Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology and, Ardabil University of Medical Sciences, Ardabil, Iran,

2 Tuberculosis and Lung Disease Research Center , Nursing Research Committee of Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

INTRODUCTION: Cultural competence is the main component of cultural care; therefore, it is
necessary to be aware of its levels. The lack of a suitable tool that can measure cultural competence
levels among midwives led us to carry out the present study aiming to develop and validate a cultural
competence questionnaire for health promotion of Iranian midwives.
METHODOLOGY: This methodological study was performed on 302 midwives selected through
three‑stage cluster sampling method in 2018 in East Azarbaijan Province. The initial tool was designed
after qualitative study and searching similar studies. Then, the tool validity was assessed through
evaluating the face and content validity in midwives and performing survey and psychometrics.
Finally, the data were statistically analyzed by SPSS version 19 through exploratory factor analysis,
item analysis, Cronbach’s alpha coefficient, and Pearson correlation, at the significant level of <0.05.
RESULTS: The initial tool was constructed with 42 items in the five‑point Likert scale. By eliminating
9 items during face and content validation and 6 items during factor analysis, the final 25‑item
questionnaire was developed in five areas of theoretical and practical learning, clinical application,
cultural skill, cultural excellence, and cultural competence. According to Cronbach’s alpha, reliability
of the tool was at a good level (0.889) with a confidence interval of 0.95 (P < 0.001).
CONCLUSION: The cultural competence questionnaire for Iranian midwives, with five‑factor
verification and acceptable validity and reliability can be used in studies considering the components
of Iranian culture.

