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J Educ Health Promot. 2019 Sep 30;8:179. doi: 10.4103/jehp.jehp_185_19. eCollection 2019.

Development and validation of a cultural competence questionnaire for health promotion of Iranian midwives.

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Gynecologic Oncology, Ardabil University of Medical Sciences, Ardabil, Iran.
Department of Obstetrics and Gynecology and, Ardabil University of Medical Sciences, Ardabil, Iran.
Tuberculosis and Lung Disease Research Center, Nursing Research Committee of Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.



Cultural competence is the main component of cultural care; therefore, it is necessary to be aware of its levels. The lack of a suitable tool that can measure cultural competence levels among midwives led us to carry out the present study aiming to develop and validate a cultural competence questionnaire for health promotion of Iranian midwives.


This methodological study was performed on 302 midwives selected through three-stage cluster sampling method in 2018 in East Azarbaijan Province. The initial tool was designed after qualitative study and searching similar studies. Then, the tool validity was assessed through evaluating the face and content validity in midwives and performing survey and psychometrics. Finally, the data were statistically analyzed by SPSS version 19 through exploratory factor analysis, item analysis, Cronbach's alpha coefficient, and Pearson correlation, at the significant level of <0.05.


The initial tool was constructed with 42 items in the five-point Likert scale. By eliminating 9 items during face and content validation and 6 items during factor analysis, the final 25-item questionnaire was developed in five areas of theoretical and practical learning, clinical application, cultural skill, cultural excellence, and cultural competence. According to Cronbach's alpha, reliability of the tool was at a good level (0.889) with a confidence interval of 0.95 (P < 0.001).


The cultural competence questionnaire for Iranian midwives, with five-factor verification and acceptable validity and reliability can be used in studies considering the components of Iranian culture.


Assessment tool; Iran; cultural competence; midwife

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