Latino cultural competence among Health Educators: professional preparation implications.

Abstract: Research concerning Latino cultural competence among Health Educators is lacking. This study utilized a self-rating scale to assess individual perceptions of cultural competence, knowledge, attitudes and barriers to acquiring Latino cultural competence to provide recommendations for professional development. Results indicate that Health Educators with graduate degrees scored higher on the knowledge component, while nearly 70% of all respondents acknowledged feeling comfortable in their interactions with Latinos. However, lack of bi-lingual staff and culturally specific knowledge were reported as primary barriers. The results obtained from this study may inform curricular revisions within health education professional preparation programs.

**********

Today in the United States, Latinos are the largest minority group followed by African Americans (U.S. Census Bureau, 2004a). Latinos have also been projected to be the second fastest-growing population, after Asians in the 30 year period from 1995 to 2025 (Campbell, 1996). However, traditionally the Latino culture has not been a mainstay in the professional preparation of health educators. According to the U.S. Census Bureau, as of March of 2002, more than 1 in 8 people (13.3%) in the United States were Latino (2003). Based on the 2000 U.S. census, it is also projected that by the year 2050, 24.4% of the nation's population will be Latino (U.S. Census Bureau, 2004b). Furthermore, the projected population change from 2000 to 2002 for Latinos in the U.S. was 187.9% (U.S. Census Bureau, 2004b).

The purpose of this study was to identify Latino cultural competence by health education professionals. Specifically, the level of cultural competence, acquisition process, knowledge, attitudes and barriers to Latino cultural competence and recommendations for future professional development were investigated. This study aimed to answer the following research questions: 1) What is the current self rated level of Latino cultural competence among health education professionals in the field? 2) What are the acquisition processes by which health education professionals gain or obtain cultural competence of the Latino culture? 3) What is the current knowledge level of health education professionals about the Latino culture? 4) What are the current attitudes of health education professionals about Latino cultural competence in their profession? 5) What are present barriers to Latino cultural competence faced or identified by health education professionals? 6) What are the recommendations for future professional development regarding Latino cultural competence from health education professionals?

To date there are few studies identifying issues in professional preparation around cultural competence specifically for the Latino culture. Even more s0ignificant is the lack of studies addressing Latino cultural competence among Health Education professionals.

SUMMARY OF BACKGROUND

The United States is experiencing a shift in demographic trends, including an increase in cultural diversity (Galambos, 2000). According to the U.S. Department of Health and Human Services, 2001, African Americans, American Indians, Alaska Natives, Asian Americans, Pacific Islanders, and Hispanic Americans accounted for 30 percent of the population in 2000. These groups are projected to account for about 40 percent of the population by 2025 (U.S. Department of Health and Human Services [USDHHS], 2001). Due to cultural differences, these population groups are likely to encounter various barriers in accessing health care. Hence, the preparation of culturally competent health educators and the preparation of culturally appropriate health education programs become crucial. It is also important because culturally competent health interventions have been described as an approach to achieve the goals of Health People 2010 (Luquis and Perez, 2003). Health educators must be aware of how culture influences personal understanding of health and illness, how this affects personal health practices, and how these views can be incorporated into health education interventions (Luquis and Perez, 2003). Understanding and gaining knowledge of other cultural beliefs and values is a key element in expanding the view and appreciation of the health care clients/patients served (Encarnacion-Garcia & Torabi, 2003).

People of different cultures encounter numerous barriers as they attempt to access health care. Research indicates that Native Americans, Asian Americans, African Americans, and Hispanic and Latino groups tend to underutilize health and mental health services (USDHHS, 2001). Communication has been identified as one of the main barriers in receiving health care (Brach & Fraser, 2002; Shearer & Davidhizar, 2003; Sharma & Kerl, 2002; Encarnacion-Garcia & Torabi, 2003). According to Brach and Fraser, communication with physicians presents a problem for 27% of Asian Americans and 33% among Hispanics. Some of the barriers for Mexican Americans identified by Sharma and Kerl (2002) were a lack of bilingual health care staff, racial biases and stereotyping, and lack of understanding of the goals and values of rehabilitative care.

