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Intercultural Competence Predicts Intercultural Effectiveness: Test of an Integrative Framework

April 2022
International Journal of Environmental Research and Public Health 19(8):4490

DOI:10.3390/ijerph19084490

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Project: EdisTools - Ethnic discrimination in labour, housing, health care and education

Authors:

Stijn Schelfhout

Ghent University

Robin Vandecasteele

Ghent University

Stephanie De Maesschalck

Ghent University

Fanny D'hondt

Ghent University

Show all 6 authorsHide

Why does someone thrive in intercultural situations; while others seem to struggle? In 2014, Leung and colleagues summarized the literature on intercultural competence and intercultural effectiveness into a theoretical framework. This integrative framework hypothesizes that the interrelations between intercultural traits, intercultural attitudes and worldviews, and intercultural capabilities predict the effectiveness with which individuals respond to intercultural situations. An empirically verified framework can contribute to understanding intercultural competence and effectiveness in health care workers, thus contributing to more equity in health care. The present study sets out to test this integrative framework in a specific health care context. Future health care practitioners (N = 842) in Flanders (Belgium) were questioned on all multidimensional components of the framework. Structural equation modeling showed that our data were adequate to even a good fit with the theoretical framework, while providing at least partial evidence for all hypothesized relations. Results further showed that intercultural capabilities remain the major gateway toward more effective intercultural behavior. Especially the motivation and cognition dimensions of cultural intelligence seem to be key factors, making these dimensions an excellent target for training, practical interventions, and identifying best practices, ultimately supporting greater intercultural effectiveness and more equity in health care.

Correlation matrix.

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Regressions from model 1.

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Regressions from Model 2.

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Regressions from Model 3b.

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Citation: Schelfhout, S.;

Vandecasteele, R.; De Maesschalck, S.;

D’hondt, F.; Willems, S.; Derous, E.

Intercultural Competence Predicts

Intercultural Effectiveness: Test of an

Integrative Framework. Int. J.

Environ. Res. Public Health 2022,19,

4490. https://doi.org/10.3390/

ijerph19084490

Academic Editors: David L. Rowland

and Paul B. Tchounwou

Received: 19 January 2022

Accepted: 1 April 2022

Published: 8 April 2022

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International Journal of

Environmental Research

and Public Health

Article

Intercultural Competence Predicts Intercultural Effectiveness:

Test of an Integrative Framework

Stijn Schelfhout 1,2,3,*, Robin Vandecasteele 4, Stéphanie De Maesschalck 4, Fanny D’hondt 5, Sara Willems 4,6

and Eva Derous 1,3

1Research Group Vocational and Personnel Psychology, Department of Work, Organisation and Society,

Faculty of Psychology and Educational Sciences, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium;

eva.derous@ugent.be

Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Ghent University,

Henri Dunantlaan 2, 9000 Ghent, Belgium

3Interdepartmental Research Group Vocational and Personnel Psychology, Faculty of Psychology and

Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium

4Research Group Equity in Health Care, Quality & Safety, Department of Public Health and Primary Care,

Faculty of Medicine and Health Sciences, Ghent University, University Hospital Campus Entrance 42, C.

Heymanslaan 10, 9000 Ghent, Belgium; robin.vandecasteele@ugent.be (R.V.);

stephanie.demaesschalck@ugent.be (S.D.M.); sara.willems@ugent.be (S.W.)

Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41,

9000 Ghent, Belgium; fanny.dhondt@ugent.be

6Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2,

9000 Ghent, Belgium

*Correspondence: stijn.schelfhout@ugent.be

Abstract:

Why does someone thrive in intercultural situations; while others seem to struggle? In 2014,

Leung and colleagues summarized the literature on intercultural competence and intercultural effec-

tiveness into a theoretical framework. This integrative framework hypothesizes that the interrelations

between intercultural traits, intercultural attitudes and worldviews, and intercultural capabilities

predict the effectiveness with which individuals respond to intercultural situations. An empirically

veriﬁed framework can contribute to understanding intercultural competence and effectiveness in

health care workers, thus contributing to more equity in health care. The present study sets out to test

this integrative framework in a speciﬁc health care context. Future health care practitioners (N= 842)

in Flanders (Belgium) were questioned on all multidimensional components of the framework. Struc-

tural equation modeling showed that our data were adequate to even a good ﬁt with the theoretical

framework, while providing at least partial evidence for all hypothesized relations. Results further

showed that intercultural capabilities remain the major gateway toward more effective intercultural

behavior. Especially the motivation and cognition dimensions of cultural intelligence seem to be

key factors, making these dimensions an excellent target for training, practical interventions, and

identifying best practices, ultimately supporting greater intercultural effectiveness and more equity

in health care.

Keywords:

intercultural traits; intercultural attitudes and worldviews; intercultural capabilities; inter-

cultural competence; intercultural effectiveness; multicultural personality; ethnocentrism;

ethnorelativism; cultural intelligence; cultural self-efﬁcacy

1. Introduction

In our ever globalizing world of today, interculturalism is becoming the norm. People

select and communicate cultural information (for instance regarding ethnicity, race, religion

and nationality) according to the situation and their personal interests [

]. Moreover, in

health care, such communication can deﬁne interactions between practitioners and patients

with diverse cultural background [

–

]. This intercultural and interacting health care

Int. J. Environ. Res. Public Health 2022,19, 4490. https://doi.org/10.3390/ijerph19084490 https://www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2022,19, 4490 2 of 21

setting can instigate speciﬁc challenges, especially as these interactions can threaten equity

in health care [

–

]. Literature features quite some variance in how equity in health care

is described [

]. Lane and colleagues reviewed this equity literature and suggested a

practically operationalized deﬁnition of equity in health care depending on the speciﬁc

application [

]. Following Lane and colleagues [

], the present study thus deﬁnes equity

in health care as follows: Reducing disparities toward access to and use of health care

services for groups of people with different nationality or ethnic backgrounds. As a prime

example of such a challenge to equity in health care, ethnic prejudice is described as the

unjustiﬁed or incorrect attitude toward individuals based solely on their membership of

certain groups like race or nationality [

]. As a consequence, ethnic prejudice can

cause inequity in health care as people from different races or nationalities are receiving

suboptimal treatment, resulting in less favorable therapy outcomes and poorer health

altogether [13–15].

Recently, literature aimed at studying problems such as ethnic prejudice in a broader

framework of intercultural interaction [

]. Indeed, why do some people thrive in

intercultural situations, while others seem to struggle? To answer this question, Leung

and colleagues proposed an integrative framework that theorizes how the intercultural

competence of individuals leads to effective behavior in intercultural situations [

]. The

model is developed based on an extensive review of theoretical and empirical developments

in the intercultural competence literature. As such, the model describes how personality,

world views (including attitudes), and knowledge of different cultures interact toward

effectiveness in intercultural situations. The framework beneﬁts from a broad scope that

can be applied to a multitude of settings including health care. The authors have explicitly

stated that researchers should explore how the components of intercultural competence

interrelate regarding their effect on intercultural effectiveness, instead of viewing the

different components as independent predictors.

For sure, the merit of this framework cannot be underestimated in summarizing the

extant literature on intercultural competence and its (theorized) effects on intercultural

effectiveness. However, despite the authors’ call for empirical validation, to this date and to

our knowledge, the theoretical framework has not been empirically veriﬁed in full. Toward

a speciﬁc setting like health care, such a veriﬁcation can provide us with an invaluable

basis to further study and even remedy urgent problems like ethnic prejudice that threaten

equity in health care.

The present study in Flanders (i.e., the largest region in Belgium) therefore aims to

provide empirical veriﬁcation of the framework on intercultural competence by investigat-

ing how the components of intercultural effectiveness interrelate in exerting their effects on

intercultural effectiveness. In doing so, the present study also focuses on identifying which

speciﬁc framework components are responsible for intercultural effective behavior in a

health care setting. Following the advice of Brottman and colleagues, these components

can become the future target of training, intervention, and evaluation, in order to establish

a compendium of best health care practice and education [

]. For instance, the present

study is conducted within the EdisTools project. The project wants to improve intercultural

effectiveness of practitioners toward clients in key domains of society like health care by

developing a set of digital tools for training and education.

