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International Journal of Nonprofit and Voluntary Sector Marketing Int. J. Nonprofit Volunt. Sect. Mark. 14: 1–15 (2010) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/nvsm.404

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Do quality perceptions of health and social services vary for different ethnic groups? An empirical investigation Subir K. Bandyopadhy 1* and Manoj Pardasani 2

Business & Economics, Indiana University Northwest, Gary, USA Graduate School of Social Service, Fordham University, New York City, USA

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The United States of America is now more ethnically diverse than at any other time in its history. In 2000, minority ethnic groups comprised 26% of the US population. In 2008, they comprised approximately 35% of the population, and in 2080, it is predicted that they will form the majority of Americans (US Census Bureau, 2004; US Department of Health and Human Services, 2008). And among these ethnic groups, African-Americans (12.4%), Hispanics (15.4%), and Asian-Americans (4.4%) were the most predominant in 2008.

Center for Health Statistics [NCHS] 2002; Institute of Medicine [IOM] 2008; Furman et al., 2009; Ramos-Sanchez, 2009). These studies have shown that even when insurance status, income, age, and severity of conditions are comparable, racial and ethnic minorities:

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Introduction

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Racial/ethnic disparities in utilization of healthcare and social services

Several studies have identified the disparities between the various ethnic and racial groups in the seeking and the receipt of health care services (Betancourt et al., 2002; National *Correspondence to: Subir K. Bandyopadhy, Business & Economics, Indiana University Northwest, Dunes 1116, 3400 Broadway, Gary, Indiana 46408 USA. E-mail: [email protected]

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(i) Receive lower quality healthcare than Caucasian consumers. (ii) Have higher rates of mortality. (iii) Have lower life expectancies. (iv) Are less likely to assess adequate and competent care. (v) Are more likely be dependent on Medicaid and other public assistance programs. (vi) Receive limited health education and resource information. (vii) Are less likely to find providers from their own ethnic or racial group, and (viii) Less likely to receive services that incorporate their cultural and spiritual values and beliefs. The reasons identified by researchers and practitioners for the large health disparities are language/cultural barriers to service, distrust of Int. J. Nonprofit Volunt. Sect. Mark., xxx DOI: 10.1002/nvsm

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Subir K. Bandyopadhy and Manoj Pardasani

Literature review Review of the cross-cultural marketing literature

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Marketers in the for-profit world are becoming increasingly aware of the growth in population and purchasing power of ethnic groups such as African-Americans, Hispanics, and AsianAmericans. Collectively, these three groups will soon control approximately $4 trillion dollars of purchasing power as these grow much faster than the Caucasian population (Raymond, 2001Q4). Companies are increasingly using multicultural marketing strategies that appeal to a variety of cultures at the same time. This requires a greater understanding of the unique cultural characteristics of the ethnic sub-groups. Earlier studies on crosscultural consumer behavior (see, e.g., Dunn, 1992; Rosen, 1997; and Halter, 2002) have focused on the following characteristics: Product and service usage pattern. Shopping behavior. Media exposure patterns. Message preferences.

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the healthcare establishment by many minority consumers, and perceptions of bias experienced by consumers when receiving care (Williams and Johnson, 2002; Thomas, 2005; IOM, 2008; Peterson and Yancy, 2009). Also, poorer individuals are more likely to have limited education/literacy, less bargaining power for, and access to, free services (social services and healthcare), and therefore, least likely to receive quality care (Brown, 2000; US Department of Health and Human Services, 2008; Healthy Carolinians, 2010). With respect to social services, social workers in community-based or publicly funded organizations are most likely to work with vulnerable, low-income individuals and families seeking public assistance. Thus, in many social service settings, African-Americans and Hispanics are over-represented in the client population. Many practitioners and researchers have identified the critical need for culturally competent programs, outreach and marketing (Switzer et al., 1998; Taylor et al., 2001; Furman et al., 2009; RamosSanchez, 2009). The most common barriers cited are lack of knowledge about the consumer on part of the providers, limited access, distrust of providers, lack of effective outreach, language barriers, and a lack of interest in incorporating clients’ beliefs into the treatment plan (Martin and Bonder, 2003; Yan and Wong, 2005; William, 2006Q3).