Given the multicultural nature of contemporary U.S. society, health educators must strive to achieve cultural competence and incorporate this concept into the planning, implementing, and evaluating process of health education programs (Luquis & Perez, 2003). Health educators can achieve this by understanding the meaning of culture and its complexity with each racial and ethnic group; increasing cultural awareness, knowledge, skills, and desire; using sensitivity in communication, and applying the National Standards for Culturally and Linguistically Appropriate Services (Luquis & Perez, 2003).

Since there is an established need to be culturally competent professionals, health educators are faced with a significant task. Even more, institutions that prepare future health education professionals face a significant challenge, to provide relevant and necessary cultural competence professional development opportunities to their students. However, little was found in the professional literature as to what was currently being done to provide such opportunities regarding Latino cultural competence. This study aims to identify current knowledge, attitudes and practices in professional development of practicing health educators regarding Latino cultural competence. Furthermore, it reports on recommendations for professional preparation in health education as identified by practicing professionals in our field.

METHOD

PROCEDURES

After obtaining Institutional Review Board approval, 192 health education professionals listed in a Midwestern state-level professional health education organization directory of members were invited to participate. Potential participants received a letter of invitation with a copy of the survey and a postage paid return envelope in January 2005. A second follow up mailing, approximately 4 weeks later, was sent only to those who did not return a completed survey. Of the 192 health education professionals invited to participate, 17 had undeliverable or non-valid addresses. Of the remaining 175 invited participants, 110 returned completed surveys producing a return rate of 63%.

INSTRUMENT

The survey consisted of five sections that measured 1) demographics of the participants, 2) Latino cultural competence acquisition processes reported by the participants, 3) self-rated cultural competence, 4) knowledge, attitudes and barriers to Latino cultural competence, and 5) recommendations for future professional development.

Demographics and Latino cultural competence acquisition were measured using categorical and nominal types of data. Knowledge, attitudes and barriers were measured using a combination of Likert-type and dichotomous items. A 10-item true/false scale was used to measure knowledge of Latino demographic profiles, health status and risk factors, common misconceptions about origin and legal status, and economic status among others. Participants were asked to identify the top-five health education programming barriers to addressing the needs of the Latino community by their respective organizations. In addition, participants were asked what steps, if any, they had taken to increase their Latino cultural competence and barriers encountered in this process.

Self-rated cultural competence was measured with two scales. The first scale used was an adapted version of the Cultural Competence Agency Self-Assessment Instrument by the Child Welfare League of America [CWLA] (2002) and consisted of six questions measuring overall cultural competence in their work activities and interactions with community members and respective organization clients. The items were scored using a five-point Likert scale ranging from 1 to 5 where 1 was never (0% of the time) and 5 was always (100% of the time).

The second scale was designed by the researchers and is based on the seven competencies required of professional health educators as outlined by the National Commission for Health Education Credentialing (2002). The seven items in this scale are designed to assess the comfort level of the health professional in executing their areas of responsibility when working with Latino communities. The items were scored using a five-point Likert scale including 1- very uncomfortable, 2- uncomfortable, 3- neutral, 4- comfortable and 5- very comfortable.

Recommendations for future professional development were identified in several ways. Participants were asked their opinion as to whether a) Latino cultural competence should be a requirement in health education professional preparation and at what level of study, b) they received sufficient knowledge about Latino culture in their own professional preparation curriculum, and c) they thought Latino cultural cognizance and competence should be required in health education professional preparation. Lastly, a five-point Likert scale was designed by the researchers to rate the importance of eight representative types of learning experiences in acquiring cultural competence (5=very important, 1=very unimportant).

A panel of experts established face and content validity of the survey instrument. The panel consisted of two experts in health education professional preparation and one expert in Latino culture and cultural competence training. Reliability was established for the three scales used in the instrument by using the Cronbach Alpha statistical test. All statistical analyses for this study were conducted using the Statistical Package for the Social Sciences (v11.5). The reliability scores for the three scales are as follows: Alpha = .80 for the Cultural Competence Self-Rating scale, Alpha = .93 for the Health Education Latino Cultural Competency Scale, and Alpha = .78 for the Learning Experiences Importance Scale (p=.05).