1.1. The Framework of Intercultural Competence and Intercultural Effectiveness

Dias and colleagues describe intercultural competence as a multifaceted and com-

plex concept, that combines the knowledge and skills needed to perform effectively and

appropriately when interacting with others who are culturally different [

]. Literature

already features a plethora of articles on the nature of this knowledge and these skills as

intercultural competence is becoming key in important areas of human interaction such as

education and healthcare. Leung and colleagues have summarized this literature into an

integrative framework that theorizes how three components of intercultural competence

interact to achieve intercultural effectiveness [

]. First, intercultural traits indicate how

Int. J. Environ. Res. Public Health 2022,19, 4490 3 of 21

well an individual’s personality is able to handle intercultural situations [

]. Second,

intercultural worldviews indicate how individuals perceive (information from) other cul-

tures [

–

]. Finally, intercultural capabilities represent an amalgam of what a person can

undertake in order to be effective in an intercultural situation such as a job interview where

participants have different cultural backgrounds [26,27].

1.1.1. Intercultural Traits

The Big Five (extraversion, agreeableness, openness, conscientiousness, and emo-

tional stability) of human personality are known to be good predictors of how successful

individuals are in actually evaluating (intercultural) situations and also appropriately re-

sponding to these situations [

]. For instance, Shaffer and colleagues reported that expats

showed a positive relation of r= 0.24 between emotional stability and work adjustment

and a negative relation of r=

−

0.27 between emotional stability and cognitions about

early withdrawal from the job [

]. Toward multicultural settings, van der Zee and van

Oudenhoven have proposed a contextualized model of ﬁve multicultural personality traits

that have incremental validity above and beyond the original Big Five [

]. Cultural

empathy thus refers to empathy toward the feelings, thoughts, and behavior of individuals

with a diverse culture. Emotional stability refers to the ability to stay calm despite novel

and stressful intercultural conditions. Flexibility reﬂects an aptitude in interpreting novel

intercultural situations as a positive challenge, while also adapting to these situations.

Open mindedness represents an unprejudiced disposition toward differences in culture.

Finally, social initiative refers to actively approaching intercultural social situations while

also taking the initiative in these situations. A high score on these multicultural personality

dimensions was found to be predictive regarding the successful adjustment of employees,

students, migrants, and expats in their intercultural work or study activities, even when

controlling for the original Big Five [

–

]. Recently, a Short Form of the Multicultural

Personality Questionnaire (i.e., SF-MPQ with 40 items) [

] has also been validated for use

in health care-related contexts [36].

The predictive value of traits as constructs is partly explained by their stability, as

personality traits are known to be quite stable over the lifespan, especially past child-

hood [

]. For instance, literature indicates that personality traits are associated with

ethnocentric world views like ethnic prejudice and right-wing authoritarianism [

Personality traits are also associated with intercultural capabilities like cultural intelli-

gence [

]. The framework of Leung and colleagues [

] thus hypothesizes the following

relations regarding intercultural traits, intercultural worldviews, and intercultural capabili-

ties (see further).

H1.

Higher scores on intercultural traits predict a more ethnorelative world view (As a standalone

investigation, the present study’s cross-sectional data do not allow for a strict causal interpretation

of the results. However, (a) as the hypotheses are investigated through regression SEM analyses

and (b) as the hypotheses tested are the result of prior extensive theoretical and empirical research in

extant literature, the present study’s hypotheses are posited as predictions.).

H2. Higher scores on intercultural traits predict higher scores on intercultural capabilities.

1.1.2. Intercultural Worldviews

Intercultural worldviews address how individuals perceive information from other

cultures [

–

]. As an example, the Developmental Model of Intercultural Sensitivity

places ethnocentrism and ethnorelativism at both ends of a continuum that represents

increasing intercultural competence [

]. An individual with an ethnocentric disposition

almost exclusively observes the world through the looking glass of its own culture [

An individual with an ethnorelative disposition emphasizes the complexities and contra-

dictions of many different countries and cultures instead [

]. Research by Hammer has

shown that a score on this continuum can predict reduced intercultural anxiety, satisfaction

with studying abroad, the number of intercultural friends, and inclusion policies on staff

Int. J. Environ. Res. Public Health 2022,19, 4490 4 of 21

recruiting [

]. In health care speciﬁcally, Kaya and colleagues showed that Turkish

nursing students showed a negative correlation between intercultural sensitivity and eth-

nocentrism of about r=

−

0.40 [

]. Based on the already extensive literature on the topic,

Leung and colleagues hypothesized that an ethnorelative world view has a positive effect

on intercultural capabilities [18,50,51].

H3. A more ethnorelative world view predicts higher scores on intercultural capabilities.

1.1.3. Intercultural Capabilities

Intercultural capabilities focus on what a person can do to be effective in an intercul-

tural interaction like showing knowledge of other cultures [

]. One often-used conceptual-

ization of intercultural capabilities is (inter)cultural intelligence [53]. Cultural intelligence

can be described as a set of adaptable properties that allows an individual to effectively

manage intercultural situations [

]. Literature already reached consensus that cultural

intelligence at least features a (meta) cognitive dimension (i.e., knowledge about different

cultures), a motivational dimension (i.e., motivation to interact with people from different

cultures), and a behavioral dimension (i.e., knowledge about how to act in intercultural

interactions) [

–

]. Research on these dimensions with adolescents showed a posi-

tive relation with contact and cooperation and multiculturalism in both immigrant and

non-immigrant students [

]. In health care speciﬁcally, Harrison and colleagues found

that intercultural competence of health care professionals and effective practitioner-patient

engagement are strongly related regarding ethnic minority populations [60].

These observed effects are possible due to the adaptable nature of intercultural capabilities.

In other words, capabilities like cultural knowledge are teachable and thus trainable, making

these capabilities a prime target for training and education interventions in order to improve

an individual’s intercultural competence and eventually also the individual’s effectiveness

in intercultural situations [

]. In the framework of Leung and colleagues [

], intercultural

capabilities are thus hypothesized to have a positive effect on intercultural effectiveness.

H4. Higher scores on intercultural capabilities predict higher scores on intercultural effectiveness.

1.2. Intercultural Effectiveness

The goal of intercultural competence in an individual is for that individual to exhibit

effective behavior in intercultural situations. The downside of studying actual behavior lies

in the fact that you can observe the behavior, but you cannot directly tell why individuals

exhibit said behavior. As an alternative, literature harbors classic models that explain

human behavior through different psychological (multidimensional) constructs that can

be measured instead of actual behavior. For instance, the Social Cognitive Theory posits

that human behavior can be explained through the determinants of self-efﬁcacy belief (i.e.,

can I make it happen?), outcome expectation (i.e., what will be the outcome if it happens?),

and goal representation (i.e., what will I gain if it happens?) [

]. Self-efﬁcacy belief is

regarded the most essential component as an individual with low self-belief will have a

very low chance to initiate the behavior to begin with [

]. As such, previous studies have

already indicated a strong connection between general self-efﬁcacy and behavior [

For instance, meta-analytic evidence on the theory of planned behavior shows that as

perceived behavioral control, self-efﬁcacy can have major average correlations with actual

behavior of about r= 0.46 [

]. More speciﬁcally, literature has also already established a

relationship between cultural intelligence and self-efﬁcacy [

]. For example, Quine and

colleagues reported that Canadian nursing students self-rated their cultural self-efﬁcacy as

moderate when dealing with diabetes patients from aboriginal ancestry [

]. Moreover,

Quine and colleagues also showed that higher cultural self-efﬁcacy was related to greater

intercultural communication and lower intercultural anxiety, with an explained variance of

about 33 to 35% [69].

Cultural self-efﬁcacy can be operationalized as a multidimensional construct. As an

example, Briones and colleagues suggest a ﬁve-dimensional construct as operationalized

Int. J. Environ. Res. Public Health 2022,19, 4490 5 of 21

in the cultural self-efﬁcacy scale for adolescents or CSES-A [

]. The process dimension

indicates how well individuals estimate their own ability to process information about

other cultures. The mix dimension indicates how well individuals estimate they would mix

within other cultures. The cope dimension indicates how well individuals estimate their

ability to cope with homesickness and separation from loved ones. The understanding

dimension indicates how well individuals estimate their ability to understand other ways

of life. Finally, the language dimension indicates how well individuals estimate they are

able to learn and understand other languages. Both the multidimensional construct as well

as the instrument are already quite common in health care literature [71–73].

