Table 1.

Review of Instruments.

Instrument	Purpose	Subjects	Description of instrument	Stated conceptual framework	Score methods	Reported reliability	Reported validity	Subsequent use/testing	Reliability reported in subsequent testing
(1) Cultural Self-Efficacy Scale (CSES), Bernal and Froman, 1993 [14]	Designed to test perceived sense of self efficacy in caring for diverse patients (Black, Hispanic, and Asian)	Piloted with community health nurses	30 items testing knowledge of cultural concepts, comfort in performing cultural nursing skills, and knowledge of cultural patterns for specific ethnic groups	Consistent with Bandura Self Efficacy (Social Learning Theory) and Leininger; otherwise not linked with an overarching conceptual model	Survey—5-point Likert-type scale with 1—very little confidence and 5—quite a lot of confidence	Cronbach's alpha .97 overall with subscales ranging from .85 to .98.	Content validity determined by an expert panel of 5 public health nurses followed by factor analysis confirming construct validity	Jones et al., 2004 [15]	Consistent with pilot study
								Coffman et al., 2004 [16] reported multiple published and unpublished uses of CSES	Reliability reported ranging from .86 to .98
								Quine et al., 2012 [17]	Reliability reported for knowledge subscale .95 and skills subscale .87
(2) Transcultural Self-Efficacy Tool (TSET), Jeffreys and Smodlaka, 1996 [18]	Diagnostic tool designed to evaluate students perceived self efficacy caring for diverse clients	Original pilot study had 357 nursing students	83-item questionnaire with 3 subscales: cognitive, practical, and affective	Bandura—Self Efficacy (Social Learning Theory), concepts of transcultural nursing	Survey—10-point Likert-type scale. For all items 1—not confident to 10—totally confident	Total alpha .97 and .98 with subscale alpha ranging from .90 to .98	Content validity by 6 member expert panel followed by factor analysis confirming construct validity	Jeffreys, 2000 [19]	Consistent with pilot study
								Jeffreys and Smodlaka, 1999 [20] Lim et al., 2004 [21]	Published reliability .091–.093 for subscales
								Larsen and Reif, 2011 [22]	Cronbach's alpha ranged from 0.982 to 0.990
								Jeffreys and Dogan, 2010 [23]	CEFA testing internal consistency .94 to .98 and reliability of .99
								Jeffreys and Dogan, 2012 [24]	Authors confirm validity and reliability
(3) Inventory for Assessing the Process of Cultural Competency (IAPCC and IAPCC-R), Campinha-Bacote, 2009 [6]	Designed to measure level of cultural competence in health care providers	Acute care setting with 15 registered nurses	Original scale of 20 items revised scale of 25-item questionnaire based on 5 constructs of desire, awareness, knowledge, skill, and encounters	Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8]	Survey—4-point Likert-type scale with differing range for responses	Reliability of original version reported as a “limitation”	Content validity determined by 5 national health care experts in fields of transcultural nursing and construct validity determined by known groups technique	Multiple reported uses of IAPCC-R [6]	Consistent with reported psychometric values of revised version The author reports “average” reliability of revised version Cronbach's alpha .83
(4) Ethnic Competency Skills Assessment Inventory— (ECSAI), Napholz, 1999 [25]	Originally designed for another discipline; used to examine self-report cultural competence of nursing students	56 nursing students from 2 campuses	23 items with no description of items	Not reported	Survey—5-point Likert-type scale—never to always	Coefficient alpha .9444	Not reported	Not reported	Not reported
(5) Cultural Awareness Scale (CAS), Rew et al., 2003 [26]	Designed to test cultural awareness of nursing students	Instrument piloted with 72 undergrad and grad nursing students	36-item questionnaire with 5 subscales: general education experience, cognitive awareness, research issues behavior/comfort with interactions, and patient care issues	Based on the Pathways Model and consistent with the Purnell Model of Cultural Competence	Survey—7-point Likert-type scale—strongly agree to strongly disagree	Cronbach's alpha .82 for faculty and for students .91 on overall test	Content validity determined by 7 member expert panel	Krainovich-Miller et al., 2008 [27]	Overall testing was consistent with original pilot reporting
(6) Cultural Competence Assessment (CCA), Schim et al., 2003 [28].	Designed to measure cultural competence among hospice nurses and workers	Field tested and pilot tested with 51 hospice nurses and caregivers	25 items with subscales—awareness and sensitivity, cultural diverse experiences, and cultural competence behaviors	Based on Cultural Competence Model of Schim and Miller	Survey—5-point Likert-type scale—strongly agree to strongly disagree and no opinion	Cronbach's alpha overall was .92 with subscales reliability of .93 and .75	Content and face validity determined by 2 expert panels	Doorenbos et al., 2005 [29]	Tested in health care providers with consistent results
							Construct validity testing by factor analysis with two factors loading over .40 and contrasted group validity was determined	Starr and Wallace, 2009 [30]	Not reported
(7) Cultural Knowledge Scale (CKS) [31]	Designed to evaluate effectiveness of cultural competence training	Convenience sample of 76 public health nurses enrolled in 5-week cultural competence training course	24 items with 2 knowledge subscales—items taken from IAPCC-R and CSES	Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8]	Survey—5-point Likert-type scale—strongly agree to strongly disagree	Cronbach's alpha of 0.71 to 0.96	Otherwise reliability and validity were based on original instruments from which items were taken	Not reported	Not reported
(8) Cultural Diversity Questionnaire for Nurse Educators— CDQNE [32]	Designed to measure cultural competence of nurse educators	Convenience sample of 163-nursing faculty	72 items with 2 subscale measuring 5 constructs of desire, awareness, knowledge, skill, and encounters—included items from the IAPCC-R	Based on The Process of Cultural Competence in the Delivery of Healthcare Services Campinha-Bacote, 2002 [8]	Survey—5-point Likert-type scale—strongly agree to strongly disagree	Not reported	Content validity was determined by a panel of experts	Reneau, 2013 [33]	Not reported
(9) Cultural Competency Instrument (CCI), Kosoko-Lasaki et al., 2006 [34]	Designed to assess provider and investigator knowledge, attitudes, and sensitivity to other cultures	Pilot tested with “small” group of clinical researchers and research nurses	20 items	Not reported	Survey—multiple choice	Not reported	Content validity was based on review of the literature “no attempts” to further validate	O'Brien et al., 2006 [35]	Psychometric values not reported
(10) Cross-Cultural Evaluation Tool (CCET), Hughes and Hood 2007 [36]	Designed to measure the cultural sensitivity of nursing students after educational activity	Convenience sample of 218 nursing students	20 items	Based on items from an unpublished presentation by Freeman, 1993 [37]	Survey—5-point Likert-type rating scale assessing behaviors with range from always exhibited to never demonstrated	Cronbach's alpha of 0.73 to 0.87. Significant alpha increases on posttest	Subjected to factor analysis by PCA. Four factors accounting for 51.9% of variance for the concept cross-cultural interaction	Not reported	Not reported
(11) Nurse Cultural Competence Scale (NCCS), Perng and Watson 2012 [38]	Designed to measure cultural awareness, cultural knowledge, cultural sensitivity, and cultural skill	Pilot testing with 47 Taiwanese on the job nursing students	41 items, measuring 4 constructs: cultural awareness, knowledge, sensitivity, and skill	Based on the literature of Campinha-Bacote, Jeffreys, and others	Survey—5-point Likert-type scale—strongly agree to strongly disagree	Cronbach's alpha for 4 scales ranged from 0.78 to 0.96	Face validity established through reviews by 4 experts	Perng and Watson, 2012 [38]	Not reported