Cultural Competence Assessment Research Articles

Predictors of Hospital Nurses' Cultural Competence: The Value of Diversity Training.

RNs must be culturally competent to facilitate optimal health outcomes for diverse patients and families. The purpose of this study was to identify factors associated with cultural competence in hospital nurses. In this cross-sectional, descriptive study, the Cultural Competence Assessment Tool was administered to RNs (N = 74) from a 500-bed urban medical center in the southeastern United States. The mean age of participants averaged 40.6 (SD = 11.0) years, and most participants were White (63%) and had encountered more than five (66%) different cultures in their work environment in the prior 12 months. Forty-two percent had received two or more different types of diversity training (M = 1.6, SD = 1.1). Mean score for overall cultural competence was 7.3 (SD = 0.8) on a scale of 0 to 10 (10 = highest possible). Years of education was positively associated with diversity training (r = 0.31, p < .01) and cultural competence (r = 0.25, p < .05). Only diversity training predicted greater cultural competence (β = 0.40, p = .001). Results suggest that diversity training is associated with greater cultural competence. Further research is needed to identify optimal types, dose, and frequency of diversity training to enhance overall cultural competence. [J Contin Educ Nurs. 2019;50(10):469-474.].

Teaching Online Graduate Nursing Students Cultural Diversity From an Ethnic and Nonethnic Perspective.

Introduction: Nursing programs requiring a short-term cultural diversity immersion experience can impose financial, family, and work schedule hardships for graduate students. This study aimed to measure changes in cultural practice, awareness, sensitivity, and behaviors before and after completing an online cultural diversity course without travel. Methodology: A quasi-experimental pretest/posttest design collected data from a convenience sample of graduate nursing students (n = 37) enrolled in a 16-week online course using the Cultural Competency Assessment (CAS/CCB), Culturally Congruent Care for Advanced Nursing Course Objectives (CCCAN-CLO) and Teaching/Assignment Inventory tools. Results: There was a statistically significant increase in graduate nursing students' cultural competency postcourse scores: CAS, t(36) = -5.16, p < .001; CCB, t(36) = -5.42, p < .001; CCCAN-CLO, t(36) = -6.21, p < .001. Students identified conducting cultural interviews and online discussions as the most effective teaching strategies and assignments for learning cultural diversity content. Conclusion: Effective approaches for teaching graduate nursing students' cultural diversity for practice are available for online learners.

Three zones of cultural competency: surface competency, bias twilight, and the confronting midnight zone

BackgroundRegulatory authorities in healthcare are authorised to develop and assess the cultural competence of their professionals. There remains significant diversity on approaches to cultural competency training and assessment. Little evidence exists about whether existing cultural competency training leads to improved patient health outcomes and reductions in health disparity.DiscussionIn this paper I frame cultural competency as analogous to the ocean and consisting of three zones: surface competency zone, bias twilight zone, and the confronting midnight zone. The surface competency zone focuses on deployment of culturally-specific knowledge: what people see, say, and do. The bias twilight zone is where people engage in critical reflection on their inherent/unconscious biases, and how such biases inform their thoughts and practices. The confronting midnight zone is where people engage in critical consciousness and self-awareness. Here they look beyond their biases to interrogate their power and positionality in society (their own privileges and centralisation). This attention is coupled with a commitment to social justice and to working within their means to reduce health disparities.ConclusionsI suggest surface cultural competency is somewhat easier to see, teach and reach than the bias twilight or confronting midnight zones. But it is these deeper zones that cultural competency training needs to attend to if we are to see systemic cultural changes in healthcare provision. Research assessing the extent by which cultural competency training within each zone informs improved patient outcomes and reductions in health disparity is called for.

Improving nursing student cultural competence: Comparing simulation to case-based learning

Background: Cultural competence encompasses knowledge, skills, and comfort in caring for patients from diverse cultures and is a core competency in providing patient-centered care. Simulation provides an opportunity to expose students to diverse cultures. Case-based learning has been effective in improving nursing student communication and problem-solving skills, but no research describes its use in cultural education. The purpose of this study was to compare the effect of simulation to case-based learning on nursing students’ perceived cultural competence, awareness, and sensitivity.Methods: Eighty baccalaureate nursing students were randomly assigned to a simulation experience or case-based learning exercise. The Cultural Competence Assessment Survey was used to measure perceived cultural competence, awareness, and sensitivity. Results: Both simulation and case-based learning improved nursing student perceived cultural awareness and sensitivity. Case-based learning improved perceived cultural competence.Conclusions: Integration of cultural learning opportunities into nursing education provides a foundation for continued development of cultural competence.