1.3. Present Study

The present study aims to empirically verify the integrative framework of Leung and

colleagues in a health care setting [

]. To this extent, H1 to H4 are tested in a structural

equation model (SEM), using a multidimensional approach. For the present study, a

multidimensional approach is important as such an approach can pinpoint how exactly

the intercultural competence triangle (through multidimensional cultural intelligence)

relates to intercultural effectiveness (through multidimensional cultural self-efﬁcacy). Such

interrelations are key to establishing future training, intervention, and evaluation targets,

in order to establish a compendium of best health care practice and education [19].

The framework by Leung and colleagues does not elaborate on two relations: (a) does

multicultural personality have a direct effect on intercultural effectiveness and (b) does an

individual’s world view have a direct effect on intercultural effectiveness [18]?

First, literature already reports some evidence of direct effects of various dimensions

of multicultural personality on intercultural effectiveness. Indeed, Ward and Fischer

found that ﬂexibility, social initiative, and emotional stability had a direct effect on the

general adjustment of international students in New-Zealand [

]. Moreover, the general

personality trait openness to experience was found to have a direct effect on adaptive

performance [

] and job performance [

], albeit partially mediated through the motivation

dimension of cultural intelligence. As a speciﬁc example from health care, Herrera and

Owens found that higher post-traumatic stress disorder (PTSD) in US service members

was predicted by higher levels of open mindedness and lower levels of ﬂexibility and

emotional stability [

]. As such, we have examined the possibility of extending the

proposed framework of Leung and colleagues with a direct relation between (multicultural)

personality traits and intercultural effectivity [18].

H5.

Higher scores on intercultural traits directly predict higher scores on intercultural effectiveness.

Second, literature also reports direct effects of world views on intercultural effec-

tiveness. For sure, an ethnocentric world view in health care professionals is known to

lead to negative outcomes like misdiagnosis, mistreatment, and undertreatment in cul-

turally diverse individuals [

]. For instance, an experimental design in a health context

revealed that the willingness to interact with an intercultural health professional correlated

negatively with ethnocentrism, r=−0.19 [77].

H6. A more ethnorelative world view directly predicts higher scores on intercultural effectiveness.

Figure 1summarizes the presented hypotheses toward the empirical veriﬁcation of

the integrative framework of intercultural competence and effectiveness.

Int. J. Environ. Res. Public Health 2022,19, 4490 6 of 21

Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 6 of 22

Figure 1 summarizes the presented hypotheses toward the empirical verification of

the integrative framework of intercultural competence and effectiveness.

Figure 1. Hypotheses summary: test of an integrative framework. Note: The grey squares represent

intercultural competence. The operationalizations of intercultural competence and effectiveness are

presented in italic. H1, H2, H3, and H4 represent the empirical test of the integrative framework as

proposed by Leung et al., 2014. H5 and H6 represent additional hypotheses in dashed arrows. All

hypothesized relationships are expected to have positive effects.

2. Materials and Method

2.1. Data and Procedure

The data were gathered in the context of the EdisTools project, a large Strategic Basic

Research project in Belgium (Flanders), subsidized by Scientific Organizations Flanders.

This EdisTools project aims to map out interculturalism and prejudice in four different

professional settings, which are also embedded in legislation as constitutional rights: ed-

ucation, health care, housing, and work. The project focuses on the intercultural effective-

ness of the ethnic majority (i.e., Belgian) service provider (i.e., teachers, doctors, estate

agents and employers) toward the ethnic minority client (i.e., learners, patients, potential

tenants, and job applicants respectively). This project was approved by the Ethical Medi-

cal Committee of Ghent University Hospital, with approval number BC-07577. Practically,

the project wants to improve intercultural effectiveness in key domains of society like

health care by developing a set of digital tools for training and education. As the present

study also focuses on identifying key pathways of intercultural competence for purposes

of future education and training in a medical context, a student sample of undergraduate

medical students was deemed appropriate. In April 2020 and April 2021, all students in

the 1st year of Medical School, in the pre-Master program in Management and Organiza-

tion of Healthcare, and in pre-Master Program in Health Promotion at the Faculty of Med-

icine and Health Sciences of a large Belgian University with a top 100 rating in the Aca-

demic Ranking of World Universities (ARWU; see also [78]) were therefore invited to par-

ticipate in the present study and fill out an online survey. All students gave informed

Figure 1.

Hypotheses summary: test of an integrative framework. Note: The grey squares represent

intercultural competence. The operationalizations of intercultural competence and effectiveness are

presented in italic. H1, H2, H3, and H4 represent the empirical test of the integrative framework as

proposed by Leung et al., 2014. H5 and H6 represent additional hypotheses in dashed arrows. All

hypothesized relationships are expected to have positive effects.

2. Materials and Method

2.1. Data and Procedure

The data were gathered in the context of the EdisTools project, a large Strategic Basic

Research project in Belgium (Flanders), subsidized by Scientific Organizations Flanders. This

EdisTools project aims to map out interculturalism and prejudice in four different professional

settings, which are also embedded in legislation as constitutional rights: education, health care,

housing, and work. The project focuses on the intercultural effectiveness of the ethnic majority

(i.e., Belgian) service provider (i.e., teachers, doctors, estate agents and employers) toward the

ethnic minority client (i.e., learners, patients, potential tenants, and job applicants respectively).

This project was approved by the Ethical Medical Committee of Ghent University Hospital,

with approval number BC-07577. Practically, the project wants to improve intercultural

effectiveness in key domains of society like health care by developing a set of digital tools for

training and education. As the present study also focuses on identifying key pathways of

intercultural competence for purposes of future education and training in a medical context, a

student sample of undergraduate medical students was deemed appropriate. In April 2020

and April 2021, all students in the 1st year of Medical School, in the pre-Master program in

Management and Organization of Healthcare, and in pre-Master Program in Health Promotion

at the Faculty of Medicine and Health Sciences of a large Belgian University with a top 100

rating in the Academic Ranking of World Universities (ARWU; see also [

]) were therefore

invited to participate in the present study and fill out an online survey. All students gave

informed consent prior to filling out the survey. Response rate was 76% (N= 842), with

74% female students with an average age of M= 22.03 (SD = 3.28), Mdn = 21 (i.e., 69% of

the student population aged between 20 and 22). The vast majority of the students (96%)

had Belgian nationality. These numbers are in line with population statistics as 78% of the

Flemish health care practitioners are women [

], while 92% of the total Belgian population

has the Belgian nationality [

]. Slightly less than 11% of the students reported a parent or

grandparent with a non-Belgian nationality. Furthermore, 41% of the students reported (close)

friends, close colleagues, or family with a migration background.

2.2. Measures

2.2.1. Intercultural Traits

Intercultural traits were conceptualized as multicultural personality dimensions and

operationalized using the SF-MPQ [

]. The SF-MPQ has ﬁve subscales with eight items

Int. J. Environ. Res. Public Health 2022,19, 4490 7 of 21

each and a recurring instruction: “to what extent do the following statements apply to

you?” Participants have to respond to this question on a 5-point Likert scale from 1 (totally

not applicable) to 5 (completely applicable). For cultural empathy (MPQ-CE, M= 4.18,

SD = 0.43,

= 0.80), the subscale included items like “Is a good listener”. For ﬂexibility

(MPQ-FX, M= 2.45, SD = 0.71,

= 0.87), the subscale included items like “Works according

to plan” (reverse coded). For social initiative (MPQ-SI, M= 3.32, SD = 0.64,

= 0.85), the

subscale included items like “Takes initiative”. For emotional stability (MPQ-ES, M= 3.08,

SD = 0.71,

= 0.85), the subscale included items like “Is insecure” (reverse coded). Finally,

for open mindedness (MPQ-OP, M= 3.45, SD = 0.53,

= 0.78), the subscale included items

like “Has broad range of interests”. Important to note, although the ﬁve dimensions of the

MPQ are correlated [33], the MPQ does not support an overarching general dimension.

