Cross-cultural Instrument Research Articles

Construction of the Views oN Infant Sleep (VNIS) Questionnaire

Parents' beliefs about infant sleep behaviour vary over time and across cultures. No validated instrument exists to understand parents' pre- and postnatal views on infant sleep behaviours, which may influence their caregiving decisions. The Views oN Infant Sleep Questionnaire (VNIS) will be a tool to assess parents' beliefs in order to facilitate tailored perinatal care, increase the reliability of postnatal self-report measures, allow for cross-cultural comparisons, and provide a baseline for researchers to use in longitudinal studies. We recruited an online sample of 971 female participants who were resident in the United Kingdom, at least 28 weeks pregnant, and at least 18 years of age. The initial questionnaire consisted of 31 questions about infant independence, night-waking, infant feeding, touch, and safety, and items were rated on a 5-point Likert scale. The item pool was reduced to 12 using principal component analysis and a structure was found for the three components “Closeness”, “Independence”, and “Night-waking”. Overall, these results suggest that the VNIS can provide a brief scale to measure different aspects of individuals' beliefs about infant sleep. In further research the VNIS needs to be validated with a confirmatory factor analysis in another sample, and to be tested as a cross-cultural instrument.

Measuring design thinking competence in Taiwanese nursing students: a cross-cultural instrument adaptation

BackgroundDesign thinking (DT) competence, a creative problem-solving ability, has been investigated extensively among college students in various professional fields within the western cultures. No instrument, however, is available for assessing DT competence in nursing students, particularly, those in non-western cultures.ObjectiveTo adapt and validate the use of Creative Synthesis Inventory (CSI) assessing the four components (i.e., visualization, discovery, prototyping, and evaluation) of DT competence in nursing students in Taiwan.DesignCross-sectional, mixed methodological design combining qualitative and quantitative strategies.ParticipantsA 19-item CSI was administered to a total of 520 nursing students from two campuses of a science and technology university in Taiwan. The data collection was conducted between September 2020 and June 2022.MethodsThe cross-cultural adaptation and validation of CSI-Taiwan was done in two phases: Phase I included content validity check, translation, and cross-cultural adaptation. Phase II involved pilot testing and psychometric evaluation.ResultsA first-order confirmatory factor analysis validated the four-component structure, namely visualization, discovery, prototyping, and evaluation, of an 18-item CSI-Taiwan (model fit indices: χ2/df = 3.953, NNFI = 0.942, CFI = 0.956, TLI = 0.947, SRMR = 0.035, and RMSEA = 0.075). A second-order confirmatory factor analysis further indicated that the four components converged on a unitary construct of DT competence (model fit indices: χ2/df = 4.082, NNFI = 0.935, CFI = 0.949, TLI = 0.940, SRMR = 0.040, and RMSEA = 0.080). Moreover, the CSI-Taiwan also demonstrated satisfactory reliability and validity. Together these results validated the construct of DT competence and its components as theorized.ConclusionsThe CSI-Taiwan was a reliable and valid self-report instrument to be used by Taiwanese nursing students.

5 Normative Data Collection for the Multicultural Neuropsychological Scale (MUNS)

Objective:Despite the array of neuropsychological tests available, these assessments are largely made and developed for use in WEIRD (western, educated, industrialized, rich, democratic) societies (Fernandez, 2019; Ponsford, 2017). The Multicultural Neuropsychological Scale (MUNS) was developed with underrepresented groups in mind as a universally valid neuropsychological assessment which can be used across cultures and adapted to different languages. To assist with the validation of the MUNS as a cross-cultural instrument, investigators administered the MUNS to a cognitively 'healthy’ college-aged population in the United States as a means of collecting normative data. Results were compared to samples taken from an Argentine university, Universidad Catelica de Cerdoba, and combined with another American university, Marymount Loyola University. The goal of this comparison was to provide evidence supporting the validity of the MUNS as a universal, cross-cultural neuropsychological assessment battery.Participants and Methods:Students from James Madison University (JMU) in Harrisonburg, Virginia (N = 24, Age = 20.083 1.93, Female = 87.5%) were recruited via a campus-wide email. Students who met inclusionary criteria were selected for MUNS administration. Students completed a background questionnaire and effort measure (REY-15; Rey, 1964) before completing the MUNS battery, consisting of eight subtests with four delayed trials. Descriptive statistics of the group were assessed, and one-way ANOVAs were conducted on the various subtests to determine whether differences exist between the American and Argentine samples.Results:No significant difference between groups was found for seven subtests. A difference existed on the Attention subtest between the American (f (1, 106) = 45.409, p < .001).Conclusions:The results show support for the cross-cultural validity of the MUNS. The only significant difference was found in the Arrows (Old) subtest. This is in alignment with previous administrations of the MUNS (Fernandez et al., 2018). Further studies are needed to assess potential bias within this subtest, as well as to pursue comparison studies for the New Arrows subtest administered within this USA sample. The present findings provide further evidence that the MUNS can be applied as a neuropsychological assessment across a variety of populations.

Ethical Considerations in Global Mental Health Research: Lessons Learned From Binational U.S.–Mexico Collaborations

Binational research is critical to better understand the health, mental health, and health outcomes of immigrant communities. Binational studies are often difficult to conduct, however, due to cost, challenges with participant recruitment and data collection, lack of appropriate cross-cultural instruments, and challenges ensuring ethical reviews and approval in both counties. This research note discusses ethical issues navigating institutional review board (IRB) procedures while striving to maintain the highest ethical protection for participants when engaging in binational behavioral sciences research between México and the United States. We discuss the need to clarify requirements for international research between México and the United States and navigating differences that may exist or emerge between IRBs in México and the United States. We provide some recommendations to assist researchers in ensuring IRB approval for their research protocols and ethical protection for their participants.

Cultural adaptation and validation of the Others as Shamer scale: a barrier to effective health-care assessment

PurposeDespite the fact that shame is recognized as a significant factor in clinical encounters, it is under-recognized, under-researched and under-theorized in health prevention, assessment and cross-cultural contexts. Thus, this study aims to investigate the psychometric properties of the most widely used scale, the “Other as Shamer Scale” (OAS), to assess the risk and proclivities of external shame in adults. As in health care, there is a barrier between what is known through research in one culture and what is acceptable in practice in another culture.Design/methodology/approachThe Urdu version was prepared using the standard back-translation method, and the study was conducted from June 2021 to January 2022. The translation and adaptation were completed in four steps: forward translation, adaptation and translation, back translation, committee approach and cross-language validation. The sample, selected through the purposive sampling method, is comprised of 200 adults (men = 100 and women = 100), with an age range of 18–60 years (M = 28, SD = 5.5), spanning all stages of life. The Cronbach's alpha reliability and factorial validity of the OAS were assessed through confirmatory factor analysis and Pearson correlation analyses. Internal consistency and test–retest reliability (at a two-week interval) were used to evaluate the reliability. Statistical analyses were performed using Statistical Package for Social Sciences (version 22) software.FindingsPreliminary analysis revealed that the overall instrument had good internal consistency (Urdu OAS a = 0.91; English OAS a = 0.92) as well as test–retest correlation coefficients for 15 days (r = 0.88). The factor loading of all items ranged from 0.69 to 0.9, which explained the significant level and indicated the model's overall goodness of fit.Originality/valueFindings suggest that this scale has significant psychometric properties and the potential to be used as a valid, reliable and cost-effective clinical and research instrument. This study contributes to scientific knowledge and helps to develop and test indigenous cross-cultural instruments that can be used to examine external shame in Pakistani people.

Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review.

BackgroundModification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture.ObjectiveThis study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening.MethodsA systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling’s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method.ResultsA total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty’s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales.ConclusionsThis study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence.

Cross-Cultural Instrument Adaptation and Validation of Health Beliefs About Cancer Screening: A Methodological Systematic Review.

The uptake of cancer screening is significantly associated with participants' health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations. The aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening. A systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched. A total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity. Back translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated. Clinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

Psychometric properties of the revised Urdu version dyadic adjustment scale for evaluating marital relationship quality between madrassa and Non-Madrassa married women