Behavior, Awareness and Sensitivity of Healthcare Providers in a Multicultural Environment

Background: The healthcare workforce of Saudi Arabia is characterized by diverse cultural backgrounds as a consequence of employment of expatriate workers from various countries. The heterogeneity of both providers of health services and clients resulted to cultural barriers that affected the delivery care. It is paramount to evaluate the cultural competence of the healthcare providers (HCPs) to maintain quality holistic care. Objective: The primary objective of this study was to assess the cultural diversity experience, cultural competence behavior (CCB) and cultural awareness and sensitivity (CAS) of HCPs in a hospital setting of Saudi Arabia. Methods: This was a cross-sectional study involving survey of HCPs from medical, nursing and laboratory technology disciplines using the Cultural Competence Assessment (CCA) tool. Results: There were a total of 104 HCPs who completed the survey. The characteristics of the respondents resulted to a mean age of 38.7 ±10.4 who were predominantly Asians and nurses. The majority had working experience of 10 years and below, with more than half who had prior diversity trainings. Reported cultural diversity experience included all HCPs caring for Arab Middle Easterners and Asians and encountering at least one or more special population groups. There was an overall high cultural competence (5.28 ±0.46), high CCB (5.84 ±0.56) but only moderately high CAS (4.72 ±0.35). Significant differences were only identified between CCB scores and three demographic variables (racial/ethnic identification, area of discipline and years of experience). No significant result was found between CAS scores and demographic variables as well as between CCB and CAS scores. Conclusions: In spite of high CCB, the HCPs responded with lower CAS scores. Interventions should be initiated to increase CAS such as cultural diversity training and availability of cultural care resources.

Validity and utility of the Swedish version of the Cultural Competence Assessment Instrument

IntroductionGlobal migration as well as migration to Sweden has increased during the last few decades. A self-rating instrument that measures cultural competence could support occupational therapists’ professional knowledge when they encounter clients from different cultural backgrounds. The purpose of this study was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument among occupational therapists. Nineteen occupational therapists participated in four focus groups. ResultsThe results revealed that all 24 items of the Cultural Competence Assessment Instrument were valid, even though six of the items were in need of reformulations and exemplifications. The category Interactions with clients showed that the Cultural Competence Assessment Instrument – Swedish version could be utilised individually to raise awareness on cultural issues in practice. The category Workplace and its organisational support showed that the Cultural Competence Assessment Instrument – Swedish version had potential for use in different workplaces, and indicated the importance of organisational support in the development of communications and cultural competence. ConclusionThe evaluation indicated positive content validity for the Cultural Competence Assessment Instrument – Swedish version, and that it had the potential to be utilised in the Swedish context.

Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand

BackgroundEnsuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels.MethodsA cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer’s Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis.ResultsA total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05).ConclusionsThese results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.

The Spanish version of the Cultural Competence Assessment (CCA-S): Transcultural validation study and proposed refinement

BackgroundCultural competence (CC) is becoming an essential component of healthcare professionals. There is a gap in the research evaluating CC in order to develop competency-based approach programs. Spain has become a multicultural society and it is necessary to evaluate and promote CC attitudes to reduce the disparity of care for vulnerable and minority groups. ObjectivesTo adapt and validate the Cultural Competence Assessment (CCA) of Schim et al. (2003), to get evidence-based data of CC in Spanish healthcare professionals. MethodA process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. An on-line cross-sectional survey questionnaire was used. Statistical and metrical analysis was based in a sample of 568 healthcare professionals who worked daily with patients in a health care institution in South Catalonia in 2018. ResultsThe results of the exploratory factorial analysis and subsequent confirmatory analysis showed that the data had an adequate fit for a four-factor model. The reliability analysis results confirm an acceptable consistency for each subscale: active behaviour (0.86), seeking information (0.86), awareness (0,94), and sensitivity (0.69). ANOVA showed no differences between healthcare professionals, age and gender. The scores showed a normal distribution and it was proposed a standardization of scores. ConclusionsThe translation and transcultural-validation process of the CCA resulted in a Spanish-language for the 25 items, like the original. The psychometric analysis proved that the Spanish version is a reliable and valid instrument. This scale is going to be useful to analyze healthcare professional's attitudes to create effectiveness training programs focused on specific needs. The four-factor model and the standardization of the scores will be useful to achieve future objectives about research in cultural competence in healthcare professionals.