2.2.2. Intercultural Attitudes and Worldviews

Intercultural attitudes and worldviews were conceptualized through the ethnocentric-

ethnorelative continuum (EC-ER) and operationalized using six items adapted from the

European Social Survey [

] on a ten-point Likert scale (M= 6.67, SD = 1.37,

= 0.81). As an

example, participants had to respond to items like “Would you say it is generally bad or good

for the economy that people come to live here from other countries?” A higher or lower score

on the EC-ER scale respectively represents a more ethnorelative or ethnocentric world view.

2.2.3. Intercultural Capabilities

Intercultural capabilities were conceptualized as cultural intelligence (CQ) and opera-

tionalized using the Adapted Self-Report CQ Scale [

]. The Adapted Self-Report CQ Scale

has four subscales with six items each. For each item, participants had to indicate to which

degree they agreed to the presented statement on a 5-point Likert scale (1—strongly disagree

to 5—strongly agree). For motivation (CQ-MOT, M= 3.88, SD = 0.53,

= 0.79), the sub-

scale included items like “It’s fun for me to interact with people from other cultures”. For

cognition (CQ-COG, M= 2.86, SD = 0.67,

= 0.87), the subscale included items like “I can

describe how parents treat their children in various cultures”. For metacognition (CQ-META,

M= 3.53

SD = 0.56, α

= 0.75), the subscale included items like “When I meet people from

another culture, I try to find out how to act appropriately in that culture”. And finally, for

behavior (CQ-BEH, M= 3.57, SD = 0.48,

= 0.68), the subscale included items like “If there is

a misunderstanding between people from different cultures, I try to clear it up”.

2.2.4. Intercultural Effectiveness

Intercultural effectiveness was conceptualized as cultural self-efficacy (CSE) and opera-

tionalized using the CSES-A [

]. The Brottman and colleagues review on cultural competence

in health care mentioned that CSES-A was the most frequent (i.e., about 6%) assessment tool

found in the selected papers [

]. This scale has five subscales with a varying amount

of items. For each item, participants had to answer to a recurring question on a five-point

Likert scale (1—cannot do at all to 5—certainly can do): “In the situations posed below, mark

to what extent you feel capable of carrying them out using the options given”. For process

(CSE-process, five items, M= 3.61, SD = 0.53,

= 0.74), the subscale included items like

“Speaking to people from a different culture, I can realize what I know about that culture”. For

mix (CSE-mix, eight items, M= 3.82, SD = 0.56,

= 0.87), the subscale included items like “If I

lived in a different culture, I would be able to make new friends”. For cope (CSE-cope, four

items, M= 2.90, SD = 0.86,

= 0.88), the subscale included items like “If I lived in a different

culture, I would be able to overcome loneliness”. For understanding (CSE-US, five items,

M= 3.66, SD = 0.62,

= 0.78), the subscale included items like “Approaching a different

culture, I can understand other religious beliefs”. And finally, for language (CSE-LAN, three

items, M= 3.17, SD = 0.85,

= 0.86), the subscale included items like “Approaching a different

culture, I can learn a language different from mine”.

Int. J. Environ. Res. Public Health 2022,19, 4490 8 of 21

2.3. Analyses

Analyses were conducted using a SEM set up by means of the lavaan package in

R [

]. For an overview on SEM-analyses, we also refer to Rosseel [

]. For an

overview regarding modifying and reporting SEM, we refer to Ullman and Bentler [

] and

Schreiber and colleagues [

]. For analyzing model ﬁt, we made use of common guidelines

in literature by Hu and Bentler [

], Kenny and colleagues [

], and Rosseel [

]. As SEM

literature shows quite some controversy regarding cherry picking ﬁt indices, the present

study features a small, but commonly reported battery of ﬁt indices. The chi-square test

is the primary test for SEM. A model has a good ﬁt if the chi-square test does not reach

signiﬁcance at the

= 0.05 level. However, literature has reached consensus that this test is

too strict. As such, we report a set of three other ﬁt indices, that are generally considered as

complementary [

]. The ﬁrst index used is the Root Mean Square Error of Approximation

(RMSEA). The RMSEA renders an absolute ﬁt value (i.e., no comparison to other models),

of which the 90% conﬁdence interval (CI) should have a lower value no higher than 0.05

and a higher value lower than 0.08. The second index used is the Standardized Root Mean

Square Residual (SRMR). The SRMR also renders an absolute ﬁt value, which should be

lower than 0.08. Finally, the third index used is the Comparative Fit Index. The CFI is an

incremental (relative) index that compares models to the (worst possible) null model. In a

model with an adequate ﬁt, the CFI should be higher than 0.95. However, if the RMSEA

of the baseline model is too good (i.e., RMSEA < 0.158), the CFI estimate will be too low,

rendering the CFA useless as a measure of ﬁt [

]. Literature does recommend caution in

interpreting these rules of thumb too rigorously. Researchers should primarily aim for ﬁt

indices that show similar results, while also scanning for other indications of bad ﬁt like

non-signiﬁcant parameters at different levels of signiﬁcance (The p-values are reported

with three decimals to allow for model respeciﬁcation at different signiﬁcance levels.). For

a concise overview on additional SEM ﬁt literature, we also refer to Kenny [90].

A SEM analyses consists of two major parts. The structural part presents path analyses

on how variables interact with each other. The latent part allows to assess how individual

items load on latent constructs, as is the case in conﬁrmatory factor analyses (CFA). For

the present study, we are primarily interested in the structural part, as speciﬁc regression

analyses will allow us to test H1 through H6 and the instruments are already validated

in various studies (see Section 1Introduction). However, as the validity of data is always

dependent on both population and instrument, we have used CFA to evaluate the construct

validity of the data, generated by the full battery of instruments. As the full models are

quite extensive, we have provided two variance–covariance matrices as a data supplement,

allowing full replication of our results.

3. Results

3.1. Preliminary Analysis: First Order Correlations and CFA

Table 1shows the ﬁrst order Pearson correlation coefﬁcient for all variables. Important

to note, both the total scales as well as the subscales (if present) are included. To assess

the construct validity of our data, we performed a CFA on the following (sub-)scales and

their theorized individual internal structure: MPQ (CE, FX, SI, ES, and OM), EC-ER, four

subscales of CQ (MOT, COG, META and BEH) and ﬁve subscales of CSE (process, mix, cope,

US, and LAN). The model converged after 128 iterations, with

χ2(N= 842, 4333) = 12301.53

p< 0.001. The set of ﬁt indices showed a somewhat mixed result. Both the RMSEA = 0.047,

90% CI [0.046, 0.048], p= 1.000 as well as the SRMR = 0.068 indicated an adequate to even a

good ﬁt, while the CFI = 0.77 indicated a poor ﬁt. However, closer inspection of the base

null model (which the CFA model is compared against to calculate the CFI) revealed that

the null model rendered a RMSEA = 0.097, which violates the condition that the null model

has to have an RMSEA > 0.158. As such, the CFI is no longer considered informative. As

the CFA model ﬁts the data adequately, we therefore conclude that our obtained data allow

us to draw valid conclusions regarding the present study’s hypotheses.

Int. J. Environ. Res. Public Health 2022,19, 4490 9 of 21

Table 1. Correlation matrix.

M SD EC-ER MPQ-

CE MPQ-FX MPQ-

MPQ-

CSE-

process

CSE-

mix

CSE-

cope

CSE-

LAN CSE CQ-

MOT

CQ-

COG

CQ-

META

CQ-

BEH EC-ER SE-

Process SE-Mix SE-Cope SE-US SE-LAN

R20.397 0.092 0.116 0.076 0.167 0.384 0.361 0.035 0.339 0.135

Note: EC-ER = ethnocentric–ethnorelative continuum, CQ = cultural intelligence, MOT = motivation, COG = cognition,

META = meta-cognition, BEH = behavior, CSE = cultural self-efficacy, US = understanding, LAN = language.

