Cultural competency is theorized as the sensitivity of practitioners from the dominant culture towards the diverse cultural backgrounds of their patients. Less attention is placed on how communication between providers and patients can enable patients to share their health care beliefs. An evidence review of the literature around the conceptualization of cultural competency in health care was performed, and interviews were conducted aiming to understand what immigrant patients perceive as culturally competent care and its effect on the relationship between them and their providers. Definitions of cultural competence varied, and no conclusive studies linking cultural competence to improved health outcomes were found. Findings from the participant interviews helped to address gaps in the literature by confirming a preference for a patient-centred approach to culturally competent care, in addition to identifying pre-existing expectations for the health care encounter and patient-dependent factors as additional elements influencing the physician-patient relationship.

In this study the author explores contextual factors that impact practice beliefs and behaviors among social workers with lesbian and gay clients. The Gay Affirmative Practice scale was used to measure levels of gay affirmative practice beliefs and practice behaviors among social workers in a medical setting. A model is presented that illustrates how contextual factors related to education, training, relationships with lesbian and gay individuals, and religiosity affects social workers’ practice behaviors. The results illustrate the importance of educational exposure and affirming practice beliefs on practice behaviors.

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There is a paucity of occupational therapy literature related to the professional development process that occurs when students participate in immersive, international servant leadership experiences in developing countries. A scarcity of literature exists on how such culturally rich experiences can influence the development of the participating students’ dispositional critical thinking and cultural competency skill sets. This mixed methods study depicts how a 3-week servant leadership experience in Zambia, Africa, measured the acquisition of dispositional critical thinking and cultural competency skill sets in novice to experienced occupational therapy students. Moreover, this study infuses a constructivist grounded theory approach to uncover a holistic understanding of the professional development process that occurred for the participating students over a 3-week immersion experience in Zambia. This study highlights how a hands-on servant leadership experience in Zambia contributed to the acquisition of professional development and problem-solving skills and cultural responsiveness for students who were trained in westernized health care practices. The participants demonstrated statistically significant increases in their critical thinking skills with medium effect sizes in truth-seeking, inquisitiveness, analyticity, systematicity, confidence, and maturity of judgment. In addition, the participants demonstrated statistically significant increases in cultural competency skills with medium to very large effect sizes in cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desires. The qualitative strand of the study revealed the professional growth of the students during the experience through the themes that emerged: “resilient occupational therapy lens” and “empowered occupational therapy students.” Furthermore, this mixed methods study provides a Servant Leadership Professional Development Model to illustrate the transformational professional development process that students underwent that is supported by the mixed methods data findings.

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Faculty members from Brigham Young University's special education/ESL program participated in professional development centered on increasing multicultural competence. The primary investigator interviewed faculty members regarding their perceptions of professional development. After conducting the interviews, faculty members' feedback was coded to determine whether or not the professional development aided them in infusing more culturally sensitive practices into the curriculum and created a more sensitive learning environment for students from diverse backgrounds. Researchers also coded the faculty members' feedback to determine if faculty members felt they have changed at an individual/personal level in terms of how they view their own cultural background as well as how they view their students' cultural backgrounds. Information is summarized, providing insight into factors that strengthen professional development, ultimately increasing cultural competence. Additionally, suggestions are made to improve consultation skills and build stronger rapport with those from diverse backgrounds and at the university level, more effectively recruiting and retaining diverse students in school-based professions, including special education programs.

In recent decades, both global migration in general and specifically migration to Sweden have increased. This development compels the need for delivering healthcare to the increasingly diverse populations in Sweden. To support health professionals, for instance occupational therapists, in developing their professional knowledge in encounters with foreign-born clients a self-rating instrument measuring cultural competence is developed. This may contribute to the development of suitable services for foreignborn clients and improve person-centered interventions for these clients. The general aim of this thesis was to develop an instrument for health professionals by examining psychometric properties and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The specific aim of study I was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The study had a descriptive and explorative design. Nineteen occupational therapists participated, divided into four focus groups. Qualitative content analysis was used to examine the content validity and utility of the CCAI-S. The specific aim of study II was to examine the clinical relevance, construct validity and reliability of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among Swedish occupational therapists. The study had a cross-sectional design. A web-based questionnaire was e-mailed to a randomised sample of 428 occupational therapists to investigate the construct validity, reliability and utility of the CCAI-S. Factor analysis was performed as well as descriptive statistics. The findings from study I revealed high content validity for all 24 items. However, six items needed reformulations and exemplifications. Regarding utility, the results showed strong support for CCAI-S. The category ‘Interactions with clients’ showed that the CCAI-S could be utilised individually for the health professional and create a higher awareness of cultural questions in practice. The category ‘Workplace and its organisational support’ displayed potential for use in different workplaces regarding CCAI-S and indicated the importance of organisational support for health professionals in the development of cultural competence. The findings from study II regarding construct validity generated a three-factor model with the labels ‘Openness and awareness’, ‘Workplace support’ and ‘Interaction skills’. All three factors showed high factor loadings and contained 12 of the 24 original items. The Cronbach’s Alpha showed high support for the three-factor model. Concerning utility, the participants reported that all 24 items had high clinical relevance. In conclusion, the findings from the two studies indicated good measurement properties and high clinical relevance for the CCAI-S. This may sup-port the utilisation of CCAI-S in the Swedish context for health professionals, for instance occupational therapists. The results of the instrument development show that the upcoming published version of the CCAI-S can be a valuable self-assessment tool for health professionals who strive to improve in person-centred communication in encounters with foreign-born clients. CCAI-S can also be of support for the organisation to serve as a guide for what to focus on to develop cultural competence within the staff. Altogether this presumably influence the effectiveness of the healthcare and enhance the evidence of interventions for foreign-born clients. To develop an instrument is an iterative process requiring several evaluations and tests in various settings and populations. Therefore further psychometric testing and utility studies on the CCAI-S is crucial.

