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Original Article

Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)

Heeseung Choi1, Eunyoung E. Suh1, Chang Park2, Jisun Park3, Eric Fernandez3
Korean Journal of Adult Nursing 2015;27(4):472-479.
Published online: August 31, 2015

1College of Nursing, the Research Institute of Nursing Science, Seoul National University, Seoul

2Research Specialist, University of Illinois at Chicago, College of Nursing, Chicago, U. S. 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Corresponding author: Suh, Eunyoung, E. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-740-8484, Fax: +82-2-740-8484, E-mail: esuh@snu.ac.kr
• Received: May 13, 2015   • Accepted: August 10, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Few instruments are available to measure nurses’ perceptions of cultural competence in South Korea. Furthermore, the equivalence of factors between original and translated instruments has not been evaluated. The specific aims of this study were to identify the validity and reliability of a Korean version of the Cultural Awareness Scale (K-CAS) and to evaluate the equivalence of factors between the original CAS and the K-CAS. A total of 515 nursing students completed the 26-item K-CAS, 28-item Caffrey Cultural Competence in Healthcare Scale (CCCHS), and eight-item Openness to Diversity and Challenge Scale (ODCS). The K-CAS exhibited good reliability (⍺=.83) and construct validity by correlating with the CCCHS (r=.344, p<.001) and ODCS (r=.394, p<.001). Confirmatory factor analysis results of the K-CAS confirmed the same factor structure as the original CAS. The K-CAS could be a useful tool to assess the concept of cultural competence among nursing students and nurses.
  • Key Words: Cultural competence; Nursing; Education; Healthcare; Instrumentation; Factor analysis
Table 1.
General Characteristics of the Participants (N=515)
Variables Categories n (%)
Type of program Undergraduate 364 (70.7)
Master's 116 (22.5)
Doctorate 35 (6.8)
Gender Male 20 (3.9)
Female 495 (96.1)
Religion Christian 146 (28.3)
Roman catholic 86 (16.7)
Buddhism 40 (7.8)
Others 6 (1.2)
None 237 (46.0)
Have you stayed in a foreign country for over three months? Yes 83 (16.1)
No 432 (83.9)
   
Have you taken college courses that are related to foreign studies? Yes 61 (11.8)
No 453 (88.0)
Missing 1 (1.9)
Do you have contact with patients or clients from different cultural backgrounds? Often 24 (4.7)
Sometimes 302 (58.6)
None 185 (35.9)
Missing 4 (0.8)
Do you have contact with other health care professionals from different cultural backgrounds? Often 7 (1.4)
Sometimes 165 (32.0)
None 340 (66.0)
Missing 3 (0.6)
   
