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| Instrument | Purpose | Subjects | Description of instrument | Stated conceptual framework | Score methods | Reported reliability | Reported validity | Subsequent use/testing | Reliability reported in subsequent testing |
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(1) Cultural
Self-Efficacy Scale (CSES), Bernal and Froman, 1993 [14] | Designed to test perceived sense of self efficacy in caring for diverse patients (Black, Hispanic, and Asian) | Piloted with community health nurses | 30 items testing knowledge of cultural concepts, comfort in performing cultural nursing skills, and knowledge of cultural patterns for specific ethnic groups | Consistent with Bandura Self Efficacy (Social Learning Theory) and Leininger; otherwise not linked with an overarching conceptual model | Survey—5-point Likert-type scale with 1—very little confidence and 5—quite a lot of confidence | Cronbach’s alpha .97 overall with subscales ranging from .85 to .98. | Content validity determined by an expert panel of 5 public health nurses
followed by factor analysis confirming construct validity | Jones et al., 2004 [15] | Consistent with pilot study |
| Coffman et al., 2004 [16] reported multiple published and unpublished uses of CSES | Reliability reported ranging from .86 to .98 |
| Quine et al., 2012 [17] | Reliability reported for knowledge subscale .95 and skills subscale .87 |
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| (2) Transcultural Self-Efficacy Tool (TSET), Jeffreys and Smodlaka, 1996 [18] | Diagnostic tool designed to evaluate students perceived self efficacy caring for diverse clients | Original pilot study had 357 nursing students | 83-item questionnaire with 3 subscales: cognitive, practical, and affective | Bandura—Self Efficacy (Social Learning Theory), concepts of transcultural nursing | Survey—10-point Likert-type scale. For all items 1—not confident to 10—totally confident | Total alpha .97 and .98 with subscale alpha ranging from .90 to .98 | Content validity by 6 member expert panel followed by factor analysis confirming construct validity | Jeffreys, 2000 [19] | Consistent with pilot study |
Jeffreys and Smodlaka, 1999 [20]
Lim et al., 2004 [21] | Published reliability .091–.093 for subscales |
| Larsen and Reif, 2011 [22] | Cronbach’s alpha ranged from 0.982 to 0.990 |
| Jeffreys and Dogan, 2010 [23] | CEFA testing internal consistency .94 to .98 and reliability of .99 |
| Jeffreys and Dogan, 2012 [24] | Authors confirm validity and reliability |
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| (3) Inventory for Assessing the Process of Cultural Competency (IAPCC and IAPCC-R), Campinha-Bacote, 2009 [6] | Designed to measure level of cultural competence in health care providers | Acute care setting with 15 registered nurses | Original scale of 20 items
revised scale of 25-item questionnaire based on 5 constructs of desire, awareness, knowledge, skill, and encounters | Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8] | Survey—4-point Likert-type scale with differing range for responses | Reliability of original version reported as a “limitation” | Content validity determined by 5 national health care experts in fields of transcultural nursing and construct validity determined by known groups technique | Multiple reported uses of IAPCC-R [6] | Consistent with reported psychometric values of revised version
The author reports “average” reliability of revised version Cronbach’s alpha .83 |
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(4) Ethnic Competency Skills Assessment Inventory—
(ECSAI), Napholz, 1999 [25] | Originally designed for another discipline; used to examine self-report cultural competence of nursing students | 56 nursing students from 2 campuses | 23 items with no description of items | Not reported | Survey—5-point Likert-type scale—never to always | Coefficient alpha .9444 | Not reported | Not reported | Not reported |
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(5) Cultural Awareness Scale (CAS), Rew et al., 2003 [26]
| Designed to test cultural awareness of nursing students | Instrument piloted with 72 undergrad and grad nursing students | 36-item questionnaire with 5 subscales: general education experience, cognitive awareness, research issues behavior/comfort with interactions, and patient care issues | Based on the Pathways Model and consistent with the Purnell Model of Cultural Competence | Survey—7-point Likert-type scale—strongly agree to strongly disagree | Cronbach’s alpha .82 for faculty and for students .91 on overall test | Content validity determined by 7 member expert panel | Krainovich-Miller et al., 2008 [27] | Overall testing was consistent with original pilot reporting |