To ﬁnalize our analyses, we inspected the modiﬁcation indices of Model 3b. Modiﬁca-

tion indices present information on possible model improvements by presenting alternative

pathway relations that can possibly improve the model. Conservatively, we only considered

modiﬁcation indices above 10.83, as this threshold corresponds with an effect size of which

the p-value is lower than 0.001. Analyses rendered eight possible extensions to the model,

with a maximum modiﬁcation index of 20.51. We did not observe any pathways that were

linked to our hypotheses, which strengthens the validity of Model 3b. We did observe four

possible additions in which CQ subscales are regressed on other CQ subscales, and four

possible additions in which CQ subscales were regressed on CSE subscales. Especially the

latter suggestions are interesting, suggesting that self-efﬁcacy can also have an (recursive)

effect on intercultural competencies. However, for the present study, we do not have

sufﬁcient theoretical grounds to add these possible additions to the ﬁnal model.

As we now have adequate ﬁt measures on a model with speciﬁc subscales and no non-

signiﬁcant regressions in Model 3b, we can assess our hypotheses based on the regressions

of the model.

3.5. Hypotheses Evaluation

For H1 (i.e., higher scores on intercultural traits predict an ethnorelative world view)

Table 4shows that the regression of EC-ER on both MPQ-OP as well as MPQ-FX is significant.

We therefore conclude, we have at least partial empirical evidence that supports H1.

For H2 (i.e., higher scores on intercultural traits predict higher scores on intercultural

capabilities), Table 4shows that (a) the regression of CQ-MOT on MPQ-CE and MPQ-OP is

signiﬁcant; (b) the regression of CQ-COG on MPQ-OP is signiﬁcant; (c) the regression of

CQ-META on MPQ-CE and MPQ-OP is signiﬁcant; and (d) the regression of CQ-BEH on

MPQ-CE is signiﬁcant. In sum, two out of ﬁve MPQ dimensions are positively related to

all four dimensions of CQ. We therefore conclude that we have at least partial empirical

evidence that supports H2.

For H3 (i.e., a more ethnorelative world view predicts higher scores on intercultural

capabilities), Table 4shows that the respective regressions of CQ-MOT, CQ-MET, and

CQ-BEH on EC-ER are signiﬁcant. In sum, EC-ER was positively related to three out of four

Int. J. Environ. Res. Public Health 2022,19, 4490 14 of 21

dimensions of CQ. We therefore conclude that we have at least partial empirical evidence

that supports H3.

For H4 (i.e., higher scores on intercultural capabilities predict higher scores on inter-

cultural effectiveness), Table 4shows that (a) the regression of CSE-process on CQ-MOT

and CQ-COG is signiﬁcant; (b) the regression of CSE-mix on CQ-MOT is signiﬁcant; (c)

the regression of CSE-cope on CQ-MOT and CQ-COG is signiﬁcant; (d) the regression of

CSE-US on CQ-MOT and CQ-COG is signiﬁcant; and (e) the regression of CSE-LAN on

CQ-COG is signiﬁcant. In sum, two out of four dimensions of CQ are positively related to

all ﬁve dimensions of CSE. We therefore conclude that we have at least partial empirical

evidence that supports H4.

For H5 (i.e., higher scores on intercultural traits predict higher scores on intercultural

effectiveness), Table 4shows that (a) the regression of SE-process on MPQ-CE and MPQ-OP

is signiﬁcant; (b) the regression of SE-mix on MPQ-OP and MPQ-SI is signiﬁcant; (c) the

regression of CSE-cope on MPQ-ES is signiﬁcant; (d) the regression of CSE-US on MPQ-CE

is signiﬁcant; and (e) the regression of CSE-LAN on MPQ-OP is signiﬁcant. In sum, four

out of ﬁve dimensions of the MPQ are positively related to all ﬁve dimensions of CSE. We

therefore conclude that we have at least partial empirical evidence that supports H5.

Finally, for H6 (i.e., a more ethnorelative world view predicts higher scores on inter-

cultural effectiveness), Table 4shows that the regression of CSE-US on EC-ER is signiﬁcant.

As EC-ER is only related to one out of ﬁve sub-dimensions of CSE, we conclude that we

have some partial empirical evidence that supports H6.

For replication of our analyses, two variance-covariance matrices were added as

Supplementary Materials.

4. Discussion

Today, effective intercultural interaction is an essential part of ensuring equity in

health care [

–

]. Negative outcomes like prejudice are responsible for subopti-

mal treatment of people from different race or nationality, resulting in less favorable therapy

outcomes [

–

]. Leung and colleagues have summarized the literature on the effective-

ness of intercultural interaction (i.e., inside and outside of health care) into a theoretical

framework [

]. This integrative framework hypothesizes that intercultural competence

determines how effective individuals handle intercultural situations. This competence is

determined through the interrelations between three key framework components: inter-

cultural traits, intercultural interactions and worldviews, and intercultural capabilities.

Although the theoretical importance of this framework cannot be underestimated, the

authors themselves have called for empirical veriﬁcation. Addressing this call, the present

study empirically tested the integrative framework on intercultural effectiveness, rather

than just studying parts of it. As such, we conceptualized all framework components using

validated multidimensional constructs, operationalized with appropriate instruments. Ulti-

mately, a validated framework can identify which framework components are responsible

for intercultural effective behavior. Moreover, these components can become the target of

training, intervention, and identiﬁcation of best practices to ensure all ethnic groups of

patients with different nationalities are treated fairly toward more equity in health. As an

example, the EdisTools project will use these ﬁndings to develop a set of digital tools for

training and education in health care.

A fairly large sample of (future) health care practitioners from the faculty of Medicine

and Health Sciences of a large Western-European university ﬁlled out the online survey

including the operationalized constructs. Using structural equation modeling on the data

obtained, we tested the general ﬁt and the hypothesized relations from the framework. In

doing so, we also tried to explore how exactly the different components of the framework

are interrelated and if we could possibly extend the model.

For the ﬁrst time in literature, to the best of our knowledge, the present study em-

pirically veriﬁed the full theorized framework proposed by Leung and colleagues (2014),

as the model ﬁtted our data quite well. First, the present study replicated the (latent)

Int. J. Environ. Res. Public Health 2022,19, 4490 15 of 21

structure of four independently developed instruments, thus validating our data toward

the current research. Second, the battery of ﬁt indices indicated an adequate ﬁt, for models

with and without subscales (see also Figure 2). Third, the hypothesized relations between

the components of the framework were at least partially conﬁrmed (see also Figure 1).

Finally, the present study provided at least partial evidence for possible future additions to

the framework.

In line with literature, multicultural personality traits were positively related to both

the ethnocentric–ethnorelative worldview continuum [

], as well as multidimensional

cultural intelligence [

]. Closer inspection of the framework components revealed

that individuals with an open mind have a more ethnorelative disposition, while also

showing better cultural capabilities through a higher score on motivation, cognition, and

metacognition. Our ﬁndings also indicated that culturally empathic individuals showed

a higher cultural intelligence through higher scores on motivation, metacognition, and

behavior. As such, these two multicultural personality traits, open mindedness, and cultural

empathy, seem to cover the full spectrum of cultural intelligence dimensions. These results

were also largely in line with literature as the motivational dimension was pointed out as

the key dimension that was positively related to the personality traits [41,42].

Moreover, also in line with the literature, individuals with a more ethnorelative dis-

position showed better intercultural capabilities [

]. Indeed, analogous to the cultural

empathy trait, an individual’s ethnorelative disposition was related positively to the motiva-

tion, metacognition, and behavior dimension of the individual’s cultural intelligence.

Higher levels of cultural intelligence also predicted higher levels of cultural self-

efﬁcacy. These ﬁndings were also largely in line with literature [

]. An individual

with higher scores on the motivation and cognition dimension of cultural intelligence

showed higher levels of cultural self-efﬁcacy through higher scores on the process, mix,

cope, and understanding dimensions and on the process, cope, understanding, and lan-

guage dimensions respectively.

Finally, the present study also explored possible extensions of the framework. First,

four multicultural personality traits had a direct effect on intercultural effectiveness.

(a) Open minded, (b) emotionally stable, (c) culturally empathic individuals or individ-

uals that take (d) social initiative also showed higher levels of self-efﬁcacy across all

(sub)dimensions that was not mediated fully by the other components of the framework.