RESULTS

SAMPLE DEMOGRAPHICS

Health education professionals participating in this study (n=110) had a mean age of 41 (range = 22 to 62) and were primarily female (88.0%). The group was predominantly white (90.9%). The remainder 9.1% of the sample was comprised of 6.4% black, 1.8% Asian/Pacific Islander, & 0.9% multiracial. A small percentage (3.4%) self-identified as Latino/Hispanic, and nearly 22% reported speaking Spanish. However, only 20% rated their proficiency as "good" or "better."

The professional preparation level in health education was high, with 38.2% having a Bachelor's degree, 40.0% having a master's degree and 10.9% a doctorate. The remainder 10.9% of respondents had less than a bachelor's degree. Forty-five percent reported being a Certified Health Education Specialist. As expected, a large proportion of health education professionals in this study reported carrying out design (85.5%), implementation (78.2%) and evaluation (73.6%) activities in their current positions. Other responsibilities included administration (64.5%), teaching health (40.9%) or exercise instruction (10.0%). Almost 70% are employed by non-for-profit community health agencies and public health agencies, 20.0% and 48.2% respectively. Twenty percent reported employment in higher education settings and the remainder 10.9% in "other" settings.

KNOWLEDGE

Almost half (47.1%) of the professional health educators in this study reported having noticed the growth among the Latino community in the area where they work. However, 40.1% rated their knowledge of Latinos in their area of work as "low" or "very low" and only 10.9% rated it as "high" or "very high." When asked how they have acquired their current knowledge, skills and cultural competence about the Latino culture, the most frequently reported source was work experience (59.6%). The next most reported sources included personal experience (58.7%), continuing education (40.4%), health education college preparation courses (40.4%) and volunteer experiences (19.3%). Analyses of the brief ten-item knowledge quiz reveal that just over half of respondents were able to correctly answer 8 out of 10 questions (80% test-score), however, 10.9% (n=11) scored 60% or less.

Comparison of knowledge quiz scores and levels of education across the sample indicated that there was a significant difference. Participants with a masters degree or higher were more likely to score above 80% [F (1, 99) =7.741, p=.006]. Comparisons looking at knowledge scores and two age categories (<40 or >41 years old) found no significant differences [F (1, 99) =.996, p=.321]. Correlational analyses were conducted to identify if knowledge quiz scores were associated with any of the self-steps to improve Latino cultural competence. Results showed that there was a significant correlation between professionals with knowledge scores at 80% or above and those who 1) reported having sought continuing education opportunities (n=26, 50%, [X.sup.2]=4.620, p=.026) and 2) those who emerged themselves in community experiences (n=12, 32.6%, [X.sup.2]=3.649, p=.047).

ATTITUDES

Participants were asked to rate their comfort level interacting with Latino families in their work. Almost 70% reported being either "comfortable" or "very comfortable," however nearly 1 out of every 3 felt either "neutral," or expressed discomfort. Overall, participants recognize the significance that cultural competence has in health education professional endeavors and many have undertaken efforts to increase their knowledge and understanding of the Latino culture. Forty-three percent (n=47) have taken some steps to increase their cultural competence with the Latino culture by either interacting with other professionals with higher Latino cultural competence (n=47), taking continuing education classes (n=40), engaging themselves in projects with this community (n=25) or emerging in the community itself (n=24). Other reported methods included trying to learn the language and reading about the culture. Almost all, (98.2%, n=108) responded that it is of importance for health education professionals to be culturally cognizant and competent when working with Latino clients or students.

REPORTED BARRIERS

Health education professionals faced several barriers when trying to design, implement, and evaluate programs for the Latino community. Participants reported several commonly encountered barriers to programming for this community. The top five most reported barriers include: 1) the lack of bilingual health educators, 2) the lack of bilingual staff, 3) the lack of culturally specific knowledge by professionals in their organizations, 4) the lack of funding resources and 5) institutional priorities that do not align with serving the Latino community. Barriers were also reported for professional individuals trying to achieve Latino cultural competency. These barriers included but are not limited to: a) language and communication issues, b) access or limited contact with community members, c) immigration status issues and organizational guidelines, d) lack of peer and/or community member support, e) significant diversity within the Latino community, and lastly f) limited resources and educational opportunities.

