Republic of the Philippines Mindanao State University Iligan Institute of Technology College of Nursing Andres Bonifacio Avenue, 9200

0 Iligan City, Philippines Telephone no. +632210714/Telefax: +632214068

CLINICAL CULTURAL COMPETENCY QUESTIONNAIRE INSTRUCTION: Fill in the necessary information. A. Demographic Characteristics 1. Name (optional) : 2. Age: ______ 3. Sex: __ Male __ Female _______________________

4. Ethnic Background with which you identify: ___Cebuano ___ Maranao ___ Tagalog ___ Hiligaynon ___ Hgaonon ___Boholano ___Waray ___Ilocano ___Kankanai ___Surigaonon ___Zamboangeno ___Davaweno ___Bicolano ___Chinese ___Masbate ___ Others, Please specify ___________ 5. Indicate your religious background ___ Roman Catholic ___ Islam ___ Iglesia ni Cristo ___ UCCP ___ Seventh Day Adventist ___ Other Evangelical Churches ___ Assembly of God ___ Other Baptist Churches ___ Aglipay ___ Protestant ___ Other Methodist Church ___ Church of Jesus Christ Of the Latter Day Saints ___ Jehovas Witness

___Phil Benevolent Missionaries ___Lutheran Church ___Tribal Religions ___Buddhist ___Other, please specify: ________

6. Years of clinical exposure : ____________________ 7. Have you ever visited or lived in any countries outside Philippines? ___ Yes ____ No If yes, please specify: ______________ 8. Do you speak any language other than Bisaya? ___ Yes ___ No If yes, please specify: ______________

INSTRUCTION: Mark check ( / ) to the box that best corresponds to your answer.

LEGEND: Not At All-Has not experienced situations in the statement given; A Little- Has minimal experience; Somewhat-Fairly encountered the situations in the statement given; Quite A Bit- Has moderate encounter of the statement given; Very- Has sufficient experience in the statement given; and NA (Not Applicable)-Statement does not apply.

B.

Knowledge

How KNOWLEDGEABLE are you about each of the following subject areas concerning ethnic make-up?

Not at All (1) 1. Demographics of diverse racial, and ethnic groups 2. Sociocultural characteristics of diverse racial and ethnic groups 3. Health risks experienced by diverse racial and ethnic groups 4. Health disparities experienced by diverse racial and ethnic groups

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

5. Sociocultural issues in: a. Geriatrics b. Psychiatry c. Womens Health 6. Ethnopharmacology (i.e., variations in medication responses in diverse ethnic populations) 7. Different healing traditions (i.e., Traditional Native Medicine, Traditional Chinese Medicine) 8. Historical and contemporary impact of racism, bias, prejudice, and discrimination in health care experienced by various population groups in Philippines.

C. Skills How SKILLED are you in dealing with sociocultural issues in the following areas of patient care?

Not at All (1) 1. Greeting patients in a culturally sensitive manner 2. Eliciting the patients perspective about health and illness (e.g., its etiology, name, treatment, course, prognosis) 3. Eliciting information about use of folk remedies and/or alternative practitioners 4. Eliciting information about use of folk healers and/or alternative practitioners 5. Performing a culturally sensitive physical examination 6. Prescribing/negotiating a culturally sensitive treatment plan 7. Providing culturally sensitive patient education and counseling 8. Providing culturally sensitive clinical preventive services

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

9. Providing culturally sensitive end of life care 10. Assessing health literacy 11. Working with medical interpreters 12. Dealing with cross-cultural conflicts relating to diagnosis or treatment 13. Dealing with cross-cultural adherence/compliance problems 14. Dealing with cross-cultural ethical conflicts 15. Apologizing for cross-cultural misunderstandings and errors

D. Awareness/Situations/Encounters How COMFORTABLE do you feel in dealing with the following cross-cultural encounters or situations?

Not at All (1) 1. Caring for patients from culturally diverse backgrounds 2. 3. Caring for patients with limited Vernacular proficiency. 4. Caring for a patient who insists on using or seeking folk healers or alternative therapies 5. Identifying beliefs that are not expressed by a patient or caregiver but might interfere with the treatment regimen 6. Being attentive to nonverbal cues or the use of culturally specific gestures that might have different meanings in different cultures 7. Interpreting different cultural expressions of pain, distress, and suffering 8. Advertising a patient to change behaviors or practices related to cultural beliefs that impair ones health 9. Speaking in an indirect rather than a direct way to a patient about

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

his/her illness if this is more culturally appropriate 10. Breaking bad news to a patients family rather than to the patient if this is more culturally appropriate 11. Working with health care professionals from culturally diverse backgrounds 12. Working with a colleague who makes derogatory remarks about patients from a particular ethnic group 13. Treating a patient who makes derogatory comments about your racial or ethnic background

E. Attitudes/Sensitivity 1. How IMPORTANT do you believe sociocultural issues are in your interactions with:

Not at All (1) a. Patients b. Health Professionals Colleagues c. Residents, Medical Students d. Staff 2. How AWARE are you of your own:

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

Not at All (1) a. Racial, ethnic, or cultural identity b. Racial, ethnic, or cultural stereotypes c. Biases and prejudices

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

3. How IMPORTANT do you feel it is for health professionals to receive:

Not at All (1)

A Little (2)

Somewhat (3)

Quite a bit (4)

Very (5)

NA

a. Training in cultural diversity and/or Multicultural health care

F. Education and Training HOW MUCH TRAINING in cultural diversity have you previously had:

None (1) a. In college/post Secondary education b. In university

A Little (2)

Some (3)

Quite a bit (4)

Very (5)

NA

c. In medical school

d. During Residency Training e. In Continuing professional education

2. What are some potential challenges to integrating training about culturally competent care in health care organizations and clinical practice?

3. What necessary adaptations you use to provide quality care to clients despite the cultural and linguistic barriers? Check all that apply. ______ Ask signifant others (SO) to interpret ______ Uses sign language ______ Ask for client to write or draw ______ Uses visual aid/s ______ Ignore the client ______Other, Please specify: ________

4. Comments/suggestions: