Advertisement

Advances in Health Sciences Education

, Volume 16, Issue 5, pp 609–626 | Cite as

Factor analysis of a modified version of the California Brief Multicultural Competence Scale with minority pharmacy students

  • Margarita EcheverriEmail author
  • Cecile Brookover
  • Kathleen Kennedy
Article

Abstract

While most of the more frequently used self-report measures of cultural competence in health professionals are targeted to practicing physicians and mental health providers from the majority-white population, no measures have been specifically developed for minority pharmacy students. With the objective to find a suitable tool to be used for curriculum development in cultural competence, this study applied a modified version of the California Brief Multicultural Competence Scale (CBMCS) to 467 pharmacy students at the Xavier University of Louisiana, a Historically Black University. Confirmatory and exploratory factor analyses were conducted to examine if the CBMCS factor structure was replicated using a modified tool and a different population and Cronbach alphas were calculated to determine internal consistency reliability. The CBMCS’s original factor structure was not replicated, perhaps because of modifications introduced in the original tool or because of differences between the sample population in this study (minority pharmacy students) and the population used in the original CBMCS study (majority-white mental health providers). However, results show that a modified factor structure fits the data well. The primary difference between the factors found in this study and the CBMCS factors is the appearance of a new factor composed of three items related to interpersonal and racial dynamics, which includes racial discrimination, white privilege, and power imbalance. The significant relationships (p < 0.001) found between respondents’ race and these three items suggest that the wording in these items should be modified when the respondents do not belong to the majority population. Results imply that racism, prejudice and bias are not just issues of the majority-white health providers and point to the need for more racially diverse samples. The unique results in this study advance research on racial dynamics and self-assessment of cultural competence of minority health professionals.

Keywords

Self-assessment Factor analysis Cultural competence Racial dynamics Pharmacy students Minority health providers 

Notes

Acknowledgments

The authors would like to express our deep appreciation to Dr. Glenn Gamst, Chair Psychology Department, University of La Verne, California, and author of the CBMCS for granting us authorization to use and modify the CBMCS, and to Dr. Robert Like, Director Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, and the Editors and Reviewers for improving this manuscript through their comments. The authors also acknowledge the students who completed the survey instruments, the Faculty who authorized the application of the instrument, and the Institutional Review Board who approved the research. Funding: This work was supported by the National Cancer Institute [grant numbers 5P20CA118767-04 and 5P20CA118768-04].

Conflict of interest

The authors report no conflict of interest in the conduct of this study or the preparation of this manuscript.