Although the open mindedness trait thus represented an inﬂuential node in the framework

with seven outgoing pathways, it was not the only dimension of multicultural personality

that had a direct effect on cultural self-efﬁcacy. Although we did not ﬁnd a direct effect of

ﬂexibility which is at odds with literature [

], our results are largely in line with literature

as the present study shows direct effects regarding four out of ﬁve multicultural personality

traits on intercultural effectiveness [

]. Despite literature already features reports of

direct effects regarding all ﬁve traits, these reports are inconclusive in pinpointing a trait

of which the positive effect on intercultural effectiveness is consistent over situations. For

the time being, we therefore advise to refrain from extending the existing framework with

direct pathways from intercultural traits to intercultural effectiveness until more research

on the matter is presented.

Second, the present study also reported some partial evidence that an ethnorelative

world view is directly related to intercultural effectiveness through a larger understanding.

This ﬁnding seems plausible that a broader view on the world evokes greater understanding

of other cultures. The ﬁnding is also further supported by reports in literature of an

ethnocentric view that evokes less understanding [

]. However, we again evaluate the

existing evidence from literature and from the present study as insufﬁcient to warrant an

extension of the existing framework until more research is presented. Still, we do advocate

testing the presence of direct pathways between (a) intercultural traits and effectiveness

and (b) intercultural world views and effectiveness in future studies, as speciﬁc samples

can always cause additional effects, above and beyond the current integrative framework.

Int. J. Environ. Res. Public Health 2022,19, 4490 16 of 21

Third and ﬁnally, analyses also revealed possible recursive pathways of self-efﬁcacy

to intercultural capabilities. Although these pathways can prove a worthwhile addition to

the framework in the future, more theoretical and practical research needs to be conducted

before such framework adaptations are warranted. At the moment, we consider the

evidence too limited and too divergent (i.e., four possible pathways between cultural

intelligence subdimensions and four possible pathways from self-efﬁcacy subdimensions

to cultural intelligence subdimensions) to suggest a speciﬁc recurrent pathway setup.

Summarizing our ﬁndings regarding the framework pathways, the main pathway

in the framework from traits to effectiveness leads from open mindedness and cultural

empathy (over an ethnorelative disposition) to cultural intelligence and ultimately to

cultural self-efﬁcacy, affecting all ﬁve self-efﬁcacy subdimensions. In this indirect pathway,

the motivation dimension of cultural intelligence is the ﬁrst key node, as the node receives

three pathways and is also sending out four pathways toward cultural self-efﬁcacy. The

second key node is the cognitive dimension of cultural intelligence, which receives only

one pathway, but is also sending out four pathways toward cultural self-efﬁcacy. This

evidence conﬁrms that knowledge and motivation form the prime gateway toward effective

intercultural behavior [41,42,58,74,75].

4.1. Implications for Practice

The empirical validation of the framework can have important consequences for inter-

ventions that want to increase the effectivity of individuals in intercultural health situations

by targeting speciﬁc components of intercultural competence. To obtain a basic under-

standing of an individual’s potential for intercultural effective behavior, a measurement of

multicultural personality can serve as a baseline at the start of an intervention or education

in health care. The speciﬁc results of the present study seem to suggest that researchers

and practitioners should focus on the traits of open mindedness and cultural empathy.

However, as traits are less suited for actual interventions that want to change behavior due

to their higher stability [

], we instead advise to focus on the key node of motivation

and cognition to a lesser extent for actual intervention. Indeed, both the present study and

literature already indicate that the relation between cultural intelligence (motivation and

cognition) and effective intercultural behavior is fairly strong as already stated. Moreover,

cultural intelligence is quite malleable, making for an excellent candidate to target directly

in future training, interventions, and identifying best practices, ultimately improving the

intercultural effectiveness of individuals [19,58].

As a practical example of a future intervention, health care education can start by

making students aware that motivated and educated practitioners will treat patients with

a different cultural background more fairly and more effectively. This awareness can

be complemented with a training that focuses on familiarizing students with important

cultural phenomena and learning them how to incorporate these phenomena in treatment

procedures. For instance, patients that adhere to the ways of Islam are not allowed to eat

from sunrise to sunset during Ramadan. As a consequence, such a matter of faith can

inﬂuence the diet of the patient during recovery. Health practitioners have to ensure that

such nutritional issues are (at the very least) the subject of dialogue between practitioners

and patients. In such a way, openminded responses to patient questions, supported

by practitioner motivation and knowledge, can go a long way in making therapy and

therapy outcomes during recovery more effective across patients with different cultural

backgrounds, thus ensuring more equity in health care.

4.2. Limitations and Future Research

First, the theoretical framework clearly ﬁts our data quite well [

]. Despite the good

ﬁt between the current empirical data and the proposed theoretical framework, we do

acknowledge that we cannot rule out the possibility of additional components. For instance,

patient/practitioner diversity is not limited to cultural aspects like ethnicity, but can also

include gender or generation variables like the Six G’s Approach [

]. However, such

Int. J. Environ. Res. Public Health 2022,19, 4490 17 of 21

an investigation into additional components is beyond the scope of the present study

as the present study primarily focused on exploring the component relations within the

framework. Second, the framework should be replicated using different conceptualizations,

measures, and population samples of future health care practitioners. Although we have

used speciﬁc conceptualizations of the core constructs, the present study does replicate

the internal structure of four independent conceptualizations and instruments, while also

providing empirical veriﬁcation for the hypothesized framework relations. As such, we are

conﬁdent that our empirical veriﬁcation can serve as a baseline for future research. Third,

our study makes use of a proxy of real world behavior. By using multidimensional cultural

self-efﬁcacy, we were able to also pinpoint how the different components of intercultural

competence were related to intercultural self-efﬁcacy. Future research should however

include real-time behavior work adjustment, early withdrawal from intercultural jobs,

the number of intercultural friends, inclusion policies on staff recruiting, an interest in

politics and (a lack of) contact, and cooperation in both immigrant and non-immigrant

students [

]. Fourth, the sample consisted of a sample of mostly future practitioners.

Although such a sample validates our results toward education and previews the nature of

health care practitioners in the near future, toward actual practice we do advocate some

caution, as the students are not yet (fully) active. Finally, the framework should also be

tested comparing different settings both inside and outside of health care. Although our

hypotheses on the main components were conﬁrmed, a health care setting could have

different important (sub-) dimensions compared to housing or work settings. Barring the

evidence on the motivational dimension from both literature and the present study, we

therefore acknowledge that some (sub) dimensional pathways could shift depending on

the setting of future studies. Of course, subsequent practical interventions should also take

into account such shifted pathways. We therefore advise to always verify the framework as

a baseline for practical interventions. To conclude, given the results of the present study

regarding the construct validity and hypothesized relations of the components, we are

cautiously optimistic that the empirically veriﬁed integrative framework is a robust starting

point for future studies on intercultural competence and effectiveness.

5. Conclusions

In conclusion, the present study empirically veriﬁes an integrative framework of

intercultural competence and effectiveness. Intercultural capabilities remain the major

gateway toward more effective intercultural behavior, with motivation and cognition acting

as the key nodes in the framework. These dimensions are thus an excellent target for

training, practical interventions, and identifying best practices, ultimately supporting

greater intercultural effectiveness and more equity in health care.

Supplementary Materials:

The following supporting information can be downloaded at: https:

//www.mdpi.com/article/10.3390/ijerph19084490/s1, File S1: variance-covariance matrix full.txt

for replication of the CFA analyses, File S2: variance-covariance matrix sub.txt for the replication of

the structural SEM analyses.

Author Contributions:

Conceptualization, S.S. and E.D.; data curation, S.S.; formal analysis, S.S.;

funding acquisition, S.W. and E.D.; investigation, S.S., R.V., S.D.M., F.D., S.W. and E.D.; methodology,

S.S.; project administration, S.S., F.D., S.W. and E.D.; resources, S.S., S.D.M., S.W. and E.D.; software,

S.S.; supervision, S.S., F.D., S.W. and E.D.; validation, S.S.; visualization, S.S.; writing—original draft,

S.S.; writing—review and editing, S.S., R.V., S.D.M., F.D., S.W. and E.D. All authors have read and

agreed to the published version of the manuscript.

Funding:

This research was funded by Research Foundation-Flanders grant number [Strategic Basic

Research–S004119N]. The sponsors had no role in the design, execution, interpretation, or writing of

the study.

Institutional Review Board Statement:

The study was conducted according to the guidelines of the

Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of

UZGent, in collaboration with Ghent University (BC-07577, 22 April 2020).