Factor analysis to validate a survey evaluating cultural competence in maternity care for Indigenous women

Objective: This research set out to develop and validate a tool to assess the self-reported progress of Australian publicly funded maternity services towards the goal of culturally competent maternity care for Indigenous women. The tool aimed to measure the degree to which these services had incorporated actions towards achieving 149 identified characteristics into the current fabric of their organisation. Design: An online exploratory survey was distributed to consenting respondents nationally. Setting: Public maternity services in each State and Territory of Australia. Subjects: The survey was distributed to 149 public maternity organisations, with 85 organisational consents and 44 respondents completing the survey. Main outcome measure: Construct validity of a survey designed to describe progress in working towards organisational cultural competence in maternity services was assessed by principal factor analysis and varimax with Kaiser rotation. Results: The results support the two subscales identified as appropriate groups of questions to address 1) assessment of cultural competence and 2) assessment of the survey. Reliability was assessed by Cronbach’s reliability and results established evidence of a reliable survey. Conclusion: The results of this study show that the survey assessing and identifying organisational cultural competence in public maternity care for Indigenous women demonstrated acceptable reliability and validity for a newly developed instrument. Responses to the survey provided participants of this study with a baseline for assessing further progress. Upon further testing and refinement, the survey can provide a validated tool to guide both national and local activity to improve the maternity experiences of Indigenous women.

THE CONCEPT OF CULTURAL COMPETENCE OF THE DIGITAL GOVERNANCE SPECIALISTS WITHIN PUBLIC ADMINISTRATION

The purpose of this article is to define and analyze the concept of cultural competence of the digital governance specialists in the public administration science. The methodological bases of the research are the methods of observation and comparative analysis that allow to systematize important factors of cultural competence assessment of digital governance specialists. Scientific novelty of the article consists of the identification of the digital governance specialists’ cultural competence concept in public administration and defining the elements of its assessment. Conclusions. Cultural competence based on developed communication skills makes digital governance more effective, because corresponding knowledge and communication skills help service delivery agencies to solve the majority of internal and external conflicts within the public administration system. The main advantage of intercultural communication skills development is the improvement of services delivery process and the increase in efficiency of interactions between citizens and public administration institutes via mechanisms of digital governance. Considering global experience in digital governance implementation, conclusions and recommendations for Ukraine were made.

Decreasing health disparities for children with asthma and their families: Conceptualizing cultural weaving & identifying the cultural characteristics of a head start organization in the United States

ABSTRACTThe overall purpose was to identify cultural competency characteristics of a community organization and its staff in caring for chronically ill children from diverse backgrounds. The study used a qualitative design to explore the elements of cultural values and beliefs within the context of a Head Start organization that cares for chronically ill, low income children. A small convenience sample of organization employees provided demographic data, completed cultural competency assessment instruments and participated in focus groups. Qualitative data were analyzed first coding and identifying themes related to cultural values and belief of the individuals who manage a local Head Start. The results indicated previous experience influences the working with diverse populations. Whereas the socialized culture had a greater effect on working with diverse groups of children and their families. Although there is a need to provide knowledge on communicating with diverse population of children and families, importantly the past beliefs and values have a powerful effect on the ability to working with diverse population. Nurses need to be more involved in the community and provide educational training on cultural diversity to various organizations. The training should include the personal values and beliefs. In addition, there is the need for the nurses to provide health care training to community organizations on management of chronically ill children in their care. The findings support the benefits of cultural competency training for all those who care for children from diverse backgrounds with health problems.

Assessment of a Peer-Taught Structural Competency Course for Medical Students Using a Novel Survey Tool

Structural competency is an emerging framework for teaching health disparities from a systems-level perspective. A group of medical students piloted a peer-taught course on applying structural competency to patient care. Measuring the impact of educational innovations is critical, yet no literature quantitatively assessing structural competency curricula currently exists for the medical school setting. Students adapted an existing cultural competency assessment instrument to create the Clinical Structural Competency Questionnaire, a 52-item Likert-based survey tool. This tool was used to assess students’ self-reported knowledge, skills, and attitudes before, immediately after, and 6 months after the course. Data were analyzed using the Wilcoxon signed-rank test. Response proportion immediately after the course was 84% (n = 114). Of these, 34% (n = 39) could be matched for all survey time-points. Students reported increases in knowledge of structural competency (p < 0.01). They reported higher levels of comfort addressing structural issues in patient care, including “coming up with a treatment plan which takes into account any structural issues in a patient’s life” (p < 0.01). Student attitudes changed significantly, including a decrease in perceived importance of genetics in determining health and health disparities (p < 0.01), relative to factors like zip code (p < 0.01), voting (p < 0.01), and housing stability (p < 0.01). Medical students perceived an improvement in knowledge, skills, and attitudes regarding application of structural thinking and practices to patient care, after a peer-taught course. Peer-taught structural competency instruction can be effective and should be implemented to train health professional students in understanding and addressing health disparities using systems-level thinking.

