1. Surveys
  2. 2016
  3. April
  4. C
  5. Cultural Competence Questionnaire for Internationa
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Exit Survey
 
Cultural Competence
Hello:
You are invited to participate in our survey of cultural competence for dental students in the international dentists program. In this survey, approximately 100 people will be asked to complete a survey that asks questions about cultural competence. It will take approximately 20 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Irene Lubker at 555-5555 or by email at the email address specified at the end of the survey.

Thank you very much for your time and support. Please consent to the survey below and start with the survey now by clicking on the "Next" button below.
 
 
 
How knowledgeable are you about each of the following subject areas? (select one response line)
Very Quite a bit Somewhat A little Not at all
Historical and contemporary impact of racism in health care experienced by various population groups in the United States
 
Office for Civil Rights August 30, 2000 Policy Guidance on the Title VI Prohibition Against National Origin Discrimination as it Affects Person with Limited English Proficiency
Office of Minority Health’s National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care
 
 
How SKILLED are you in dealing with sociocultural issues in the following areas of patient care in the USA? (select one response per line)
Very Quite a bit Somewhat A little Not at all
Prescribing/negotiating a culturally sensitive dental treatment plan?
Dealing with cross-cultural compliance problems
Eliciting the patient’s perspective about health and illness (e.g., its etiology, name, treatment, course, prognosis)
 
 
How IMPORTANT are each of the following factors in contributing to health disparities (select one response per line)
Very Quite a bit Somewhat A little Not at all
Genetics
Lifestyle
Poverty
Education
 
 
How AWARE are you of your own: (select one response per line)
Very Quite a bit Somewhat A little Not at all
Racial, ethnic, or cultural stereotypes?
Biases and prejudices?
 
 
How IMPORTANT do you believe sociocultural issues are in your interactions with: (select one response per line)
Very Quite a bit Somewhat A little Not at all
Patients
Colleagues
Other students
Staff
Faculty
 
 
 
* How long have you lived in the United States?
 
0 - 5 years
 
6 -10 years
 
11 to 15 years
 
More than 15 years
 
 
 
* What year did you graduate from your previous dental school?
 
1990 - 1995
 
1996 - 2000
 
2001 - 2005
 
2006 - 2010
 
2011 and later
 
 
 
* Country of origin
   
 
 
 
* What gender do you identify with?
 
Male
 
female
 
Other
 
 
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