SELF-RATED CULTURAL COMPETENCE

Scale scores for overall cultural competence ranged from 18 to 30 (within a possible range of 5 to 30) and had a mean of 26.77 (SD= 2.7, n=107). The majority of respondents scored high, reporting that they are culturally competent in their practice most of the time. There was very little variance across item means. Table 1 shows specific frequencies for each scale item. Analyses also showed that there was a significant difference between knowledge quiz scores and cultural competence scale scores. Specifically, those who scored 80% or higher were also more likely to score higher on the cultural competence scale [F (1, 92) =3.970, p=.049]. No significant differences were found when comparing cultural competence scale scores with either age or level of professional preparation. Multiple analyses of variance testing showed a significant difference between knowledge quiz score means and two specific cultural competence scale items. Namely, those with higher means on "acknowledging culture as integral" and "considering culture when delivering programs" were more likely to have scored above 80% on the knowledge quiz.

As table 3 shows, multiple regression analysis of item one in the cultural competence scale, as predicted by education level (#bachelor's or $masters), age (#40 or 40+ years old), and knowledge quiz scores (#80% and $81%) found that knowledge quiz scores were the only statistically significant predictor of acknowledging "culture as an integral part of the physical, emotional, intellectual, and overall development and well-being of children, youth and their families." Item 3 in the scale, "I consider cultural factors such as language, race, ethnicity, customs, family structure, and tribal and / or community dynamics when delivering programs & services" was not significantly predicted by either education level, age, or knowledge quiz scores.

Analysis of the Health Education Latino Cultural Competency Scale scores showed a range of scores from 8 to 35 within the possible range of 7 to 35. The mean score was 21.96 and its standard deviation was 4.897. Overall, respondents scored high, however between 39% and 44% of respondents rated their comfort level as "neutral." In addition, up to 22.6% reported being uncomfortable. Table 2 contains specific item frequencies for this scale. Analyses of variance found no significant differences between Health Education Latino Cultural Competency Scale scores and either age, knowledge quiz scores or education level. However, multivariate analyses of variance found that professionals who felt more comfortable "implementing health education programs for Latino communities" scored significantly higher in the knowledge quiz scores (80% or higher) [F (1, 98) =4.517, p=.036]. Follow up multiple regression analyses were run to see if either education level (#bachelor's or $masters), age (#40 or 40+ years old), and knowledge quiz scores (#80% and $81%) could predict comfort level of health educators in implementing programs for Latinos. Both age and knowledge quiz scores were found to be statistical predictors (See Table 3).

RECOMMENDATIONS FOR PROFESSIONAL PREPARATION

Nearly 87% of respondents (n=92) expressed that Latino cultural cognizance and competence should be a required part of health education professional preparation. Of the participants who thought it should be required, most (67.0%, n=27) felt that it should be required at both graduate and undergraduate levels of professional preparation, with 30.7% (n=59) of respondents preferring that it only be required at the undergraduate level. Among participants who responded that Latino cultural cognizance and competence should not be required (n=19) in professional preparation of health educators, all but two felt that it should not be singled out but instead be a part of comprehensive cultural competence skill development. When asked about their own professional preparation experience, 87.5% (n=91) responded that they had not received enough knowledge about the Latino culture.

Lastly, participants rated the importance of eight learning experiences in acquiring the cultural competence necessary for health educators in today's America. The mean scale score for this eight item scale was 32.47 (SD=3.728) and scores ranged from 22 to 40 (with in a possible range of 8 to 40). As can be seen in Table 4, "exposure to the culture" was ranked the most important with "interaction with the culture" in second place. The least important, although with a mean score of 3.52 (SD=.839), was "immersion in the culture."

DISCUSSION

The rapid growth in the Latino population within the United Sates has created many challenges for health educators and the health care system in general. The goals of Latino cultural competence should be to prepare health educators who are comfortable, confident and competent in their interactions with Latinos.

The results of this study suggest that health education professional preparation programs need to consider revisions, at both the graduate and undergraduate levels, in how Latino cultural competence is acquired by their students. In addition, professional preparation programs may consider the development of dual major programs in health education and Spanish as a means to address the need for more bi-lingual health educators. Efforts to increase the number of Latino health educators through specialized recruitment strategies should also be considered.