Cultural adaptation of a pediatric functional assessment for rehabilitation outcomes research

BackgroundSignificant racial and ethnic health care disparities experienced by Hispanic children with special health care needs (CSHCN) create barriers to enacting culturally competent rehabilitation services. One way to minimize the impact of disparities in rehabilitation is to equip practitioners with culturally relevant functional assessments to accurately determine service needs. Current approaches to culturally adapting assessments have three major limitations: use of inconsistent translation processes; current processes assess for some, but not all, elements of cultural equivalence; and limited evidence to guide decision making about whether to undertake cultural adaptation with and without language translation. The aims of this observational study are (a) to examine similarities and differences of culturally adapting a pediatric functional assessment with and without language translation, and (b) to examine the feasibility of cultural adaptation processes.MethodsThe Young Children’s Participation and Environment Measure (YC-PEM), a pediatric functional assessment, underwent cultural adaptation (i.e., language translation and cognitive testing) to establish Spanish and English pilot versions for use by caregivers of young CSHCN of Mexican descent. Following language translation to develop a Spanish YC-PEM pilot version, 7 caregivers (4 Spanish-speaking; 3 English-speaking) completed cognitive testing to inform decisions regarding content revisions to English and Spanish YC-PEM versions. Participant responses were content coded to established cultural equivalencies. Coded data were summed to draw comparisons on the number of revisions needed to achieve cultural equivalence between the two versions. Feasibility was assessed according to process data and data quality.ResultsResults suggest more revisions are required to achieve cultural equivalence for the translated (Spanish) version of the YC-PEM. However, issues around how the participation outcome is conceptualized were identified in both versions. Feasibility results indicate that language translation processes require high resource investment, but may increase translation quality. However, use of questionnaires versus interview methods for cognitive testing may have limited data saturation.ConclusionsResults lend preliminary support to the need for and feasibility of cultural adaptation with and without language translation. Results inform decisions surrounding cultural adaptations with and without language translation and thereby enhance cultural competence and quality assessment of healthcare need within pediatric rehabilitation.

Evaluation of the psychometric properties of the Korean version of the Cultural Competence Assessment.

The 25 item Cultural Competence Assessment assesses the cultural competence of multiple types of healthcare providers. This study aimed to examine the validity and reliability of the Korean version of the questionnaire (KCCA) and to determine the need for changes to improve its validity and reliability. Data from 161 hospital nurses were used for the item analysis and to assess the reliability and construct validity of the KCCA before and after the deletion of nine items. The KCCA did not demonstrate acceptable construct validity and subscale internal reliability. Nine items with high interitem correlations, high modification indices, and relatively lower factor loadings were deleted. The 16 item Modified KCCA showed improved construct validity, convergent and discriminant validity, and reliability. While further psychometric evaluation of the Modified KCCA should be undertaken with larger samples and diverse professionals, the study's data provide evidence that the Modified KCCA might be a more suitable measure for use among Korean healthcare providers.

Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study.

The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents' cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.

Cultural Competence of Obstetric and Neonatal Nurses

ObjectivesTo measure the cultural competence level of obstetric and neonatal nurses, explore relationships among cultural competence and selected sociodemographic variables, and identify factors related to cultural competence. DesignDescriptive correlational study. SettingOnline survey. ParticipantsA convenience sample of 132 obstetric and neonatal registered nurses practicing in the United States. MethodsNurse participants completed the Cultural Competence Assessment (CCA) instrument, which included Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behaviors (CCB) subscales, and a sociodemographic questionnaire. Correlation and regression analyses were conducted. ResultsThe average CCA score was 5.38 (possible range = 1.00–7.00). CCA scores were negatively correlated with age and positively correlated with self-ranked cultural competence, years of nursing experience, years of experience within the specialty area, and number of types of previous cultural diversity training. CCB subscale scores were correlated positively with age, years of nursing experience, years of experience within the specialty area, and number of types of previous diversity training. CAS subscale scores were positively correlated with number of types of previous diversity training. Standard multiple linear regression explained approximately 10%, 12%, and 11% of the variance in CCA, CAS, and CCB scores, respectively. ConclusionObstetric and neonatal registered nurses should continue to work toward greater cultural competence. Exposing nurses to more types of cultural diversity training may help achieve greater cultural competence.

