The Development and Validation of an Instrument Measuring Clinician Cultural Humility

Background and Purpose

Racial and ethnic disparities in mental health remain a critical issue in the United States, driven by systemic inequities, exclusionary practices, and microaggressions. Although cultural competence has been widely adopted, it is increasingly critiqued for emphasizing clinician expertise over client experience. In contrast, cultural humility is a relational, self-reflective framework that prioritizes lifelong learning, awareness of biases, and acknowledging systemic power imbalances. Despite its growing relevance, few validated instruments assess clinicians’ perceived cultural humility. This study aimed to develop and validate the Howard Bembry–Multidimensional Assessment of Cultural Humility Scale (HB-MACHS), a clinician-report measure designed to assess key dimensions of cultural humility and examine its relationship to contextual variables such as diversity, and lifelong learning.

Methods

A three-study, cross-sectional quantitative design was used. Study 1 conducted an exploratory factor analysis (EFA) on data from 440 clinicians recruited through a large East Coast university listserv. Items were informed by concept analysis and expert review. Study 2 conducted confirmatory factor analysis (CFA) using a separate validation sample of 228 clinicians to confirm the factor structure identified in Study 1. Study 3 used structural equation modeling to test a theoretical path model examining whether perceived diversity awareness predicted cultural humility and whether cultural humility was associated with clinicians’ attitudes toward lifelong learning. Analyses followed established guidelines for psychometric validation and model fit.

Results

The EFA revealed a two-factor structure for the HB-MACHS: (1) Intrapersonal Reflection—self-awareness, critical self-reflection, and bias recognition; and (2) Interpersonal Reflection—openness to clients’ lived experiences and cultural perspectives. CFA confirmed this structure, yielding good model fit (CFI = .95, RMSEA = .05). Path analysis demonstrated that diversity significantly predicted cultural humility. Cultural humility, in turn, was positively associated with clinicians’ endorsement of lifelong learning. Intrapersonal reflection emerged as a particularly strong mediator in this model.

Conclusions and Implications

The HB-MACHS is a psychometrically sound measure that captures two interrelated dimensions of clinician cultural humility. It addresses a critical gap in the assessment of culturally responsive practice and offers a useful tool for training, supervision, and evaluation in social work and other helping professions. Findings emphasize the central role of intrapersonal reflection in translating awareness of structural inequities into professional growth. As the social work profession continues to confront racism and health inequities, the HB-MACHS can guide workforce development efforts aimed at improving relational accountability and reducing disparities in mental health care.