Practicing health educators are also in need of increased opportunities to learn about Latino culture. Therefore, health education professional membership organizations need to consider providing more continuing education opportunities at annual meetings, local affiliate meetings and other sponsored training events that enable practicing health educators to increase their Latino cultural competence. Other approaches to increasing Latino cultural competence may include consideration of new and emerging internship sites that serve the Latino community. Also, health education faculty may encourage study abroad and summer internship experiences that engage students with Latino populations. Additional research that addresses the most effective approaches to increasing cultural competence with the Latino community is also indicated.

SUMMARY

The rapid expansion of the Latino population within the United States has created special challenges for health educators. Health Educators need to be able to work effectively with all people. Although this study focused on the Latino population in the United States, it does not in any way intend to diminish the need for health educators to develop competence in working with all ethnic and special populations. The study suggests the need for additional educational opportunities that enhance the Latino cultural competence of pre-service and in-service health educators.

REFERENCES

Brach, C. & Fraser, I. (2002). Reducing disparities through culturally competent health care: An analysis of the business case. Quality Management in Health Care, 10(4), 15-28.

Campbell, P. R. (2004). Projected population change in the United States, by race and Hispanic origin: 2000-2050. Retrieved August 25, 2005, from http://www.census.gov/ipc/www/usinterimproj/.

Child Welfare League of America. (2002). Cultural competence self-assessment instrument. Washington D.C.: CWLA Press.

Galambos, C. (2000). Moving cultural diversity toward cultural competence in health care. Health & Social Work, 28(1), 3-7.

Encarnacion-Garcia & Torabi, (2003). HIV/AIDS education: A culturally competent approach for Hispanic/ Latino. The Health Education Monograph Series, 20(2), 48-53.

Luquis R., and Perez, M. (2003). Achieving cultural competence: The challenges for health educators. American Journal of Health Education, 34(3), 131-138.

Sharma, P. & Kerl, S. B. (2002). Suggestions for psychologists working with Mexican American individuals & families in health care settings. Rehabilitation Psychology, 47(2), 230-239.

Shearer, R. & Davidhizar, R. (2003). Using role play to develop cultural competence. Journal of Nursing Education, 42(6), 273-276.

U.S. Census Bureau. (1996). Population projections for states by age, sex, race, and hispanic Origin: 1995 to 2025. Retrieved August 25, 2005, from http://www.census.gov/population/www/projections/ppl47.html.

U.S. Census Bureau. (2003). The Hispanic population in the United States: March 2002. Retrieved August 25, 2005, from http://www.census.gov/population/www/socdemo/hispanic/ho02.html.

U.S. Census Bureau. (2004a). All across the USA: Population distribution composition, 2000. Retrieved August 25, 2005, from http://www.census.gov/population/pop-profile/2000/chap02.pdf.

U.S. Census Bureau. (2004b). US interim projections by age, sex, race and Hispanic origin. Retrieved August 25, 2005, from http://www.census.gov/ipc/www/usinterimproj/.

CHES AREAS

Responsibility X--Advancing the Profession of Health Education

Competency A: Provide a critical analysis of current and future needs in health education. Sub-competency 1. Relate health education issues to larger social issues.

Competency B: Assume responsibility for advancing the profession. Sub-competency 3. Develop a personal plan for professional growth.

Liliana Rojas-Guyler, Ph.D., CHES is an Assistant Professor of Health Promotion & Education at the University of Cincinnati. Donald I. Wagner, H.S.D, CHES is a Professor of Health Promotion & Education and the Director of the Center for Prevention Studies at the University of Cincinnati. Address all correspondence to Liliana Rojas- Guyler, Ph.D., CHES, Assistant Professor of Health Promotion & Education, PO BOX 210002, ML002, Cincinnati, OH 45221-0002. PHONE: [phone], FAX: [phone]; E-MAIL: [e-mail].