Purpose of study

While several researchers have attempted to hypothesize the factors influencing health and social service disparities as described above, few studies have investigated the perceptions of the consumers directly, in order to assess factors that influence consumers’ decisionmaking in seeking health-care and social services. The aim of this study focus is to explore the experience of seeking and receiving critical health/social services by minority consumers, which can then be used to enhance social marketing endeavors designed to promote their health and welfare.

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If social service and healthcare organizations are to effectively serve consumers from various minority groups, they need to understand their consumers. Additionally, organizations need best-practice models for culturally competent campaigns. Several examples of specific, group-targeted campaign exist in the for-profit marketing literature that can provide a roadmap for non-profit organizations. Some of these relevant examples are highlighted below.

Marketing to African-American consumers

African-Americans constitute approximately 13% of the US population. They are, on average, younger than the Caucasian population, and represent lowers household incomes and educational attainment, though these differences continue to decrease (Hawkins and Mothersbaugh, 2007). Over the past decades, African-Americans have made signifiInt. J. Nonprofit Volunt. Sect. Mark., xxx DOI: 10.1002/nvsm

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QualityQ1 perceptions of health

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for Hispanic consumers. The goal was to understand the Hispanic consumer and develop campaigns that struck an emotional chord (Solomon, 2009). Q5

Review of the social marketing literature

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Social marketing is a distinct marketing discipline that aims to promote public health and empower communities (Stead et al., 2007). Social marketing is the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of society (Andreasen, 1995, p. 7).

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Social marketing projects have addressed such issues as childhood obesity (public health), helmets for bikers (safety), school social work, bio-degradable packaging material (environment), crime reduction, and participation in the voting process (communities) (Andreasen, 1995; French and Blair-Stevens, 2005; Beauchemin and Kelly, 2009; Homel and Carroll, 2009). One of the critical principles of social marketing is the involvement and inclusion of the target population in any change efforts (McDermott et al., 2005; Stead et al., 2007). For many of these issues such as public health, the ethnicity of the target population is relevant (McAlister et al., 1992; McPhee et al., 1995; Wildey et al., 1995; Schorling et al., 1997; Nader et al., 1999; Resnicow et al., 2000; Botvin et al., 2001; Baranowski et al., 2003; Beech et al., 2003; Caballero et al., 2003; Story et al., 2003). There are several examples of social marketing to racial/ethnic marketing groups in public health and healthcare services (Huerta and Macario, 1999; Shire, 2002; Van Duyn et al., 2007), available in academic literature. In a meta-review of social marketing examples, out of 54 effective social marketing interventions

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Hispanic Americans represent one of the largest, fastest growing, and most diverse ethnic groups in the US today. Hispanics can be divided into several segments or groups based on the acculturation to the host culture: (1) the acculturated, who speak mostly English and are mostly assimilated to the society, (2) the traditional, who speak mostly Spanish, and (3) the bicultural who can function either English or Spanish (Rossman, 1994Q7; Goerne, 1990Q8). A majority of Hispanics identify as Roman Catholic (Webster, 1994Q9). Language is also an important part of the cultural identity of the Hispanics. In spite of the accelerated acculturation trends, a 2003 study found that 69% of Hispanic households speak mostly Spanish at home, and a staggering 83% speak some Spanish at home (Packaged Facts, 2003Q10). Advertising is particularly important in this segment because many Hispanics prefer prestigious or nationally advertised brands. When Hanes began an ad campaign targeting Hispanic consumers in Chicago and San Antonio, its pantyhose sales increased by 8% (Hoyer and MacInnis, 2008). In 2007, Unilever launched ViveMejor, a major digital, TV, print, and retail Hispanic marketing program that combines all of its food and personal care brands together in a single marketing platform

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cant progress in education, income, and purchasing power (Market Segment Research, 1993). Some of the largest US advertisers, including General Motors, Proctor & Gamble, and Johnson & Johnson, are investing in ad campaigns specifically for this segment (Hoyer and MacInnis, 2008Q5). When Coffee–Mate discovered that African-Americans tend to drink their coffee with sugar and cream much more than do Caucasians, the company mounted a promotional blitz in the AfricanAmerican media and in return benefited from double-digit increases in sales volume and market share for this segment (Solomon, 2009Q6).

