2021).

9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would not provide solutions to the communication barrier you are experiencing?

A. Finding an effective translating software.

B. Asking a (present) member of the family to provide interpretation in the communication process.

C. Seeking the services of a professional interpreter.

D. All of the above.

Answer: B Analysis- Solutions to the challenges

Rationale: Relatives have an emotional involvement, their language ability is untested, and they do not possess any skills regarding medical terminology (Allison et al., 2016). Additionally, using as interpreters is breaches confidentiality for the patient and there is lack of guarantee of impartiality or professional conduct (Allison et al., 2016).

10. Which of the following is an example of an immediate remedy for a cultural challenge when attending to African immigrants?

A. Learning about different cultures.

B. Employing diversity training.

C. Ensuring effective communication.

D. Working towards cultural humility.

Answer: C Comprehension- Solutions to the challenges

Rationale: An effective communication strategy can provide an immediate solution to language barrier which is a common challenge when attending to African immigrants(Chikanda & Morris, 2021). All the other strategies are long-term solutions and they also require long-term planning (Omenka et al., 2020).

Experts Rating Form Instructions

Rating instructions: For each item, please indicate the following:

Please rate how relevant each item is to the assessment of the cultural competence of health care professionals regarding African immigrants by placing a number in the first box to the right of each item.

1 = Not relevant at all

2 = Slightly relevant

3 = Moderately relevant

4= Highly relevant

Expert Rating Form

Item	Relevance Rating
1. What is cultural competence in healthcare? A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage. B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact. C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.
2. A healthcare professional will know that he/she is culturally competent when A. He/ she has successfully completed a cultural competence program. B. He/she is able to obtain knowledge of a patient's individualized culturally-influenced worldview and how their culture affects their physical and mental health. C. He/she is able to answer key cultural competence questions regarding a particular cultural group. D. He/she is able to treat a patient belonging to a different culture.
3. Which of the following would not be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient? A. Difficulty understanding medical instructions. B. Problem with the reliability of information. C. Possible medical errors. D. Increased readmission for the patient.
4. Which of the following is not a basic resource needed by African immigrants as they seek healthcare services? A. Legal Resources B. Housing Resources C. Food Assistance Resources D. Finance Aid Resources
5. The main reason for cultural competence in healthcare is A. Delivering quality care. B. Improving cultural awareness. C. Demographic change D. Changing policies.
6. What is the relationship between poverty and quality care among African immigrants? A. African immigrants are barred from accessing healthcare when needed. B. African immigrants are not able to purchase those things that are needed for good health. C. B only. D. A and B.
7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ? A. Failing to understand the social determinants of the health of the patient. B. Failing to communicate in the patient’s language. C. Involving a third party (e.g. translator) to help in the communication process. D. All of the above.
8. African immigrants may fear seeking health care services due to the following reasons except : A. Fear of racial discrimination. B. Difference in culture and beliefs. C. Fear of new environments. D. Inability to pay for the services.
9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would not provide solutions to the communication barrier you are experiencing? A. Finding an effective translating software. B. Asking a (present) member of the family to provide interpretation in the communication process. C. Seeking the services of a professional interpreter. D. All of the above.
10. Which of the following is an example of an immediate remedy for a cultural challenge when attending to African immigrants? A. Learning about different cultures. B. Employing diversity training. C. Ensuring effective communication. D. Working towards cultural humility.

Content Validity Index Table

Item	Expert 1	Expert 2	Expert 3	Mean
1
2
3
4
5
6
7
8
9
10

(The procedure consists of having experts rate items on a four-point scale of relevance. Then, for each item, the item (CVI) (I-CVI) is computed as the number of experts giving a rating of 3 or 4, divided by the number of experts-the proportion in agreement about relevance)

References

Allison, K. W., Echemendia, R. J., Crawford, I., & Robinson, W. L. (2016). Predicting cultural competence: Implications for practice and training. Professional Psychology: Research and Practice, 27(4), 386.

Chikanda, A., & Morris, J. S. (2021). Assessing the integration outcomes of African immigrants in the United States. African Geographical Review, 40(1), 1-18.

Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC public health, 20(1), 1-13.