Table 1. Overall Cultural Competence Self-Rating Scale Item Frequencies

In my work ...                              Percent Frequency

I acknowledge that culture                             Almost
is an integral part of the physical,                    Always
emotional, intellectual,                   Always       (75-99%
and overall development and                100% of      of the
well-being of children, youth              the time)    time)
and their families                           55.0         43.1

I consider cultural factors such
as language, race, ethnicity,
customs, family structure, and
tribal and / or community dynamics
when planning and designing
programs & services                           33.0        42.2

I consider cultural factors such as
language, race, ethnicity, customs,
family structure, and tribal and / or
community dynamics when
delivering programs & services                41.1        39.3

I respect the culture, diversity and
rights of the children, youth, and
families I serve                              81.5        18.5

I respect the culture diversity and
rights of the staff members and
service providers of my organization          80.6        18.5

My/our programs, services and
practice acknowledge, respect,
and respond to the various culturally
defined needs of the children,
youth and families                            40.6        40.6

In my work ...                             Percent Frequency

I acknowledge that culture
is an integral part of the physical,                     Rarely
emotional, intellectual,                 Sometimes       (1-25%
and overall development and              (25-75%         of the
well-being of children, youth            of the time)     time)
and their families                             1.8           0

I consider cultural factors such
as language, race, ethnicity,
customs, family structure, and
tribal and / or community dynamics
when planning and designing
programs & services                           21.1         2.8

I consider cultural factors such as
language, race, ethnicity, customs,
family structure, and tribal and / or
community dynamics when
delivering programs & services                16.8         1.9

I respect the culture, diversity and
rights of the children, youth, and
families I serve                                 0           0

I respect the culture diversity and
rights of the staff members and
service providers of my organization           .9            0

My/our programs, services and
practice acknowledge, respect,
and respond to the various culturally
defined needs of the children,
youth and families                            17.9         .9

In my work ...                              Percent Frequency

I acknowledge that culture
is an integral part of the physical,
emotional, intellectual,                         Never
and overall development and                      (0% of
well-being of children, youth                  the time)    N
and their families                               0         109

I consider cultural factors such
as language, race, ethnicity,
customs, family structure, and
tribal and / or community dynamics
when planning and designing
programs & services                            .9          109

I consider cultural factors such as
language, race, ethnicity, customs,
family structure, and tribal and / or
community dynamics when
delivering programs & services                 .9          107

I respect the culture, diversity and
rights of the children, youth, and
families I serve                                 0         108

I respect the culture diversity and
rights of the staff members and
service providers of my organization             0         108

My/our programs, services and
practice acknowledge, respect,
and respond to the various culturally
defined needs of the children,
youth and families                               0         106

In my work ...                              Percent Frequency

I acknowledge that culture
is an integral part of the physical,
emotional, intellectual,
and overall development and
well-being of children, youth                   M          SD
and their families                            4.53       .537

I consider cultural factors such
as language, race, ethnicity,
customs, family structure, and
tribal and / or community dynamics
when planning and designing
programs & services                           4.04        .86

I consider cultural factors such as
language, race, ethnicity, customs,
family structure, and tribal and / or
community dynamics when
delivering programs & services                4.18       .845

I respect the culture, diversity and
rights of the children, youth, and
families I serve                              4.81       .390

I respect the culture diversity and
rights of the staff members and
service providers of my organization           4.8       .427

My/our programs, services and
practice acknowledge, respect,
and respond to the various culturally
defined needs of the children,
youth and families                            4.21       .765

Table 2. Health Education Latino Cultural Competency Scale Item
Frequencies.

In the following situations my level         Percent Frequency
of comfort is ...

Assessing individual and community        Comfortable
needs for health education of                Very        Comfortable
Latino communities                            3.7           39.8

Planning effective health education
programs for Latino communities               2.8           31.8

Implementing health education
programs for Latino Communities               1.9           33.6

Evaluating the effectiveness of
health education programs for Latino
communities                                   5.6           32.4

Coordinating the provision of
health education services for Latino
communities                                   3.7           34.6

Acting as a resource person in health
education for Latino communities              3.8           24.5

Communicating health and health
education needs, concerns and
resources to and for Latino communities       1.9           26.4

In the following situations my level          Percent Frequency
of comfort is ...

Assessing individual and community
needs for health education of               Neutral      Uncomfortable
Latino communities                           38.9           17.6

Planning effective health education
programs for Latino communities              42.1           22.4

Implementing health education
programs for Latino Communities              43.9           19.6

Evaluating the effectiveness of
health education programs for Latino
communities                                  41.7           19.4

Coordinating the provision of
health education services for Latino
communities                                   43            15.9

Acting as a resource person in health
education for Latino communities             44.3           22.6

Communicating health and health
education needs, concerns and
resources to and for Latino communities      43.4           25.5

In the following situations my level         Percent Frequency
of comfort is ...

