Exploring the content validity of Clinical Cultural Competence Questionnaire in diverse cultures

Cultural competence is one component of effective communication between patients, families and healthcare professionals. Tools to assess physicians’ clinical cultural competencies need validity evidence. This paper describes Lawshe’s method for determining the Content Validity Index (CVI) for the Clinical Cultural Competence Questionnaire (CCCQ) for North America (NA), Pakistan (PK) and an international group (IG) using physician simulation educators (PSEs) for diverse cultures. Five simulation educators pilot-tested the CCCQ, and initial changes were made based on their feedback. A total of 10 PSEs experts from NA, 11 PSEs from PK and 10 PSEs from IG completed two rounds of validation testing using Lawshe’s CVI survey for the CCCQ. The PSEs rated each item of the CCCQ as ‘essential’, useful but not essential’ or ‘not useful’. Lawshe’s CVI was calculated for the initial CCCQ; the CCCQ was then modified for individual items, separately for each group, NA, PK and IG. The IG comprised PSEs from Bahrain, Oman, Qatar, KSA, UAE, Australia, Argentina, India and Israel. The survey response rate was 83.33% for NA and IG and 91.6% for PK, respectively. The CVI of the CCCQ in round 1 was 0.689 for NA, 0.545 for PK and 0.691 for IG. In the second round of the CCCQ, with modified items, the CVI was 0.89 for NA, 0.802 for PK and 0.862 for IG. The major modifications suggested by the PSEs were to remove the unnecessary items, e.g. demographic information and last medical school attended, as they were deemed unnecessary or reword them for better understanding and combine related items to reduce the length of the CCCQ survey. We also evaluated the comments of PSEs from NA, PK and IG to explore the similarities and differences in their opinions regarding the CCCQ tool items. Our research emphasizes the need to thoroughly examine questionnaire content in tools like the CCCQ to accurately capture the cultural competence knowledge, attitudes and skills crucial for healthcare providers in diverse settings.