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Int. J. Nonprofit Volunt. Sect. Mark., xxx DOI: 10.1002/nvsm

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H1a: Compared to Caucasians, AfricanAmericans believe that health-care and social service providers do not cater to their medical, spiritual, and psycho-social needs. H1b: Compared to Caucasians, Hispanics believe that health-care and social service providers do not cater to their medical, spiritual, and psycho-social needs. H2a: Compared to Caucasians, AfricanAmericans believe that health-care and social services are not easily accessible to them. H2b: Compared to Caucasians, Hispanics believe that health-care and social services are not easily accessible to them. H3a: Compared to Caucasians, AfricanAmericans believe that the health-care and social service providers do not reach out to people and their cultural communities. H3b: Compared to Caucasians, Hispanics believe that the health-care and social service providers do not reach out to people and their cultural communities. H4a: Compared to Caucasians, AfricanAmericans believe that the health-care and social service providers are not good at listening to and show enough respect to persons receiving services. H4b: Compared to Caucasians, Hispanics believe that the health-care and social ser-

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Cross et al. (1989) define cultural competency as a set of behaviors, attitudes, and policies that come together in a system or agency or among professionals that enables that system, agency, or professional to work effectively in cross-cultural situations (Cross et al., 1989). Davis (1997) defines organizational cultural competency as the degree of integration and transformation of knowledge, information, and data about individuals and groups of people into specific clinical standards, skills, service approaches, techniques, and marketing programs that match the individual’s culture and increase the quality and appropriateness of healthcare outcomes. Thus, ‘‘cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals and enable the system, agency, or professionals to work effectively in cross-cultural situations’’ (National Association of Social Workers, 2000). One of the most comprehensive studies to measure cultural competency was undertaken by the Cultural Competency Advisory Group (CCAG) of the University of Maryland (Arthur et al., 2005). CCAG defines cultural competency as the degree of willingness, commitment, effort on part of providers, and their ability to recognize, understand and appreciate cultural differences and effectively use this knowledge to design and provide services to address the health needs of people from various cultures (Arthur et al., 2005). Based on a comprehensive review of literature and with input from public health experts, CCAG developed a 52-item scale that evaluates

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the cultural competence of an organization from the perspective of the consumer. The scale was tested with nearly 250 consumers and a factor analysis yielded four underlying themes of cultural competence: (1) the ability of the service providers to tune in to the medical, spiritual, and psycho-social needs, (2) the accessibility of services and the willingness of the service providers to negotiate on priorities for care, (3) the effort of the service providers to reach out to people and their cultural communities, and (4) the ability of the service providers to listen to and respect persons receiving services (Arthur et al., 2005). Based on the findings of the Arthur et al. (2005) study and a review of literature, the following hypotheses are proposed:

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reported by Stead et al. (2007), 14 interventions were targeted at minority groups. They ranged from African-American schoolgirls (Resnicow et al., 2000; Story et al., 2003) to Hispanic adults (McAlister et al., 1992) and Asian-American men (McPhee et al., 1995). However, there are fewer studies that have explored social marketing to racial-ethnic groups in social services.

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Methodology

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This study incorporated a modified version of the 52-item scale developed by Arthur et al. (2005) for several reasons. First, the scale is fairly comprehensive with items that cover all major issues relevant to our study. Second, the scale was thoroughly analyzed for validity and reliability. For example, a correlation analysis of the individual items and the sum of all 52 items was done to test for construct validity. Results revealed positive correlations between most of the individual questions in the scale, which indicated that these individual items do a good job of measuring cultural competency. Besides the correlation analysis, Arthur et al. (2005) also did a factor analysis which revealed for four factors (or themes). The reliability of the scale was ascertained by a Cronbach’s alpha of 0.92 which indicated that the items in the cultural competency scale measure the concept adequately. For this particular study, several items which made specific reference to mental health were deleted. Accordingly, the modified scale contains 35 items. Each of the 35 items are scored on a 7-point Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). The descriptive statistics for all 35 items are provided in Table 1.

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Scale development

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This study is a positivistic study that explored the perceptions and experiences of consumers receiving healthcare and social services in a community health center setting. This is a cross-sectional study that utilizes a questionnaire (cultural competence scale) to elicit information from a relatively small number of residents living in Northwest Indiana.

was adopted with ethnicity as the basis of stratification. This was necessary because the study required sub-sets of samples drawn from Caucasians, African-Americans, and Hispanics (the three major groups of residents in this region). All respondents had sought services at one of three community health centers. The respondent sample comprised 73.0% females (N ¼ 100) and 26.3% males (N ¼ 36). Thirtyseven per cent (37.2%) of the respondents were Caucasian (N ¼ 51), 30.7% were AfricanAmerican (N ¼ 42), 22.6% were Hispanic (N ¼ 31), 2.2% were Asian (N ¼ 3), and the remainder identified themselves as belonging to the ‘‘other’’ category (N ¼ 9, 6.5%). The largest proportion of the sample was aged 18– 31 years (42.3%), followed by those aged 31– 45 (30.7%) and 45–60 years (19%). There were 10 respondents (7.3%) who were over the age of 60. With respect to immigrant status, 13.1% of the sample (N ¼ 18) reported being firstgeneration immigrants, while 32.8% of the sample (N ¼ 45) identified themselves as bilingual. Spanish was identified as the most commonly spoken second language within the study sample.

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vice providers are not good at listening to and show enough respect to persons receiving services.

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Study sample

The sample of respondents was drawn from Northwest Indiana. A stratified sampling method Copyright

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Results The data analysis was conducted in two stages. In the first stage, a factor analysis was conducted on all questionnaire items to identify factors (themes) that had a significant impact the experiences of consumers. In the second stage, analysis of variance (ANOVA) tests were computed to assess the impact of ethnicity on the significant factors (themes) identified by this study.

First stage: factor analysis

The data was screened for univariate outliers. Two out-of-range values, due to administrative errors, were identified and recoded as missing data. The minimum amount of data for factor analysis was satisfied, with a final sample size of 137 (using listwise deletion), with approximately four cases per variable. Int. J. Nonprofit Volunt. Sect. Mark., xxx DOI: 10.1002/nvsm

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Table 1. Descriptive statistics for individual items SD

Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic

51 42 31 51 42 31 51 42 31 51 42 31 51 42 31 50 42 31 51 42 31 51 42 31 51 42 31 51 42 31 51 42 31

2.64 3.45 3.45 2.21 3.64 4.81 3.06 3.33 4.29 4.68 3.95 5.13 6.05 4.54 3.33 1.68 3.33 4.81 1.71 3.28 4.64 1.96 3.43 4.64 2.47 3.36 3.39 3.51 4.17 2.90 3.25 3.19 3.16

1.34 1.85 1.98 1.56 1.99 1.85 1.80 2.03 3.13 1.76 2.09 1.94 1.70 2.26 2.41 1.42 2.02 2.14 1.43 2.02 2.17 1.57 2.06 2.40 1.37 1.84 l.54 1.95 2.17 1.72 1.99 1.94 2.11

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Some of the office and support staff in the agencies are from my racial or ethnic group Some of the social workers are from my racial or ethnic group

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The staff in the agencies do not ask me verbally what I think about the social services I can get in their agency The staff in the agencies do not ask my family verbally what they think about the social services I get in their agency The staff in the agencies ask me, my family, or others close to me to fill out forms that tell them what we think of the place and services Some of the staff at the agencies I visit speak the language I usually speak at home There are translators or interpreters easily available, if required, to assist me and/or family The staff in the agencies I visit treat me with respect

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The staff in the agencies listen to me carefully when we talk to them

The staff in the agencies I visit think less of me because of the way I talk The staff in the agencies I visit think less of me because of the color of my skin

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The waiting rooms have pictures or reading material that show people from my racial or ethnic group The waiting rooms have brochures or handouts that tell me about services I can get here The brochures and handouts available in the waiting room are in other languages as well as English The reading materials are not in the language that my family and I usually speak at home Some of the staff in the agencies are from my racial or ethnic group

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When I call or came to an agency, it was easy to talk to the staff

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Caucasian Black Hispanic

51 42 31

4.29 4.17 4.58

2.05 2.18 1.99

Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic

51 42 31 51 42 31 51 42 31 51 42 31 51 42 31

1.51 2.19 3.84 4.27 4.14 4.97 2.08 3.21 3.32 6.12 4.81 4.74 6.02 4.76 4.45

1.25 2.25 2.48 1.65 2.04 2.21 1.16 1.96 2.10 1.11 1.79 2.28 1.48 1.83 2.16 (Continues)

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Table 1. (Continued)

The staff in the agencies I visit hold it against me if I complain about things that I am not happy with The staff seems to understand that I might feel more comfortable working with someone who is the same gender with me The staff in the agencies I visit are willing to be flexible and provide alternative approaches or services to meet my cultural/ ethnic treatment needs The staff who work in the agencies I visit do not talk to other people about my problems or treatment without asking getting my written permission first Most of the time, I feel I can trust the staff in the agencies I visit who work with me