Int. J. Environ. Res. Public Health 2022,19, 4490 18 of 21

Informed Consent Statement:

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement:

The data that support the ﬁndings of this study are available on

request from the corresponding author S.S. The data are not publicly available due to them containing

information that could compromise research participant privacy/consent. However, the variance–

covariance matrices of the data is provided online in .txt format, allowing for full veriﬁcation and

replication of the complete study.

Acknowledgments:

The authors would like to explicitly thank Laura Van Raemdonck for her assis-

tance in setting up the present study.

Conﬂicts of Interest: The authors declare no conﬂict of interest.

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Effects of Learner Variables on Chinese Bilingual Undergraduates’ Intercultural Sensitivity and Effectiveness

Article

Full-text available

Nov 2022

Meihua Liu

This study investigated the effects of learner variables on Chinese bilingual undergraduates’ intercultural sensitivity and effectiveness. A total of 439 students from different universities answered a battery of questionnaires. Major findings were: (a) the participants reported a moderate to high level of intercultural sensitivity and a moderate level of intercultural effectiveness; (b) no significant gender difference occurred in intercultural sensitivity and effectiveness, except for Interaction Engagement and Respect for Cultural Differences; (c) intercultural sensitivity and effectiveness were significantly positively related to and predicted each other; (d) confidence in learning English, self-efficacy in learning English and English classroom anxiety significantly predicted students’ intercultural sensitivity; and (e) English classroom anxiety, English learning motivation, and self-efficacy in learning English significantly predicted students’ intercultural effectiveness. Based on these findings, a path model was constructed which explains the relations among affect, intercultural communication sensitivity, effectiveness and competence.

InteIrcultural Competence Development for International Business Environment

Article

Full-text available

Jul 2022

The article presents the results of the work that has been carried out by an international team of partners from Poland, Italy, Spain, and Turkey as part of the Erasmus+ project entitled Interculturality – Intercultural Competence Development for International Business Environment. The project aimed to develop materials enabling educators to improve intercultural competences of adults by means of a training program and Continuing Professional Development course which are offered as open educational resources. Main issues and areas that constitute intercultural competences, important for people working in the international environment, were identified on the basis of scientific literature analysis. The final results of the project were achieved through the examination of training courses dedicated to developing intercultural competences that are available on the European market, consultations with representatives of international enterprises, gaps identification, preparation of the training program as well as pilot testing of the developed materials. Project results and the work that has been done in the transnational partnership of the Erasmus+ project highlight the importance of developing intercultural competences in the context of managing multicultural organisations.

Reducing ethnic discrimination in rental applications: the development of a training intervention

Article

Feb 2023
HOUSING STUD

While field experiments are valuable in their ability to objectively analyse patterns of discrimination, research that focuses on reducing discrimination is systematically lacking. The present study addresses this gap. Building on both cognitive and behavioural processes that steer discriminatory decision-making and insights from diversity literature, we develop and test the effectiveness of a training intervention which is tailored to the specific context of the housing market, with 113 students in real estate. We develop our training around three theoretical mechanisms of discrimination that are measured through a specified vignette experiment in pre- and post-tests. Our results show a reduction in statistical and customer taste-based discrimination after the training, but no change in agent taste-based discrimination. The driver for this reduction in discrimination is being more selective on majority candidates rather than increasing the chances of ethnic minority candidates. Additionally, we found that training has no effect on taste and that most of these effects remain present on the long term.

Perceived transcultural self-efficacy and its associated factors among nurses in Ethiopia: A cross-sectional study

Article

Full-text available

Jul 2021
PLOS ONE

Background: Transcultural self-efficacy is a nurse's perception of his or her own ability to accomplish activities effectively for culturally diverse clients. This self-efficacy may be affected by different factors, either positively or negatively. Quality care can be improved significantly when nurses provide patient-centered care that considers cultural background of the patients. Thus, this study aimed to assess perceived transcultural self-efficacy and its associated factors among nurses working at Jimma Medical Center. Methods: Facility-based cross-sectional study with both quantitative and qualitative methods of data collection was conducted among 244 nurses and 10 key informants from 20 May to 20 June 2020. Bivariate and multivariable linear regression analyses were used to identify factors associated with transcultural self-efficacy. Qualitative data were coded and analyzed thematically. Quantitative results were integrated with qualitative results. Results: A total of 236 nurses participated in the study making the response rate 96.7%. The mean transcultural self-efficacy score was 2.89 ± 0.59. Sex, work experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation were significantly associated with transcultural self-efficacy. Ten in-depth interviews were conducted and the findings of qualitative data yielded four major themes. Conclusion: The level of perceived transcultural self-efficacy was moderate among nurses. Transcultural self-efficacy of nurses varies with several factors including sex, experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation. This calls for the need to offer transcultural nursing training for nurses.

The Multicultural Personality Questionnaire (SF-40): Adaptation and Validation of the Spanish Version

Article

Full-text available

Mar 2021
Int J Environ Res Publ Health

The coexistence of diverse cultures in our society indicates the need to examine the factors related to the success of multicultural interactions. The study aims were to examine the psychometric characteristics of the Spanish version of the Multicultural Personality Questionnaire short form (MPQ-SF40), in a convenience sample of 392 university students. Then, the effect of sex and age was assessed, and finally, the levels and percentiles of multicultural personality were measured. The scale’s validity was assessed with exploratory and confirmatory factor analysis (EFA and CFA). Reliability was evaluated with Cronbach’s alpha, composite reliability (CR), and average variance extracted (AVE). The final structure of the MPQ-SF40 consisted of 18 items grouped into five factors that present adequate psychometric properties. Sex-specific differences in MPQ-SF40 were statistically significant for factor 1, cultural empathy, and for factor 5, flexibility; women showed greater values. When age was analyzed, significant low correlations were obtained. The students showed medium to high levels of multicultural personality. The highest levels correspond to the personality factors of cultural empathy and open-mindedness. The use of the Spanish version of the MPQ-SF40 seems justified to determine students’ multicultural personality traits, developing intervention programs to improve social support and the interpersonal relations between students.

The development of multicultural effectiveness in international student mobility

Article

Full-text available

Dec 2021
HIGH EDUC

International student mobility (ISM) is an important educational means to increase students’ multicultural effectiveness and their (international) job market potential. In the present study, we investigated ISM effects by addressing the following three research questions: First, how do future sojourners differ from control students in terms of their pre-departure multicultural effectiveness? Second, how does ISM affect the development of multicultural effectiveness above and beyond effects of students’ demographic characteristics, their cultural and educational background, and their previous international mobility experiences? And third, do any of these variables moderate ISM development effects and thus help to explain who benefits most from ISM? We used a sample of N = 3070 students at German higher education institutions who were assigned to three groups (i.e., control students with no mobility plans, present sojourners who participated in ISM during the study period, and a waiting group of future sojourners who participated in ISM in the semester sequencing the study period). The analyses with (moderated) latent change models showed substantially higher pre-departure multicultural effectiveness in present and future sojourners compared with control students as well as positive effects of ISM on the development of multicultural effectiveness. The strongest effects were observed amongst students without previous international mobility experiences. Theoretical implications for the understanding of adaptive development in a globalized world as well as practical inferences for ISM outreach and recruitment strategies are discussed.

What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare

Article

Full-text available

Dec 2019

Background: Effective patient engagement has been associated with high quality health care. There is a dearth of evidence around effective engagement with consumers from ethnic minority backgrounds; specifically in relation to the role of cultural competence amongst healthcare professionals in effective engagement with consumers from ethnic minority backgrounds. To address this knowledge gap, we analysed the role of cultural competence in the consumer engagement approaches taken by community healthcare professionals working with consumers from ethnic minority backgrounds. Methods: Semi-structured individual interviews were conducted with 21 healthcare professionals employed across four community healthcare and affiliated services in four local government areas in Australia. Results: Adopting patient-centric approaches (that seek to understand and be responsive to the patient as an individual) featured as an underpinning theme that transcended other emerging themes. Recognition of diversity within communities and individuals in those communities, all with their own story, was described as pivotal to effective engagement. This was encapsulated in the theme of Cultural standpoints and personal context that contained four further themes of: (1) Build foundations of trust and respect; (2) Diversify communication channels; (3) Generate system, service and community partnerships; (4) Take the time. Conclusion: Our findings indicate that cultural competence and effective consumer engagement are closely linked in ethnic minority populations. Embedding cultural competence as a health system, service and professional capability is therefore critical to ensure equitable healthcare quality for consumers from all ethnic backgrounds.