Assessing individual and community           Very
needs for health education of             Uncomfortable       N
Latino communities                             0             108

Planning effective health education
programs for Latino communities               .9             107

Implementing health education
programs for Latino Communities               .9             107

Evaluating the effectiveness of
health education programs for Latino
communities                                   .9             108

Coordinating the provision of
health education services for Latino
communities                                   2.8            107

Acting as a resource person in health
education for Latino communities              4.7            106

Communicating health and health
education needs, concerns and
resources to and for Latino communities       2.8            106

In the following situations my level           Percent Frequency
of comfort is ...

Assessing individual and community
needs for health education of                  M             SD
Latino communities                           3.30            0.8

Planning effective health education
programs for Latino communities              3.13           .825

Implementing health education
programs for Latino Communities              3.16           .791

Evaluating the effectiveness of
health education programs for Latino
communities                                  3.22           .857

Coordinating the provision of
health education services for Latino
communities                                  3.21           .855

Acting as a resource person in health
education for Latino communities               3            .905

Communicating health and health
education needs, concerns and
resources to and for Latino communities      2.99           .845

Table 3. Regression Analyses Model Summary For Statistical Prediction
of Cultural Competence, Health Education Latino Cultural Competence and
Latino Knowledge Scale Items.

                                             Un-standardized
Scale                                          Coefficients
Cultural Competence Scale Item1               B       S.E
In my work, I acknowledge that
culture is an integral part of the
physical, emotional, intellectual,
and overall development and
well-being of children, youth
and their families.                        .237      .243

Health Education Latino Cultural
  Competency Scale (2)
In the following situation-
Implementing health education
programs for Latino Communities-
my level of comfort is ...

Latino Culture Knowledge Quiz Score (3)    .349      .360
Age (4)                                   -.345      .161

                                          Standardized
Scale                                     Coefficients
Cultural Competence Scale Item1           Beta           t       p
In my work, I acknowledge that
culture is an integral part of the
physical, emotional, intellectual,
and overall development and
well-being of children, youth
and their families.                       .221       2.135    .035

Health Education Latino Cultural
  Competency Scale (2)
In the following situation-
Implementing health education
programs for Latino Communities-
my level of comfort is ...

Latino Culture Knowledge Quiz Score (3)    .217      2.121     .037
Age (4)                                   -.214     -2.144     .035

(1) Answer Options: 1= very uncomfortable, 2= uncomfortable,
3= neutral, 4= comfortable and 5= very comfortable

(2) Answer Options: 5= Always (100% of the time), 4= Almost Always
(75-99% of the time), 3=Sometimes (25-75% of the time), 2=Rarely
(1-25% of the time), 1=Never (0% of the time)

(3) Answer Options: 1=True, 2= False

(4) Categories: 1= 40 years or younger, 2= 41 years or older

Table 4. Importance of 8 Different Learning Experiences In Acquiring
Cultural Competence Necessary For Health Educators In Today's America

Learning Experience (1)                          Rank (1)      M

Exposure to the culture                              1      4.65
Interaction with the culture                         2      4.60
Work/ Internship/Volunteer experience                3      4.23
Continuing Education opportunities                   4      4.18
Classes as part of professional                      5      4.14
  development curriculum
Research project on the culture                      6      3.62
Travel opportunities as part of curriculum           7      3.54
Immersion in the culture                             8      3.52

Learning Experience (1)                            SD         n

Exposure to the culture                          .551        109
Interaction with the culture                     .595        109
Work/ Internship/Volunteer experience            .678        108
Continuing Education opportunities               .696        109
Classes as part of professional                  .859        108
  development curriculum
Research project on the culture                  .798        106
Travel opportunities as part of curriculum       .928        106
Immersion in the culture                         .839        107

(1) Item Scale Scores: 5=Very Important, 4=Important, 3=Neutral,
2=Unimportant, 1=Very Unimportant

(2) 1= highest, 8=lowest