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Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic

50 42 31 51 42 31 51 42 31 50 42 31 51 42 31

3.42 3.45 4.13 2.76 3.45 3.68 4.67 4.52 3.87 3.18 3.69 4.39 3.27 3.69 4.42

1.42 1.62 1.84 1.29 1.86 1.90 1.63 1.71 2.01 1.64 1.64 1.84 1.52 1.47 1.73

50 42 31

2.96 3.47 3.26

2.06 1.79 2.25

50 42 31 51 42 31 51 42 31 51 42 31 51 42 31 51 42 31 51 42 31 49 42 31 50 42 31 50 42 31 50 42 31 50 42 31

1.98 3.40 3.26 2.14 3.14 3.22 2.09 3.14 3.13 2.00 3.00 2.90 5.00 4.33 4.22 3.29 3.76 4.45 3.31 3.78 4.42 2.79 3.76 4.64 3.72 4.36 3.81 4.06 3.83 3.61 4.26 3.93 4.23 3.48 3.88 3.90

0.96 1.94 2.25 1.09 1.86 1.36 1.1 1.93 1.45 1.05 1.89 1.45 1.95 1.79 1.69 1.25 1.57 1.88 1.32 1.61 2.04 1.38 1.68 1.91 1.59 1.51 1.74 1.43 1.62 1.69 1.50 1.73 1.82 1.54 1.94 2.02

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Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic Caucasian Black Hispanic

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The people who work in the agencies I visit do not try to help me to be on my own as much as I can Some of the staff in the agencies I visit understand the difference between their culture and mine Staff in the agencies I visit acknowledge the importance of my cultural beliefs in my treatment process Staff in the agencies I go to understand that people of my racial or ethnic group are not all alike Staff in the agencies I go to generally assume they know enough about my cultural beliefs without asking me I do not see staff in the agencies I visit taking time to understand a person’s culture Staff in the agencies I visit treat me as if my culture is not important to them to consider in planning my treatment It was easy to get information I need about housing, food, clothing, and other social services from the agencies I go to

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Caucasian Black Hispanic

The staff in the agencies I visit talk to me about the medications they recommend to help me The staff in the agencies I visit who work with me pay attention to what I say about how the medication(s) make me feel The directions for the medication (s) are easy to follow

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If I complain, the staff in the agencies I visit try to help me with my complaint

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During several steps, a total of seven items were eliminated because they did not contribute to a simple factor structure and failed to meet a minimum criteria of having a primary factor loading of 0.6 or above, and no crossloading of 0.5 or above. A principle-components factor analysis of the remaining 28 items was conducted. A Varimax rotation provided the best defined factor structure (Kaiser, 1958; Hair et al., 2010). The factor loading matrix is presented in Table 2. Three factors explained 75.5% of the variance. All items had primary loadings over 0.6 and no items had a cross-loading above 0.6. The eighth factor had only the following item with a loading above 0.7:

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‘‘The staff in the agencies I visit holds it against me if I complain about things that I am not happy with.’’ Based on the results of the factor analysis, labels were created for each factor. Emerging common themes for all the items that loaded above 0.6 on each factor were identified and guided the decision on labeling. The labels developed were: Factor 1 – the willingness of the service provider to accommodate specific care requirement of clients (in short, special care sensitivity), Factor 2 – the sensitivity of the service provider to the racial/ethnic identity of the client (in short, racial/ethnic sensitivity), Factor 3 – the sensitivity of the service provider to different cultural beliefs of clients (in short, sensitivity to cultural beliefs), Factor 4 – the ability of the service provider to seek feedback (in short, seeking feedback), Factor 5 – the ability of the service provider to communicate effectively (in short, communication style), Factor 6 – the willingness of the service provider to share information with the client (in short, information sharing), Factor 7 – the sensitivity of the service provider to the gender and/or spirituality specific needs of the client (in short, sensitivity to gender/ spirituality needs), and Factor 8 – the ability of the service provider to deal with client complaints (in short, fear of reprisal). If the loading pattern of individual items in our study is