This study assessed 40 factors often cited in literature to determine the extent that Hispanic superintendents perceive them as influential when accessing the superintendency. Eight Hispanic superintendents in Texas participated in this qualitative study, which was based on interviews as well as written responses to a survey. This study found that the factors considered most influential to these superintendents were their ability to communicate, self-perception/self-efficacy, and level of overall preparedness. These findings contrast with previous research indicating that race or ethnicity, mentoring, and career path are most influential. The study also identified factors related to race and ethnicity that most influenced a Hispanic's ability to access the superintendency, albeit to a lesser degree. These factors were the ability to serve as a Hispanic role model to students, ability to increase Hispanic students' academic performance, and the ability to speak a second language. Moreover, through analysis of a large number of survey responses the study examined the extent to which a superintendent's race or ethnicity is significant to addressing the needs of Hispanics. To assure this question a comparative analysis of Hispanics' and non-Hispanics competencies and organizational outcome was conducted. The results indicate that superintendents, in general, regardless of race or ethnicity, can acquire knowledge about the Hispanic culture, develop cultural competence, and produce outcomes that affect Hispanics. A Hispanic, however, who possesses the ability to speak Spanish and has authentic cultural experiences, can potentially provide unique competencies in serving Hispanics. Cultural competence with Hispanics, however, does not supersede the importance of a superintendent's overall effectiveness and ability to meet the needs of all students. Whereas other studies have addressed the significance of cultural competency in other institutions that serve the public, such as the healthcare industry, this study addressed cultural competency in public education. Progressive definitions of cultural competency included the extent to which outcomes met constituent needs for measuring cultural competency. The overall findings in this study suggest a need to develop preparation programs that result in culturally competent leaders, a need to revise state required certification requirements to reflect a need for cultural competence, and a need to revise locally-developed job postings/descriptions to indicate that the superintendent must provide culturally competent leadership.

This study was designed to determine if teachers in one public school in Virginia were prepared to be evaluated based on culturally responsive practices (CRP) after completing Virginia Department of Education's (VDOE) Cultural Competency Training Module. This qualitative study sample included eight teachers from a suburban school division. The conceptual framework illustrated the connections between the evaluation of CRP and teacher preparedness after teachers completed VDOE's Cultural Competency Training Module. The research questions that directed this study were: (1) How has Virginia Department of Education's Cultural Competency Training Module prepared teachers to implement culturally responsive practices? (2) To what extent do teachers feel prepared to be evaluated based on culturally responsive practices after completing Virginia Department of Education's Cultural Competency Training Module? The research method included a basic qualitative research design that used interview protocol. Interview prompts were created based on Virginia's Cultural Competency Domains that underpin legislation approved by the 2021 Virginia General Assembly requiring that teacher evaluations include a standard for CRP. Interviews took place during the summer months of 2023 as virtual meetings using the Zoom video conferencing platform. Interview transcriptions were utilized as the data set. As categories and themes emerged, the interconnectedness of data was examined using open coding. The findings of this study revealed that teachers indicated a support for Virginia's Cultural Competency Domains. However, teachers perceived that VDOE's Cultural Competency Training Module did not achieve the desired focus of providing educators with the tools needed to implement CRP. Instead, teachers perceived that their lived experiences framed their individual approach to understand and implement CRP. The implications of the study encouraged VDOE to consider a redesign of the Cultural Competency Training Module. Another implication emphasized the need for school divisions to consider investing in professional trainers to provide deep level culturally competency training in a format that also accounts for the emotional security and comfortability of teachers. / Doctor of Education / This study was designed to determine if teachers in one public school in Virginia were prepared to be evaluated based on culturally responsive practices (CRP) after completing Virginia Department of Education's (VDOE) Cultural Competency Training Module. This study included eight teachers from a suburban school division. The conceptual framework illustrated the connections between the evaluation of CRP and teacher preparedness after teachers completed VDOE's Cultural Competency Training Module. The research questions that directed this study were: (1) How has Virginia Department of Education's Cultural Competency Training Module prepared teachers to implement culturally responsive practices? (2) To what extent do teachers feel prepared to be evaluated based on culturally responsive practices after completing Virginia Department of Education's Cultural Competency Training Module? The research method included teacher interviews. Interview prompts were created based on Virginia's Cultural Competency Domains that reinforced legislation approved by the 2021 Virginia General Assembly requiring that teacher evaluations include a standard for CRP. Interviews took place during the summer months of 2023 as virtual meetings using the Zoom video conferencing platform. Interview transcriptions were utilized as the data for the study. As categories and themes emerged from interview responses, the connection of data was examined. The findings of this study revealed that teachers indicated a support for Virginia's Cultural Competency Domains. However, teachers perceived that VDOE's Cultural Competency Training did not achieve the desired focus of providing educators with the tools needed to implement CRP. Instead, teachers perceived that their lived experiences framed their individual approach to understand and implement CRP. An implication of the study encouraged VDOE to consider a redesign of the Cultural Competency Training Module. Another implication emphasized the need for school divisions to consider investing in professional trainers to provide deep level culturally competency training in a format that also accounts for the emotional security and comfortability of teachers.