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| (6) Cultural Competence Assessment (CCA), Schim et al., 2003 [28]. | Designed to measure cultural competence among hospice nurses and workers | Field tested and pilot tested with 51 hospice nurses and caregivers | 25 items with subscales—awareness and sensitivity, cultural diverse experiences, and cultural competence behaviors | Based on Cultural Competence Model of Schim and Miller | Survey—5-point Likert-type scale—strongly agree to strongly disagree and no opinion | Cronbach’s alpha overall was .92 with subscales reliability of .93 and .75 | Content and face validity determined by 2 expert panels | Doorenbos et al., 2005 [29] | Tested in health care providers with consistent results |
| Construct validity testing by factor analysis with two factors loading over .40 and contrasted group validity was determined | Starr and Wallace, 2009 [30] | Not reported |
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(7) Cultural Knowledge Scale
(CKS) [31] | Designed to evaluate effectiveness of cultural competence training | Convenience sample of 76 public health nurses enrolled in 5-week cultural competence training course | 24 items with 2 knowledge subscales—items taken from IAPCC-R and CSES | Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8] | Survey—5-point Likert-type scale—strongly agree to strongly disagree | Cronbach’s alpha of 0.71 to 0.96 | Otherwise reliability and validity were based on original instruments from which items were taken | Not reported | Not reported |
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(8) Cultural Diversity Questionnaire for Nurse Educators—
CDQNE [32] | Designed to measure cultural competence of nurse educators | Convenience sample of 163-nursing faculty | 72 items with 2 subscale measuring 5 constructs of desire, awareness, knowledge, skill, and encounters—included items from the IAPCC-R | Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8] | Survey—5-point Likert-type scale—strongly agree to strongly disagree | Not reported | Content validity was determined by a panel of experts | Reneau, 2013 [33] | Not reported |
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| (9) Cultural Competency Instrument (CCI), Kosoko-Lasaki et al., 2006 [34] | Designed to assess provider and investigator knowledge, attitudes, and sensitivity to other cultures | Pilot tested with “small” group of clinical researchers and research nurses | 20 items | Not reported | Survey—multiple choice | Not reported | Content validity was based on review of the literature “no attempts” to further validate | O’Brien et al., 2006 [35] | Psychometric values not reported |
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| (10) Cross-Cultural Evaluation Tool (CCET), Hughes and Hood 2007 [36] | Designed to measure the cultural sensitivity of nursing students after educational activity | Convenience sample of 218 nursing students | 20 items | Based on items from an unpublished presentation by Freeman, 1993 [37] | Survey—5-point Likert-type rating scale assessing behaviors with range from always exhibited to never demonstrated | Cronbach’s alpha of 0.73 to 0.87. Significant alpha increases on posttest | Subjected to factor analysis by PCA. Four factors accounting for 51.9% of variance for the concept cross-cultural interaction | Not reported | Not reported |
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| (11) Nurse Cultural Competence Scale (NCCS), Perng and Watson 2012 [38] | Designed to measure cultural awareness, cultural knowledge, cultural sensitivity, and cultural skill | Pilot testing with 47 Taiwanese on the job nursing students | 41 items, measuring 4 constructs: cultural awareness, knowledge, sensitivity, and skill | Based on the literature of Campinha-Bacote, Jeffreys, and others | Survey—5-point Likert-type scale—strongly agree to strongly disagree | Cronbach’s alpha for 4 scales ranged from 0.78 to 0.96 | Face validity established through reviews by 4 experts | Perng and Watson, 2012 [38] | Not reported |
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