References

  1. Accreditation Council for Pharmacy Education—ACPE (2006). Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Available at http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf. Accessed 15 Jan 2010.
  2. American Public Health Association—APHA (2006) The role of the pharmacist in public health, policy number 200614, 6 Nov 2006. Available at http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1338. Accessed 15 July 2010.
  3. Arbuckle, J. L. (2007). AMOS ® 16.0 user’s guide. Spring House, PA: Amos Development Corporation.Google Scholar
  4. Babbie, E. (2009). The practice of social research (12th ed., p. 530). Belmont, CA: Wadsworth Publishing Company.Google Scholar
  5. Bastos, J. L., Celeste, R. K., Faerstein, E., & Barros, A. (2010). Racial discrimination and health: A systematic review of scales with a focus on their psychometric properties. Social Science and Medicine, 70, 1091–1099.CrossRefGoogle Scholar
  6. Boyle, D. P., & Springer, A. (2001). Toward a cultural competence measure for social work with specific populations. Journal of Ethnic and Cultural Diversity in Social Work, 9(3–4), 53–71.CrossRefGoogle Scholar
  7. Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16–29.CrossRefGoogle Scholar
  8. Dunn, T. W., Smith, T. B., & Montoya, J. A. (2006). Multicultural competency instrumentation: A review and analysis of reliability generalization. Journal of Counseling and Development, 84(4), 471–482.Google Scholar
  9. Fraering, M. (2007). Long-term stability of ethnocentric consumer attitudes. Journal of Applied Business Research, Second Quarter, 23(2), 55–68.Google Scholar
  10. Fujishiro, K. (2009). Is perceived racial privilege associated with health? Findings from the behavioral risk factor surveillance system. Social Science and Medicine, 68, 840–844.CrossRefGoogle Scholar
  11. Gamst, G., Dana, R. H., Der-Karabetian, A., Aragon, M., Arellano, L., Morrow, G., et al. (2004). Cultural competency revised: The California brief multicultural competence scale. Measurement and Evaluation in Counseling and Development, 37(3), 163–187.Google Scholar
  12. Gilbert, J. (Ed) (2003). Principles and recommended standards for cultural competence education of health care professional. Woodland, CA: The California endowment; 2003:93. Available at http://www.calendow.org/uploadedFiles/principles_standards_cultural_competence.pdf. Accessed 4 May 2010.
  13. Graves, D. L., Like, R. C., Kelly, N., & Hohensee, A. (2007). Legislation as intervention: A survey of cultural competence policy in health care. Journal of Health Care Law and Policy, 10(2), 339–361.Google Scholar
  14. Hu, L., & Bentler, P. M. (1995). Evaluating model fit. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 76–99). Thousand Oaks, CA: Sage.Google Scholar
  15. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  16. Institute of Medicine –IOM. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. In D. Brian Smedley, Y. Adrienne Stith, & R. Alan Nelson (Eds.), Committee on understanding and eliminating racial and ethnic disparities in health care. Washington, DC: The National Academies Press.Google Scholar
  17. Jackson, D. L., Gillaspy, J. A., Jr., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14, 6–23.CrossRefGoogle Scholar
  18. Jones, C. P. (2000). Levels of racism: A Theoretic framework and a gardener’s tale. American Journal of Public Health, 90(8), 1212–1215.CrossRefGoogle Scholar
  19. Kumas-Tan, Z., Beagan, B., Loppie, C., MacLeod, A., & Frank, B. (2007). Measures of cultural competence: Examining hidden assumptions. Academic Medicine, 82(6), 548–557.CrossRefGoogle Scholar
  20. Levy, R., Like, R. C., & Shabsin, H. (2009). Origins and strategies for addressing ethnic and racial disparities in pharmaceutical therapy: The health-care system, the provider, and the patient. Washington, DC: National Minority Quality Forum; 2009:62.Google Scholar
  21. Marsh, H. W., Muthén, B., Asparouhov, T., Lüdtke, O., Robitzsch, A., Morin, A., et al. (2009). Exploratory structural equation modeling, integrating CFA and EFA: Application to students’ evaluations of university teaching. Structural Equation Modeling, 16(3), 439–476.CrossRefGoogle Scholar
  22. McIntosh, P. (2008). White privilege and male privilege: A personal account of coming to see correspondences through work in women’s studies. In G. C. Gamst, A. Der-Karabetian, & R. H. Dana (Eds.), CMBCS multicultural reader (p. 572). Thousand Oaks, California: Sage Publications Ltd.Google Scholar
  23. Office of Minority Health—OMH (2001) National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: Department of Health and Human Services (DHHS); 2001:132. Available at http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf. Accessed 4 May 2010.
  24. Office of Minority Health -OMH (2002). Teaching cultural competence in health care: A review of current concepts, policies and practices: Task 2, synthesis report. Report prepared by the American Institutes for Research, Washington, DC: Department of Health and Human Services (DHHS); 2002:90. Available at http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.138.5730&rep=rep1&type=pdf.
  25. Stuber, J., Meyer, L., & Link, B. (2008). Stigma, prejudice, discrimination, and health. Social Science and Medicine, 67(3), 351–357.CrossRefGoogle Scholar
  26. Suhr, D. (2006). Exploratory or confirmatory factor analysis? In SAS Institute Inc., Proceedings of the thirty-first annual SAS, users group international conference -SUGI 31 (paper 200-31). Cary, NC: SAS Institute Inc. Available at http://www2.sas.com/proceedings/sugi31/200-31.pdf Accessed 27 April 2010.
  27. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.Google Scholar
  28. White-Means, S., Dong, Z., Hufstader, M., & Brown, L. T. (2009). Cultural competency, race, and skin tone bias among pharmacy, nursing, and medical students: Implications for addressing health disparities. Medical Care Research Review, 66, 436–455.CrossRefGoogle Scholar
  29. Der-Karabetian, A., & Gamst, G. (n.d). CBMCS scoring guide and administration packet. University of La Verne [Available upon request from Glenn Gamst].Google Scholar
  30. Yu, C. (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes, dissertation, University of California, LA, 2002:183.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Margarita Echeverri
    • 1
    Email author
  • Cecile Brookover
    • 1
  • Kathleen Kennedy
    • 1
  1. 1.Xavier University of LouisianaNew OrleansUSA

Personalised recommendations