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Initially, the factorability of the 35-scale items was examined. Several well-recognized criteria for the factorability of a correlation were used. First, all 35 items correlated at least 0.3 with at least one other item, suggesting reasonable factorability. Second, the Kaiser– Meyer–Olkin measure of sampling adequacy was 0.861, above the recommended value of 0.6, and Bartlett’s test of sphericity was significant (x2 (595) ¼ 3074.35, p < 0.05). The diagonals of the anti-image correlation matrix were all over 0.5, supporting the inclusion of each item in the factor analysis. Finally, the communalities were all above 0.5 (Table 1), further confirming that each item shared some common variance with other items. Given these overall indicators, factor analysis was conducted with all 35 items (Kaiser 1958; McDonald, 1981). Principle components analysis was used because the primary purpose was to identify and compute composite coping scores for the factors. The initial eigen values showed that the first factor explained 32.9% of the variance, the second factor 9.9% of the variance, and a third factor 6.6% of the variance. The fourth, fifth, sixth, seventh, and eighth factors had eigen values of just over one, each factor explaining 5.5%, 4.5%, 3.4%, 3.3%, and 2.9% of the variance, respectively. Various solutions were examined, using both Varimax and Oblimin rotations of the factor loading matrix. The eight factor solution, which explained 69.2% of the variance, was preferred because of the ‘‘leveling off’’ of eigen values on the scree plot after eight factors and the insufficient number of primary loadings and difficulty of interpreting the ninth factor and subsequent factors. There was little difference between the Varimax and Oblimin solutions, thus both solutions were examined in the subsequent analyses. The Varimax rotation was selected for the final solution because orthogonal rotation methods (such as Varimax) are the most widely used and the orthogonal (i.e., uncorrelated) factors are easier to interpret than the correlated factors generated from an oblique rotation method such as Oblimin (Hair et al., 2010).

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Table 2. Factor loadings and communalities based on a principle components analysis with Varimax rotation for 28 items (N ¼ 137) Survey items 1

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Factors 4 5

3

Communality 6

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8 0.804

0.816

0.780

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0.836

0.790

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0.763

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0.747

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0.720 0.709

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0.783 0.700 0.718 0.587 0.731 0.745

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0.601 0.864

0.839

0.840

0.844

0.780

0.707

0.771

0.759

0.770

0.799

EC

The staff in the agencies I visit talk to me about the medications they recommend to help me The staff in the agencies I visit who work with me pay attention to what I say about how the medication (s) make me feel The staff in the agencies I visit treat me with respect The staff in agencies listen to me carefully when we talk to them Most of the time, I feel I can trust the staff in the agencies I visit who work with me If I complain, the staff in the agencies I visit try to help me with my complaint The directions for the medication (s) are easy to follow Staff in the agencies I go to understand that people of my racial or ethnic group are not all alike Some of the office and support staff in the agencies are from my racial or ethnic group Some of the staff in the agencies are from my racial or ethnic group The waiting rooms have pictures or reading material that show people from my racial or ethnic group Some of the social workers are from my racial or ethnic group Some of the staff at the agencies I visit speak the language I usually speak at home Staff in the agencies I go to generally assume they know enough about my cultural beliefs without asking me Staff in the agencies I visit treat me as if my culture is not important to them to consider in planning my treatment I do not see staff in the agencies I visit taking time to understand a person’s culture The staff in the agencies do not ask my family verbally what they think about the social services I get in their agency The staff in the agencies do not ask me verbally what I think about the social services I can get in their agency

UN

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56

0.781

0.747

0.736

0.709

0.720

0.612 0.811

0.751

0.779

0.659

(Continues)

Copyright

#



10


Table 2. (Continued) Survey items 1

CO RR


7

8

0.748

0.706

0.629

0.567

0.627

0.600

FS

0.708

O O PR D

Internal consistency for each of the scales was examined using Cronbach’s alpha. The alphas were above 0.75 for all the factors. No substantial increases in alpha for any of the scales could have been achieved by eliminating more items (Marsh et al., 1988). Composite scores were created for each of the eight factors (ranging from 1 to 7), based on the mean of the items which had their primary loadings on each factor. Higher scores indicated greater level of cultural competence and sensitivity on part of the service providers. Communication style on part of the service provider was the factor that consumers reported as most significant, with a negatively #

Communality 6

0.595

compared with that in the CCAG study, we find that the factors 1, 2, 3, and 4 in the CCAG study closely resemble factors 7, 5, 2, and 1, respectively, of our study.

Copyright

Factors 4 5

3

0.747

EC

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