Have you worked as a nurse? Yes 149 (28.9)
No 363 (70.5)
Missing 3 (0.6)
Table 2.
Confirmatory Factor Analysis of the Korean Version of the Cultural Awareness Scale
Factors (Subscales) Item Coefficient SE z 95% CI
E(General educational experiences) 1. The instructors at this nursing school adequately address multicultural .761 0.023 33.01 0.715~0.806
issues in nursing.        
2. This nursing school provides opportunities for activities related to multicultural affairs. .638 0.030 21.40 0.574~0.694
3. Since entering this nursing school, my understanding of multicultural issues .763 0.023 32.62 0.722~0.814
has increased.        
4. My experiences at this nursing school have helped me become .691 0.027 25.39 0.635~0.743
knowledgeable about the health problems associated with various racial        
and cultural groups.        
15. My instructors at this nursing school seem comfortable discussing cultural .552 0.035 15.98 0.482~0.620
issues in the classroom.        
17. I believe the classroom experiences at this nursing school help students .489 0.037 13.13 0.403~0.552
become more comfortable interacting with people from different cultures.        
19. My clinical courses at this nursing school have helped me become more .477 0.038 12.46 0.397~0.548
comfortable interacting with people from different cultures.        
20. The instructors at this nursing school model behaviors that are sensitive to .737 0.025 29.36 0.685~0.785
multicultural issues.        
21. The instructors at this nursing school use examples and/or case studies that .664 0.029 22.81 0.605~0.721
incorporate information from various cultural and ethnic groups.        
C(Cognitive awareness) 5. I think my beliefs and attitudes are influenced by my culture. .654† 0.031 20.89 0.600~0.722
6. I think my behaviors are influenced by my culture. .659† 0.031 21.23 0.607~0.727
7. I often reflect on how culture affects beliefs, attitudes, and behaviors. .474† 0.039 11.98 0.413~0.566
11. I believe nurses' own cultural beliefs influence their nursing care decisions. .658 0.031 21.24 0.591~0.714
13. I think students' cultural values influence their classroom behaviors (e.g., .567 0.035 16.10 0.496~0.635
asking questions, participating in groups, offering comments).        
14. I think it is the nursing instructor's responsibility to accommodate students' .620 0.033 18.92 0.555~0.684
diverse learning needs.        
16. I think the cultural values of the nursing instructors influence their .690 0.029 23.54 0.631~0.747
behaviors in the clinical setting.        
B(Behaviors/ Comfort with interaction) 8. When I have an opportunity to help someone, I offer assistance less .503 0.042 11.96 0.436~0.598
frequently to individuals of certain cultural backgrounds.        
9. I am less patient with individuals of certain cultural backgrounds. .590 0.038 15.51 0.541~0.685
10. I feel comfortable working with patients of all ethnic groups. .498 0.041 12.07 0.415~0.577
12. I typically feel somewhat uncomfortable when I am in the company of .722 0.033 21.73 0.668~0.793
people from cultural or ethnic backgrounds different from my own.        
26. I feel somewhat uncomfortable working with the families of patients from .683 0.034 19.96 0.632~0.762
cultural backgrounds different than my own.        
P(Patient care/ Clinical issues) 18. I feel comfortable discussing cultural issues in the classroom. .409‡ 0.042 9.80 0.339~0.503
22. I respect the decisions of my patients when they are influenced by their culture, even if I disagree. .637 0.032 20.15 0.573~0.698
23. If I need more information about a patient's culture, I would use resources .802 0.024 33.68 0.747~0.843
available onsite (e.g., books, videotapes).        
24. If I need more information about a patient's culture, I would feel .758 0.026 29.30 0.695~0.800
comfortable asking people I work with.        
25. If I need more information about a patient's culture, I would feel .629 0.033 18.91 0.557~0.690
comfortable asking the patient or family member.        

†Standardized coefficients for the bold values were lower than those in the original scale;

‡Standardized coefficient for the bold value was higher than that in the original scale.

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    Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)
    Korean J Adult Nurs. 2015;27(4):472-479.   Published online August 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.4.472
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    Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)
    Korean J Adult Nurs. 2015;27(4):472-479.   Published online August 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.4.472
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    Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)
    Reliability and Validity of a Korean Version of the Cultural Awareness Scale (K-CAS)

    General Characteristics of the Participants (N=515)

    Variables Categories n (%)
    Type of program Undergraduate 364 (70.7)
    Master's 116 (22.5)
    Doctorate 35 (6.8)
    Gender Male 20 (3.9)
    Female 495 (96.1)
    Religion Christian 146 (28.3)
    Roman catholic 86 (16.7)
    Buddhism 40 (7.8)
    Others 6 (1.2)
    None 237 (46.0)
    Have you stayed in a foreign country for over three months? Yes 83 (16.1)
    No 432 (83.9)
       
    Have you taken college courses that are related to foreign studies? Yes 61 (11.8)
    No 453 (88.0)
    Missing 1 (1.9)
    Do you have contact with patients or clients from different cultural backgrounds? Often 24 (4.7)
    Sometimes 302 (58.6)
    None 185 (35.9)
    Missing 4 (0.8)
    Do you have contact with other health care professionals from different cultural backgrounds? Often 7 (1.4)
    Sometimes 165 (32.0)
    None 340 (66.0)
    Missing 3 (0.6)
       
    Have you worked as a nurse? Yes 149 (28.9)
    No 363 (70.5)
    Missing 3 (0.6)

    Confirmatory Factor Analysis of the Korean Version of the Cultural Awareness Scale