PurposeThis study aims to explore the indigenous needs of married women in Pakistan due to the public health challenges they face due to marital conflict. The research focuses on investigating psychometric properties and cross-cultural validation of the revised dyadic adjustment scale’s (RDAS) Urdu translated version to assess marital relationship quality between married madrassa and non-madrassa women. The study examines empirically validated two-factor model (RDAS) between married madrassa and non-madrassa women (Busby et al., 1995; Hollist et al., 2012; Isanezhad et al., 2012; Christensen et al., 2006) and (Bayraktaroglu and Cakici, 2017). These studies approach including consensus, satisfaction and cohesion.Design/methodology/approachThe investigators executed the study into two phases: a pilot test and the main survey.FindingsThe pilot study's findings specified that the Urdu translated version of the revised DAS indicated a decent internal consistency (a = 0.70). The overall revised DAS maintained a stronger test-retest correlation and tested it over 15 days (r = 0.95). The main study recorded 300 respondents' responses from madrassa and non-madrassa married women using a purposive sampling approach and recruited them from the locality of various madrassas and housing societies of Islamabad, Azad Kashmir and Rawalpindi, Pakistan. The study findings showed higher intercorrelations between total and subscales of the revised DAS. It further compared the groups with a multi-group confirmatory factor analysis (CFA) method and examined the revised DAS structure in married madrassa and non-madrassa women.Practical implicationsThis study contributes to scientific knowledge and helps develop and validate indigenous cross-cultural instruments to examine marital life quality. It offers practical and reliable information about Pakistani couples' emotional attachment and marriage adjustment issues.Originality/valueThe study applied a three-factor solution, and it demonstrated a robust factorial validity in the context of Pakistani culture, which is a novel contribution to the literature.

Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions.

Although trauma exposure is a global phenomenon, trauma reactions vary considerably across cultures. Western psychiatric diagnoses, such as posttraumatic stress disorder (PTSD), may be limited in capturing the breadth of trauma reactions in cross-cultural contexts. Instead, cross-cultural instruments should examine locally relevant reactions, such as idioms of distress and explanatory models of illness, and account for ongoing stress and adversity. This article explains the need for complementing traditional trauma assessment approaches, how to create culturally sensitive instruments, the style and stance of practicing cultural humility when administering instruments, how to account for ongoing trauma and adversity, and ways to incorporate findings into treatment. These steps can improve culturally sensitive and comprehensive trauma assessment to capture universal and culturally relevant trauma reactions.

Assessing the quality of life of people with chronic wounds by using the cross-culturally valid and revised Wound-QoL questionnaire.

The Wound-QoL is an often used reliable and valid measure, originally developed in Germany. It has been sequentially translated and validated for other languages/countries, for the measurement of health-related quality of life (HRQoL) in patients with chronic wounds. However, a study from the United States postulated its benefits from further adaptations. Furthermore, some patients struggled to provide an answer for some of the items. We aimed to test the cross-cultural structure and psychometric performance of the questionnaire to suggest necessary revisions. This cross-sectional analysis of existing data sets included 1185 patients from Germany, the US, the Netherlands, Spain, Sweden, and Israel. Patients in the U.S. Wound Registry completed the Wound-QoL during routine care. Different studies comprised the data collection in the other countries. Almost half of the patients were women (48.4%). Furthermore, 42.6% were diagnosed with leg ulcers. Their average age was 66 years. We used a confirmatory factor analysis and an unconstrained graded response model. We revised and shortened the Wound-QoL from 17 to 14 items. In addition, we supported the cross-cultural metric invariance of the revised Wound-QoL questionnaire. The new version with 14 items and three dimensions revealed good psychometric properties with Cronbach's alpha (α) of 0.913 for the total score, and 0.709-0.907 for different dimensions. Furthermore, we provided strict invariance for different clinical variables. In conclusion, the revised Wound-QoL is a reliable and cross-cultural instrument to measure the HRQoL on patients with chronic wounds. Future studies should analyse the revised Wound-QoL for convergent validity with generic HRQoL questionnaires as well as for determining its sensitivity to clinical change.

Collecting Cultural Feedback on Ethiopian Views on Girls, Sport, and Voice

This qualitative study used data collected from five interviews conducted to gather cultural and linguistic feedback on a 21-question instrument created for a future study focused on Ethiopian girl athletes. Participants met the following criteria: (a) native to Ethiopia (b) at least 15 years old and (c) proficient English reading and speaking skills. Participants did not complete the questionnaire, rather, they read it and provided cultural and linguistic feedback on its content. Participants provided feedback via interviews both in person and over the phone during a two-week period. The instrument was designed to collect data from members of Girls Gotta Run Foundation, a non-profit organization in Ethiopia that uses sport to promote gender equity. It consists of questions that focus on girls’ perceptions on the constructs of gender, sport, and voice empowerment. Findings demonstrated the importance of providing greater flexibility in questions that related to age and career goals, while the impact running has on Ethiopian culture was reinforced. Conducting this pilot study demonstrated the importance of testing cross-cultural instruments prior to final instrument administration to gain the most culturally accurate data possible.

Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity

BackgroundEvaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity.MethodsStimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions.ResultsSixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96–1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained.ConclusionThis study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.

Cross-cultural adaptation of the recovery self-assessment instrument (RSA–R) person in recovery version to Brazilian Portuguese (Pt/Br)

Purpose The Recovery Self-Assessment (RSA–R) in Revised Version is an instrument designed to assess the degree to which mental health programs and services implement recovery-oriented practices. The purpose of this paper is to conduct a cross-cultural adaptation of the RSA–R instrument for use in local mental health services in the city of Campinas, State of São Paulo, Brazil. Design/methodology/approach This method for cross-cultural adaptation of the instrument included a series of iterative steps including preparation, translation, back translation, harmonization, expert evaluation, focus groups, in-depth interviews, expert opinion and pilot study. Findings A multi-rater assessment of the equivalence of content between the original RSA–R and the translated version revealed that each of the 32 items achieved at least 88% agreement in terms of equivalency. A multi-step harmonization process revealed additional suggestions for improvements in readability, comprehension and applicability to Brazilian context. An expert in youth and adult education provided additional stylistic recommendations. Combined, this iterative approach to cross-cultural translation resulted in an adapted version of the instrument that was well understood, culturally appropriate and adequate for further verification of psychometric properties. Originality/value The recovery process in Brazil and in the USA has culturally determined differences in terms of the way mental disorders are understood, diagnosed and treated. Moreover, there are different notions of what constitutes desirable results of recovery, health care and welfare. At the present time, there are few, if any, available cross-cultural instruments to assess the recovery-orientation of services between Brazil and the USA.

Thai Translation and Psychometric Testing of the Measure of Moral Distress for Healthcare Professionals

Objective: This study aimed to describe the translation process and to test the psychometric properties of the Measure of Moral Distress for Healthcare Professionals (MMD-HP) among Thai nurses.Material and Methods: The MMD-HP was administered via an electronic survey to registered nurses at 2 large tertiary care hospitals in a southern province in Thailand. The MMD-HP was translated into the Thai language using the modified Brislin’s cross-cultural instrument translation method. Reliability was analyzed using Cronbach’s alpha coefficient and validity was assessed using exploratory factor analysis with promax rotation.Results: In total, 448 surveys were included in the final analysis. A three-factor structure was understandable and appropriate. The 3 factors were labeled as system-level, team-level, and patient/family-level root causes of moral distress. The overall internal consistency of the MMD-HP was 0.94; with 0.89, 0.89, and 0.85 for the system-level, team-level, and patient/family-level root causes, respectively.Conclusion: Our analysis found that the 3-factor solutions of the Thai version of the MMD-HP was most appropriate in our context. Our study found it to be a reliable, valid, and useful tool to measure moral distress among nurses in the Thai context. It is an appropriate tool to be used cross-culturally.

Enriching the quality of cross-cultural instrument development through cognitive interviewing: Implications for nursing research.

During cross-cultural instrument development, a gap commonly exists between the intended meaning of questionnaire items and the extent to which the participant understands that meaning. Because cognitive interviewing can provide such a powerful means for ensuring an accurate interpretation of items, the purpose of this report is to provide a practical guide to encourage its use in nursing research. This report provides in-depth information describing: (a) advantages of cognitive interviewing, particularly for cross-cultural instrument development; (b) specific problems it can identify and solve; (c) strategies for performing cognitive interviews, including the four-step model of the question-and-answer process; (d) practical guidance for conducting successful cognitive interviews. To achieve linguistic validity as well as cultural relevance, a variety of factors need to be considered in addition to language, such as cultural interpretations, attitudes, and values. Examples of health-related studies are presented, demonstrating the advantages of cognitive interviewing for instrument development and cross-cultural research. These examples show how cognitive interviewing can be productively used to verify question clarity, patient comprehension, and patients' ease of response and judgment while also helping to establish content validity based on patients' perspectives. Cognitive interviewing can help nurse researchers discover potential instrument flaws and correct them in advance, subsequently avoiding collection of inaccurate data. Thus, cognitive interviewing should be considered an effective pretesting method for development of accurate instruments, particularly in cross-cultural nursing research.

