This dissertation examines health care provider-receiver intercultural interaction processes and measures health care receivers’ experience of health care providers’ cultural competence. To this end, cultural competence has been conceptualized as a dynamic and complex process of being aware of and recognizing individual differences and differences across cultures. Communication accommodation theory, which assumes that communicators adapt their communicative acts to a given context, was used as a theoretical framework. Appalachian Ohio, a medically underserved region, was chosen as a context. The research was carried out in three sequential phases. First, scenarios demonstrating cultural difference or sameness between patient and physician and physicians’ cultural competence or incompetence in health care interactions were developed and pre-tested employing 175 undergraduate students. In the second phase, validated scenarios were used along with a survey questionnaire of 201 members of the public from Athens and Columbus, Ohio to measure public perception of cultural competence in health care interactions, which resulted in the development of a three-factor scale, the PPPCC. In the third phase, the PPPCC scale along with measures of ethnocentrism, fear of physicians, and health professionals’ CAT goals and strategies was refined using 306 health care receivers from the patient base at Holzer Clinic in Athens, Jackson, and Gallipolis to develop a patient satisfaction instrument to measure physicians’ cultural competence. A five-factor scale emerged, the PCCPS.
This research found important connections among Appalachian patients’ perceptions of physicians’ cultural competence in health care and patients’ ethnocentric views, fear of physicians, and perceptions of physicians’ use of communication accommodation strategies of divergence and convergence. The findings indicate that research on cultural competence in health care should adopt a holistic definition of cultural competence. The findings also indicate that cultural competence in health care is one strategy for providing quality and effective care in intercultural, cross-cultural, and multicultural contexts. This dissertation research offers important directions to the design of cultural competence interventions for health care delivery and outcome. Further research should study unique cultural settings to expand cultural competence beyond cultural markers of race and ethnicity to include other social justice efforts.