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Open Access Highly Accessed Open Badges Research article

Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions

Azita Emami12 and Jalal Safipour3*

Author Affiliations

1 Karolinska Institutet, Neurobiology, Care Science and Society, Aging Research Centre, Stockholm, Sweden

2 Seattle University, College of Nursing, Seattle, WA, USA

3 Faculty of Nursing, University of Alberta, Alberta, Canada

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BMC Health Services Research 2013, 13:145  doi:10.1186/1472-6963-13-145

Published: 22 April 2013



To develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it’s important to map out and assess caregivers’ awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short).


The questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments.


Results of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach’s alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff.


This study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers’ awareness and acceptance of diversity in the healthcare environment and healthcare delivery.

Assessment; Culture; Cultural awareness; Diversity; Environment; Healthcare; Questionnaire development; Sweden