Keywords

1. Rytterström P, Cedersund E, Arman M. Care and caring culture
as experienced by nurses working in different care environments:
A phenomenological – Hermeneutic study. Int J Nurs Stud
2009;46:689‑98.
2. Nazarian A. Ethnic migration and social structural changes in
Iranian cities. Amayesh 2010;6:1‑32.
3. Betancourt JR. Cultural competence and medical education: Many
names, many perspectives, one goal. Acad Med 2006;81:499‑501.
4. Bastami MR, Kianian T, Borji M, Amirkhani M, Saber S.
Assessment of cultural competence among nurses. Med Ethics J
2016;10:65‑72.
5. Tulman L, Watts RJ. Development and testing of the blueprint
for integration of cultural competence in the curriculum
questionnaire. J Prof Nurs 2008;24:161‑6.
6. Sadeghi A, Khamarnia M. Professional ethics in health
management system regards to patient rights. Med Ethics J
2013;7:163‑75.
7. Høye S, Severinsson E. Professional and cultural conflicts for
intensive care nurses. J Adv Nurs 2010;66:858‑67.
8. Dehbashi F, Sabzevari S, Tirgari B. The relationship between
spiritual well‑being and hope in hemodialysis patients referring
to the Khatam Anbiya hospital in Zahedan 2013‑2014. Med Ethics
J 2015;9:77‑97.
9. Wittig DR. Knowledge, skills and attitudes of nursing students
regarding culturally congruent care of native Americans.
J Transcult Nurs 2004;15:54‑61.
10. Calvillo E, Clark L, Ballantyne JE, Pacquiao D, Purnell LD,
Villarruel AM. Cultural competency in baccalaureate nursing
education. J Transcult Nurs 2009;20:137‑45.
11. Hughes KH, Hood LJ. Teaching methods and an outcome tool for
measuring cultural sensitivity in undergraduate nursing students.
J Transcult Nurs 2007;18:57‑62.
12. Hajiesmaeili MR, Abbasi M, Safaiepour L, Fani M, Abdoljabari M,
Hosseini SM, et al. Spiritual health concept in Iranian society:
Evolutionary concept analysis and narrative review. Med Ethics
J 2016;10:77‑115.
13. Lakeh MA, Yazdani S, Makarem A, Gooshki ES, Shadnoosh N,
Ebrahimi M. Spirituality and cognitive and behavioral excellence
in higher education system. Med Ethics J 2013;8:115‑34.
14. Ballantyne JE. Cultural competency: Highlighting the work
of the American association of colleges of nursing‑California
endowment advisory group. J Prof Nurs 2008;24:133‑4.
15. Reihani M, Keshavarz Z, Vedadhir A, Zaeri F. Cultural safety
in motherhood: evidence from midwives and nurses in the
multicultural context of Iran society. Med Ethics J 2016;10:55‑64.
16. Campinha‑Bacote J. The process of cultural competence in the
delivery of healthcare services: A model of care. J Transcult Nurs
2002;13:181‑4.
17. Mousavi Bazaz M, Zabihi Zazoly A, Karimi Moonaghi H.
Cross‑cultural competence, an unknown necessity in medical
sciences education a review article. Iran J Med Educ 2014;14:122‑36.
18. Khanbabayi Gol M, Jabarzade F, Zamanzadeh V. Cultural
competence among senior nursing students of medical
universities in north‑west iran. J Nurs Midwifery Urmia Univ
Med Sci 2017;15:612‑9.
19. Vahedian Azimi A, Alhani F, Ahmadi F, Kazemnejad A. Effect
of family‑centered empowerment model on the life style of
myocardial infarction patients. Iran J Crit Care Nurs 2010;2:1‑2.
20. MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in
factor analysis. Psychol Methods 1999;4:84.
21. Ingersoll‑Dayton B. The development of culturally‑sensitive
measures for research on ageing. Ageing Soc 2011;31:355‑70.
22. Schwandt TA, Lincoln YS, Guba EG. Judging interpretations: But
is it rigorous? Trustworthiness and authenticity in naturalistic
evaluation. New Dir Eval 2007;2007:11‑25.
23. Waltz CF, Bausell BR. Nursing Research: Design Statistics and
Computer Analysis. Philadelphia::Davis FA; 1981.
24. Lawshe CH. A quantitative approach to content validity. Pers
Psychol 1975;28:563‑75.
25. Zomorrodi A, Mohammadipoor Anvari H, Kakaei F,
Solymanzadeh F, Khanlari E, Bagheri A, et al. Bolus injection
versus infusion of furosemide in kidney transplantation:
A randomized clinical trial. Urol J 2017;14:3013‑7.
26. Movassaghi R, Peirovifar A, Aghamohammadi D,
Mohammadipour Anvari H, Golzari SE, Kourehpaz Z.
Premedication with single dose of acetazolamide for the control
of referral shoulder pain after laparoscopic cholecystectomy.
Anesth Pain Med 2015;5:e29366.
27. Bakhshaei MH, Manuchehrian N, Khoshraftar E,
Mohamadipour‑Anvary H, Sanatkarfar M. Analgesic effects of
intrathecal sufentanil added to lidocaine 5% in elective cesarean
section. Acta Med Iran 2010;48:380‑4.
28. Aghamohammadi D, Eidi M, Lotfi A, Hosseinzadeh H,
Movasaghi R, Motighini N, et al. Effect of low level laser
application at the end of surgery to reduce pain after tonsillectomy
in adults. J Lasers Med Sci 2013;4:79‑85.
29. Hosseinzadeh H, Golzari SE, Abravesh M, Mahmoodpoor A,
Aghamohammadi D, Zomorrodi A, et al. Effect of low dose
dopamine on early graft function in living unrelated kidney
donors. Urol J 2012;9:389‑96.
30. Vahedi P, Salehpour F, Aghamohammadi D, Shimia M, Lotfinia I,
Mohajernezhadfard Z, et al. Single dose preemptive amitriptyline
reduces postoperative neuropathic pain after lumbar laminectomy
and discectomy: A randomized placebo‑controlled clinical trial.
Neurosurg Q 2010;20:151‑8.
31. Shen Z. Cultural competence models and cultural competence
assessment instruments in nursing: A literature review.
J Transcult Nurs 2015;26:308‑21.
32. Polit DF, Beck CT. The content validity index: Are you sure you
know what’s being reported? Critique and recommendations.
Res Nurs Health 2006;29:489‑97.