A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations. A systematic review was performed using six databases, without restrictions on the year or language of publication. Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29). Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

English and Swedish teachers’ perspectives on the role of parents in year one children’s learning of number: manifestations of culturally-conditioned norms

ABSTRACT This paper presents an exploratory study of English and Swedish teachers' perspectives on the role of parents in year one children's learning of number. Drawing on the results of semi-structured interviews, data from each cohort were analysed independently to ensure the cultural integrity of any response categories and the results of this process compared. Two broad themes were identified concerning implicit and explicit forms of parental involvement. The former, manifested similarly across the two cohorts, concerned the importance of parents presenting children with positive attitudes towards mathematics. The latter, incorporating three comparable subthemes, focused on the creation of number-rich home environments, home–school communication and parents' role in the completion of homework. All three subthemes differentiated the cohorts in ways that highlighted teachers' culturally situated perspective on teaching and learning. Some implications are discussed, particularly with respect to the challenge this study poses for developers of cross-cultural survey instruments.

SMAGA

The study of national culture and cultural differences has immense value in today's business world. However, contemporary cross-cultural study instruments are subjective to many biases and intensive in terms of human labor. On the other hand, social media data offers tremendous opportunities for cross-cultural studies. However, it cannot be used directly as input for existing cross-cultural study applications in social science for being unstructured and noisy. In this work, the authors develop a text mining application called Social Media Associative Group Analysis (SMAGA). It effectively discovers information relevant to cultural values from social media data and represent such information using AGA verbal associations tuples. Experimental results show that the SMAGA framework can generate meaningful results in support of cross-cultural studies with much higher efficiency than traditional cross-cultural study instruments. This research underlines the emerging trend of developing text mining applications to automate cross-cultural and other types of social science studies.

Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP)

BackgroundTo test the validity of the Finnish version of the Bernhard et al.’s Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP).MethodsThe study sample comprised registered nurses (N = 810) from the Finnish “Competent workforce for the future” -project (COPE). Exploratory factor analyses and structural equation modelling were applied to test structural validity of the CCCHP. Internal consistency of the sub-scales was evaluated using the Cronbach’s alphas. Criterion validity was explored in terms of received education for multicultural work, perceived difficulty of patients, and job satisfaction variables.ResultsThe revised version of the instrument including four (motivation/curiosity, attitudes, skills and emotions/empathy) of the five original dimensions provided satisfactory psychometric properties (internal consistency, a good model fit of the data). Of the four remaining competence sub-scales, motivation/curiosity, attitudes and emotions/empathy were associated with the amount of received education for multicultural work, and all with perceived difficulty of patients, and all but attitudes with job satisfaction.ConclusionThis revised Finnish version of the CCCHP provides a useful tool for studies focusing on the healthcare personnel’s cross-cultural competence in delivering effective and culturally sensitive healthcare services for patients from different cultures.

A Rasch Analysis of the Personal Well-Being Index in School Children.

The personal well-being index-school children (PWI-SC) is designed as a cross-cultural instrument to measure subjective well-being among high school-aged children. Several published cross-cultural studies have confirmed adequate psychometric performance in terms of reliability, validity, and measurement invariance. This study adds to this literature by applying the Rasch approach to estimate invariant comparison in a cross-cultural context, applied to both Australian and Portuguese high school students. Participants were an age- and gender-matched convenience sample of 1,040 adolescents (520 cases in each group, 51.54% male) who ranged in age from 12 to 18 years (M = 14.25 years, SD = 1.71 years). It is found that both Portuguese and Australian data fit the Rasch measurement model, with excellent levels of reliability at a country level. However, when all of the data were combined, a slight misfit was found. This was resolved by removing some issues with item thresholds in standard of living among the Australian data and splitting the data by country on health. This allowed both Australian and Portuguese cases to differ on the health item. We conclude that the PWI-SC is unidimensional, with some evidence of mild, but acceptable local dependency. This study further supports the cross-cultural validity of the PWI-SC and the use of this measure in the Australian and Portuguese context but also indicates a potential direction that development of the PWI-SC might proceed.