A multimodal measure of cultural intelligence for adolescents growing up in culturally diverse societies

Article

Full-text available

Aug 2019

Adolescents growing up in culturally diverse societies need to develop intercultural competence. To better understand how to develop intercultural competence we need measures specifically relating to the everyday intercultural experiences of adolescents. However, few measures of in-tercultural competence are available for this target group. Based on the cultural intelligence (CQ) model (Earley & Ang, 2003), we developed a measure that combines a self-report questionnaire and situational judgment tests (SJTs). The latter comprise a brief description of intercultural situations, followed by questions asking the adolescents to interpret and provide a reaction to the situations. The reliability, factor structure, measurement equivalence, and validity of the new measure was tested in two samples of adolescents in culturally diverse regions in North Rhine-Westphalia (N = 631, 48% female, M age = 13.69 years, SD age = 1.83) and Berlin (N = 1,335, 48% female, M age = 14.69 years, SD age = 0.74) in Germany. The self-report CQ scale showed good reliability and a four-dimensional factor structure with a higher-order CQ factor. The responses to the SJTs were coded based on a coding manual and the ratings loaded onto one factor. The measurement models showed metric to scalar measurement equivalence across immigrant background, gender, and grade. The CQ factor and the SJT factor were positively correlated with each other, as well as with related constructs such as openness, perspective-taking, and diversity beliefs. We conclude that the new measure offers a reliable and valid method to assess the inter-cultural competence of adolescents growing up in culturally diverse societies.

Discourses about race in the United States: A thematic analysis of short essays

Article

Jul 2021
INT J INTERCULT REL

Conversations around race have come to the forefront of public discourses in the United States with incidents of police brutality leading to movements such as Black Lives Matter and its opposition, All Lives Matter. Although there is substantial psychological literature focusing on racial attitudes and intergroup relations, much of this research is experimental, failing to capture diverse and evolving viewpoints of people in the United States. In the present study, our aim was to understand folk definitions and diverse perspectives about the role of race in the United States in participants’ own words. We thematically analyzed submissions to The Race Card Project (n = 913), a publicly available platform, and responses from a sample of college students describing perspectives on race (n = 1092). A total of 27 identified themes were organized in four domains: opinions about race, race-based interactions, race and identity, and emotions. Opinions about race ranged from color-blind ideology to racial equality, race as divisive or providing community, and excessive focus on race. References were made to historic and current race relations, assumptions based on skin color, prejudice and discrimination, White privilege, and “reverse racism.” These findings contribute to evolving scholarly understanding of race in the United States, with implications for informing initiatives to promote race relations and reduce experiences of discrimination for individuals of color.

How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students

Article

May 2021
NURS EDUC TODAY

Background Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process. Objective This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence. Design Cross-sectional survey study. Methods 271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence. Results Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning. Conclusion Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.

In search of cross-cultural competence: A comprehensive review of five measurement instruments

Article

May 2021
INT J INTERCULT REL

The assessment of cross-cultural competence (3C) and related constructs is of vital importance for both theoretical and practical reasons. The present review was undertaken to evaluate the quality of instrumentation designed to measure individuals’ capabilities for living and working successfully in cross-cultural contexts. The psychometric properties of five instruments deemed most important, useful, and visible in the field were evaluated with a focus on 3C measurement literature that became available since the publication of reviews by Gabrenya and colleagues (2013) and Matsumoto and Hwang (2013). Findings regarding the quality of 3C measures were mixed. First, we found that convergent validity was generally good across instruments and most showed reasonable criterion validity. However, discriminant validity was lacking in several instruments. The internal structures of instruments claiming to assess multiple constructs through subdimensions was in most cases poor. Content and face validity varied widely. Cross-cultural measurement equivalence was found to be poor in the limited research conducted on this important issue, as adaptation of instruments for use outside the culture in which they were developed rarely extends beyond the use of back-translation procedures. We suggest alternate approaches to assessing 3C and evaluating the validity of 3C instruments based on modeling sojourner outcomes such as expatriate adjustment and performance.

The effect of ethnocentrism and moral sensitivity on intercultural sensitivity in nursing students, descriptive cross-sectional research study

Article

Mar 2021
NURS EDUC TODAY

Abstract Background Factors affecting intercultural sensitivity and care are becoming an increasingly important issue due to ethnic diversity. Nurses play a crucial role in care and therefore should keep up with this trend and improve their intercultural sensitivity. Objective and Design. This descriptive cross-sectional study investigated the effects of ethnocentrism and moral sensitivity on intercultural sensitivity in nursing students. Methods and Participants. Data were collected using a demographic characteristics questionnaire and the Intercultural Sensitivity Scale, Generalized Ethnocentrism Scale, and Moral Sensitivity Scale. The sample consisted of 1343 nursing students. The Pearson correlation coefficient was used to determine correlations between scale scores. Multiple linear regression was used to determine the effects of ethnocentrism, moral sensitivity, and demographic characteristics on intercultural sensitivity. Results Intercultural sensitivity was found to be negatively correlated with ethnocentrism and positively correlated with moral sensitivity. Ethnocentrism predicted intercultural sensitivity more than moral sensitivity. Ethnocentrism and moral sensitivity explained 16.8% of the total variance of intercultural sensitivity. However, ethnocentrism affected intercultural sensitivity more than moral sensitivity did (beta = −0.406). Conclusion Nursing education should adopt strategies to reduce ethnocentrism by helping students develop cultural competence and intercultural sensitivity. Such education can equip nurses to provide higher quality care to patients of different cultural backgrounds. Keywords Intercultural sensitivity; Moral sensitivity; Ethnocentrism; Nursing students; Nursing education

Determining the Effect of an Intercultural Nursing Course on Empathic Skill and Intercultural Sensitivity Levels: An Intervention Study

Article

Jan 2021
NURS EDUC TODAY

Background Providing culturally sensitive healthcare services requires to command on content and concepts. Moreover, it is essential to train nurses who are sensitive toward cultural values and beliefs and who can provide holistic and individual nursing care in an increasingly diverse population. Objective This study determined the effect of the Intercultural Nursing Course on the empathic skill and intercultural sensitivity levels of nursing students in Turkey. Design This study was an interventional study that adopted a pretest–posttest design with a control group. Participants The participants of the study were 165 nursing students from a school of health; these students were completing their fourth year of studies and in the spring term of the 2017-2018 academic year. However, the sample group comprised 113 students who agreed to participate in the study and completely filled out the administered forms. The intervention group consisted of 84 students admitted to Intercultural Nursing Course, whereas the control group consisted of 29 students who were not admitted to Intercultural Nursing Course. Methods Intercultural Nursing Course, one of the elective courses in the fourth grade of the nursing program, was a 14-week course that was conducted through two contact hours per week. Data from both the groups were collected at the beginning and at the end of the course by the researchers using the “Introductory Information Form,” the “Empathic Skill Scale”, and the “Intercultural Sensitivity Scale”. Data were analyzed through descriptive tests, t-test, the Mann–Whitney U test, and the Wilcoxon signed-rank test using statistical package software. In addition, the required approval was procured from the ethics committee of the relevant university and School of Health before the study was conducted. Results No significant differences prevailed between the intervention and control groups in terms of total intragroup and intergroup Empathic Skill Scale and Intercultural Sensitivity Scale scores. However, a significant difference (Z=−4.000; p=0.000) between the pretest and posttest scores was observed in the interaction confidence subdimension of the Intercultural Sensitivity Scale in the intervention group. Conclusion Although Intercultural Nursing Course did not lead to a significant change in students’ empathic skills and cultural sensitivity levels, it enhanced their cultural sensitivity and self-confidence in intercultural communication and ensured maintenance of their empathic skills. Intercultural Nursing Course can thus valuably contribute to the understanding of cultural structure and values of society and to the development of techniques that can provide nursing care accordingly.

Intercultural Competence Predicts Intercultural Effectiveness: Test of an Integrative Framework

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