Development of a cultural competence assessment instrument for unit managers in public sector hospitals in Gauteng
Date
2020
Authors
Maboko, Disebo Rita
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Abstract
Managing cultural diversity in South Africa is a challenging task for nursing unit managers in
public sector hospitals due to the complexities resulting from the high levels of cultural
diversity and socio-political issues that affect the healthcare sector. The purpose of the study
was to develop a cultural competence assessment instrument for unit managers to identify
levels of cultural competence in their nursing units in public sector hospitals in Gauteng
Province. The study setting was three public sector hospitals of different levels of care in
Gauteng.
The research design utilised in this study was the exploratory sequential design of mixed
methodology, specifically, the instrument development variant. The theoretical framework that
guided the study was Campinha-Bacote’s Process of Cultural Competence in the Delivery of
Healthcare Services model. It was conducted in two phases using a combination of mostly
qualitative and some quantitative data collection and analysis methods. The first phase explored
patients’, nurses’ and unit managers’ perspectives regarding cultural competence and identified
components of cultural competence from the literature. The second phase of the study included
the development and selected validation of the cultural competence assessment instrument for
unit managers.
The results of 21 patient interviews and a scoping review were utilised to compile statements
for Q-sorts using Q-Methodology. Twenty one unit managers and 21 frontline nurses sorted
the statements. The Q-sort results were utilised to obtain items for the cultural competence
assessment instrument. These items were selected through a nominal group technique
discussion with a group of seven experts who helped to select the initial 30 items for the
instrument. The instrument was pilot-tested and participants found the instrument useful and
able to assess cultural competence in their nursing units. The pilot-test results revealed
strengths and weaknesses regarding cultural competence in the nursing units. This shows a
need for education about and monitoring of cultural competence in nursing units. Adjustments
for the instrument were suggested which also necessitated ensuring further content validity
through calculating the content validity index. This resulted in a final 17 item instrument.
Further validity and reliability testing of the instrument with a larger sample of unit managers
is required.
Description
A thesis submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy to the Faculty of Health Sciences,
School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2020