    Factors (Subscales) Item Coefficient SE z 95% CI
    E(General educational experiences) 1. The instructors at this nursing school adequately address multicultural .761 0.023 33.01 0.715~0.806
    issues in nursing.        
    2. This nursing school provides opportunities for activities related to multicultural affairs. .638 0.030 21.40 0.574~0.694
    3. Since entering this nursing school, my understanding of multicultural issues .763 0.023 32.62 0.722~0.814
    has increased.        
    4. My experiences at this nursing school have helped me become .691 0.027 25.39 0.635~0.743
    knowledgeable about the health problems associated with various racial        
    and cultural groups.        
    15. My instructors at this nursing school seem comfortable discussing cultural .552 0.035 15.98 0.482~0.620
    issues in the classroom.        
    17. I believe the classroom experiences at this nursing school help students .489 0.037 13.13 0.403~0.552
    become more comfortable interacting with people from different cultures.        
    19. My clinical courses at this nursing school have helped me become more .477 0.038 12.46 0.397~0.548
    comfortable interacting with people from different cultures.        
    20. The instructors at this nursing school model behaviors that are sensitive to .737 0.025 29.36 0.685~0.785
    multicultural issues.        
    21. The instructors at this nursing school use examples and/or case studies that .664 0.029 22.81 0.605~0.721
    incorporate information from various cultural and ethnic groups.        
    C(Cognitive awareness) 5. I think my beliefs and attitudes are influenced by my culture. .654† 0.031 20.89 0.600~0.722
    6. I think my behaviors are influenced by my culture. .659† 0.031 21.23 0.607~0.727
    7. I often reflect on how culture affects beliefs, attitudes, and behaviors. .474† 0.039 11.98 0.413~0.566
    11. I believe nurses' own cultural beliefs influence their nursing care decisions. .658 0.031 21.24 0.591~0.714
    13. I think students' cultural values influence their classroom behaviors (e.g., .567 0.035 16.10 0.496~0.635
    asking questions, participating in groups, offering comments).        
    14. I think it is the nursing instructor's responsibility to accommodate students' .620 0.033 18.92 0.555~0.684
    diverse learning needs.        
    16. I think the cultural values of the nursing instructors influence their .690 0.029 23.54 0.631~0.747
    behaviors in the clinical setting.        
    B(Behaviors/ Comfort with interaction) 8. When I have an opportunity to help someone, I offer assistance less .503 0.042 11.96 0.436~0.598
    frequently to individuals of certain cultural backgrounds.        
    9. I am less patient with individuals of certain cultural backgrounds. .590 0.038 15.51 0.541~0.685
    10. I feel comfortable working with patients of all ethnic groups. .498 0.041 12.07 0.415~0.577
    12. I typically feel somewhat uncomfortable when I am in the company of .722 0.033 21.73 0.668~0.793
    people from cultural or ethnic backgrounds different from my own.        
    26. I feel somewhat uncomfortable working with the families of patients from .683 0.034 19.96 0.632~0.762
    cultural backgrounds different than my own.        
    P(Patient care/ Clinical issues) 18. I feel comfortable discussing cultural issues in the classroom. .409‡ 0.042 9.80 0.339~0.503
    22. I respect the decisions of my patients when they are influenced by their culture, even if I disagree. .637 0.032 20.15 0.573~0.698
    23. If I need more information about a patient's culture, I would use resources .802 0.024 33.68 0.747~0.843
    available onsite (e.g., books, videotapes).        
    24. If I need more information about a patient's culture, I would feel .758 0.026 29.30 0.695~0.800
    comfortable asking people I work with.        
    25. If I need more information about a patient's culture, I would feel .629 0.033 18.91 0.557~0.690
    comfortable asking the patient or family member.        

    †Standardized coefficients for the bold values were lower than those in the original scale;

    ‡Standardized coefficient for the bold value was higher than that in the original scale.
    Table 1. General Characteristics of the Participants (N=515)

    Table 2. Confirmatory Factor Analysis of the Korean Version of the Cultural Awareness Scale

    Standardized coefficients for the bold values were lower than those in the original scale;

    Standardized coefficient for the bold value was higher than that in the original scale.

    Table 1.

    Table 2.

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