title: Cultural competence in mental health nursing: validity and internal consistency of the Portuguese version of the multicultural mental health awareness scale-MMHAS.
abstract: BACKGROUND
  Cultural competence is an essential component in rendering effective and culturally responsive services to culturally and ethnically diverse clients. Still, great difficulty exists in assessing the cultural competence of mental health nurses. There are no Portuguese validated measurement instruments to assess cultural competence in mental health nurses. This paper reports a study testing the reliability and validity of the Portuguese version of the Multicultural Mental Health Awareness Scale-MMHAS in a sample of Portuguese nurses.
  
  
  METHODS
  Following a standard forward/backward translation into Portuguese, the adapted version of MMHAS, along with a sociodemographic questionnaire, were applied to a sample of 306 Portuguese nurses (299 males, 77 females; ages 21-68 years, M = 35.43, SD = 9.85 years). A psychometric research design was used with content and construct validity and reliability. Reliability was assessed using internal consistency and item-total correlations. Construct validity was determined using factor analysis.
  
  
  RESULTS
  The factor analysis confirmed that the Portuguese version of MMHAS has a three-factor structure of multicultural competencies (Awareness, Knowledge, and Skills) explaining 59.51% of the total variance. Strong content validity and reliability correlations were demonstrated. The Portuguese version of MMHAS has a strong internal consistency, with a Cronbach's alpha of 0.958 for the total scale.
  
  
  CONCLUSIONS
  The results supported the construct validity and reliability of the Portuguese version of MMHAS, proving that is a reliable and valid measure of multicultural counselling competencies in mental health nursing. The MMHAS Portuguese version can be used to evaluate the effectiveness of multicultural competency training programs in Portuguese-speaking mental health nurses. The scale can also be a useful in future studies of multicultural competencies in Portuguese-speaking nurses.
authors.affiliation: Coimbra Nursing School, Rua 5 de Outubro-Apartado 55, 3001-901, Coimbra, Portugal. anapaula@esenfc.pt.
authors.forename: Ana Paula Teixeira
authors.initials: AP
authors.lastname: de Almeida Vieira Monteiro
authors.affiliation: Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
authors.forename: Alexandre Bastos
authors.initials: AB
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D054521:Cultural Competency; D018864:Cultural Diversity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011568:Psychiatric Nursing / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014175:Translating; D055815:Young Adult
keywords: Cultural competence; Instrument reliability; Instrument validity; Mental Health Nurses; Multicultural awareness; Multicultural nursing; Psychometric testing