A Cultural Competence Organizational Review for Community Health Services: Insights From a Participatory Approach.

Cultural competence is an important aspect of health service access and delivery in health promotion and community health. Although a number of frameworks and tools are available to assist health service organizations improve their services to diverse communities, there are few published studies describing organizational cultural competence assessments and the extent to which these tools facilitate cultural competence. This article addresses this gap by describing the development of a cultural competence assessment, intervention, and evaluation tool called the Cultural Competence Organizational Review (CORe) and its implementation in three community sector organizations. Baseline and follow-up staff surveys and document audits were conducted at each participating organization. Process data and organizational documentation were used to evaluate and monitor the experience of CORe within the organizations. Results at follow-up indicated an overall positive trend in organizational cultural competence at each organization in terms of both policy and practice. Organizations that are able to embed actions to improve organizational cultural competence within broader organizational plans increase the likelihood of sustainable changes to policies, procedures, and practice within the organization. The benefits and lessons learned from the implementation of CORe are discussed.

How Effective is Cultural Competence Training of Healthcare Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of Literature.

With the rapid growth of minority populations in the United States, the need to train healthcare providers to give culturally competent care has never been greater. Extensive research on cultural competence of healthcare providers has been conducted, but no systematic review specifically focused on the effect of cultural competence training on patient satisfaction of clients from minority groups. To search and critically appraise published research articles that evaluated the effectiveness of cultural competence training of healthcare providers on improving patient satisfaction of clients from minority groups. Using MeSH entry terms: Competency, Cultural; Cultural Competencies; Cultural Competence; Competence, Cultural; Satisfaction, Patient; and non-MeSh text words: Cultural Awareness, Cultural Sensitivity, Cultural Competence Training, Cultural Sensitivity Training, and Cultural Awareness Training, a comprehensive literature search of peer-reviewed articles from 2002 to 2014 in CINAHL, Cochrane, PsycINFO, PubMed, and Web of Science databases was conducted. Original studies that reported cultural competence training and measured its impact on patient satisfaction were included. Quality of the reviewed studies was assessed on the basis of methodological limitations related to experimental design, sample size and sampling approaches, and ethnic spread of the participants. Seven studies met the inclusion criteria. Six studies revealed that cultural competence training intervention significantly increased the cultural competence level of healthcare providers. Five studies demonstrated that cultural competence training of healthcare providers was significantly associated with increased patient satisfaction. Cultural competence training is an effective intervention that enables healthcare providers to give culturally competent care that increases satisfaction of patients from minority groups. However, more research with better research designs, large sample sizes, and validated standardized cultural competence and patient satisfaction assessment tools is needed to unequivocally attribute cultural competence training to patient satisfaction.

Elements of cultural competence in an Australian Aboriginal maternity program.

Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area. To identify elements of the Aboriginal Maternity Group Practice Program that contributed to the provision of a culturally competent service. The Organisational Cultural Competence Assessment Tool was used to analyse qualitative data obtained from surveys of 16 program clients and 22 individuals from partner organisations, and interviews with 15 staff. The study found that the partnership model positively impacted on the level of culturally appropriate care provided by other health service staff, particularly in hospitals. Two-way learning was a feature. Providing transport, team home visits and employing Aboriginal staff improved access to care. Grandmothers successfully brought young pregnant women into the program through their community networks, and were able to positively influence healthy lifestyle behaviours for clients. Many elements of the Aboriginal Maternity Group Practice Program contributed to the provision of a culturally competent service. These features could be considered for inclusion in antenatal care models under development in other regions with culturally diverse populations.

Evaluation of a Cultural Competence Assessment for Preservice Teachers

Globally, public schools enroll culturally and linguistically diverse student populations and teacher preparation programs must assess the cultural competence of preservice teachers. Yet, few adequately tested measures of teacher cultural competence are available. In this research study, a sample of 396 preservice teachers were surveyed to evaluate psychometric properties of one cultural competence measure designed by Liang and Zhang (2009) and to determine how well the instrument's factors reflected the construct of cultural competence. Data were collected over a 2-year period from preservice teachers enrolled in their last semester of student teaching in public school settings. Exploratory and confirmatory factor analyses were conducted along with a Schmid-Leiman solution due to strong interfactor correlations. Results revealed residualized first-order factors accounting for 47% of the variance and a second-order factor, Cultural Competence, which accounted for 53% of the variance explained. Implications for assessing preservice teachers' cultural competence and future research are discussed.