Page 132 - Encyclopedia of Nursing Research

CULTURAL/TRAnSCULTURAL FoCUS n 99

knowledge changes over time, with cultural and programmatic research are becoming
competence or cultural proficiency being cur- more frequent.
rently preferred; (e) databases on special pop- Methodological research, including C
ulations are often nonexistent or inadequate; studies of recruiting and retaining subjects
(f) although reports specify a focus on a cul- and instrumentation, is growing rapidly.
tural group, discussion may not relate find- The quality of measurement in C/TCR is
ings to that group; and (g) findings ascribed improving steadily. The standards for rig-
to culture are often not distinguished from orous translation are widely recognized,
the effects of socioeconomic status, history, and both the cultural fit of items and the
or political structures. psychometric properties of an instrument
Most quantitative C/TCR is theory for the target group are increasingly being
based. Frequently used frameworks include reported and studied. Instruments such
Leininger’s culture care theory, self-care, as the Cultural Self-Efficacy Scale and the
health-seeking behavior, health belief mod- Cultural Awareness Scale are being devel-
els, stress and coping, self-efficacy, and transi- oped to measure the outcomes of programs
tions. The transtheoretical model of behavior to promote multicultural awareness.
change is becoming popular. Reports are now There are three major needs in C/TCR.
appearing on the cultural appropriateness of First is the need for more intervention stud-
existing frameworks for particular groups. ies (Douglas, 2000). Recent estimates of the
For example, health belief models have been proportion of interventions in the C/TCR lit-
criticized for inadequately recognizing real erature range from 3.6% to 14%. More investi-
(rather than perceived) barriers to care, spir- gators must move from descriptive studies to
ituality, and the interconnectedness (rather interventions to randomized controlled tri-
than the individuality) of African American als. The sheer volume of very similar studies
women. Studies seeking explanatory mod- of the health beliefs, family values, sex roles,
els of illness are increasing, a welcome trend and importance of family decision making,
because this approach, which parallels an folk remedies, or spirituality within certain
intake history and involves all aspects of the groups suggests a sufficient base for inter-
disease course and clinical encounter, seems vention studies. A second great need is for
relevant and practical to clinicians as well as application of existing guidelines for cul-
researchers. Although most data collection turally competent research. Research needs
strategies, including physiological measure- to be planned to be culturally competent.
ments, are used in C/TCR, the most frequently Culturally competent research is broader
used are focus groups, interviews, ethnogra- than efforts to select culturally appropriate
phies, participant observation, and written instruments or to recruit appropriate sub-
questionnaires. Qualitative approaches have jects. Application of these guidelines should
long been recognized as well suited to C/TCR mesh nicely with the third great need of C/
and are frequently used. TCR, which is for research to be planned and
The overwhelming majority of C/TCR conducted with greater community involve-
has been intracultural, descriptive, small ment. More studies, particularly program-
scale, and nonprogrammatic. The typical matic studies, are needed of native American
study is an interview or survey on health health. Studies of multiracial or multiethnic
knowledge, health beliefs, and practices or persons are rare but urgently needed, given
a concept-like self-efficacy within one desig- the growing numbers of people who iden-
nated group conducted by a single investiga- tify themselves as having multiple heritages.
tor. However, cross-national nursing studies, Studies of rural, occupational, and sexual
studies with large sample sizes, studies done subcultures (groups not defined by race or
by interdisciplinary or international teams, ethnicity) are needed, as are comparative