Medical Students Cultural Attitudes: The Health Belief Attitudes Survey

Abstract

Cultural competent care is the ability to deliver effective medical care to people from different cultures. The lack of methodological rigor and paucity of psychometric properties information of the instruments limits the generalizability of cultural competency educational interventions. We examined cultural attitudes of first year medical students and examined psychometric properties of the scale to better define the constructs it intends to measure. In a cross-sectional study, first year medical students completed the Health Belief Attitudes Survey (HBAS) in September of their matriculating year (2011-2013) within the context of Introduction to Clinical Medicine. The survey has15 items scored on a 6-point Likert scale (1-6), higher score indicates higher culturally competent attitudes. We used factor analysis to explore constructs and examine internal consistency (Cronbach’s alpha). The response rate was 98% (536/548), 42.2% students were female (n=231), 73.0% (n=400) white, 14.6% Asian (n=80), and 4.4% African American (n=24)(4.9%, n=27, did not provide race or ethnicity). The HBAS median score was 5.3 (25^th percentile [Q1], 4.9; 75^th percentile [Q3], 5.7). A two-factor solution explained 97% of the variance with Eigenvalues of 5.6 and 1.2, respectively. We conceptualized the constructs as “Understanding the Patients’ Cultural and Socio-Economic Background” (Factor 1, 11 items; Cronbach’s alpha, 0.89). “Building the Professional Relationship and Quality of Care” (Factor 2, 4 items; Cronbach’s alpha, 0.74). First year medical students have high culturally-relevant attitudes. The HBAS instrument captures two main constructs, understanding the patients’ background and perspective and building the professional relationship.