Canadian Journal of Occupational

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Culture and its Influence on Occupational Therapy Evaluation

Stanley Paul
Canadian Journal of Occupational Therapy 1995 62: 154
DOI: 10.1177/000841749506200307

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CJOT * VOLUME 62 * NO 3

• STANLEY PAUL

KEY WORDS
Culture and its influence on
Assessment process,
occupational therapy occupational therapy evaluation
Culture
Cultural characteristics

ABSTRACT In the increasingly multicultural society of north Arnerica,

occupational therapists have a responsibility to develop awareness and
knowledge concerning different cultural groups. 13y accepting and understand-
ing clients' customs, values and beliefs, clinicians have a better chance of
assessing and producing more effective outcomes. Since occupational therapy
has incorporated western naiddle-class values into its theory and practice, many
evaluation tools used are based on norrns developed for a white middle-class
population. Using these evaluations with minority groups brings the danger of
improper interpretation of test results. Consequently, increasing emphasis is
being placed on the importance of culture fairness and the development of
culture-fair evaluation tools for usage across different cultural groups. This
paper will present a discussion concerning the importance, advantages and
disadvantages of both culture-fair and culture-specific tests and evaluation
tools.

RÉSUMÉ Dans la société nord-américaine de plus en plus

Stanley Paul, MS, OTR/L, is a Doc-
toral Candidate in the Occupational
Therapy Departrnent, Nevv York Univer-
sity, New York.
Mailing Address: 653 Mace Avenue,
New York, NY 10467
multiculturelle, les ergothérapeutes ont la responsabilité de favoriser la prise
de conscience et la connaissance en rapport avec les différents groupes
culturels. En acceptant et en comprenant les coutumes, les valeurs et les
croyances de leurs clients, les cliniciens augmentent leurs chances de mieux les
évaluer et de susciter de meilleurs résultats de traitement. L'ergothérapie ayant
adopté les valeurs occidentales de la classe moyenne dans ses fondements
théoriques et pratiques, plusieurs outils d'évaluation sont basés sur les normes
mises au point pour une population blanche, de classe moyenne. Le fait
d'utiliser ces évaluations auprès des minorités risque de fausser l'interprétation
des résultats des tests. Il en résulte qu'une emphase de plus en plus grande est
mise sur l'impartialité culturelle et le développement d'outils d'évaluation
équitables pour les différents groupes culturels. Cet exposé fera état d'une
discussion sur l'importance, les avantages et les désavantages de tests et d'outils
d'évaluation qui respectent l'équité et la spécificité culturelles.

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 CJOT • VOLUME 62 • NO 3
Emphasizing the importance of developing culture-fair
tests has been an issue in psychology and education
from the mid-fifties. Occupational therapy is beginning
to consider the irnplications of cultural differences in
evaluation, treatment planning and implementation
(Dyck, 1993; Evans & Salirn, 1992; Levine, 1984;
Meyers, 1992; Spadone, 1992). Evaluation is a process
of collecting relevant information in order to plan and
implement effective occupational therapy treatment
programmes. Our primary emphasis for intervention is
on improving people's ability to function in their daily
occupations. Accurate rneasurements and evaluation
tools are necessary in order to measure change and
evaluate function of our clients.
Evaluation is the cornerstone of occupational therapy
service provision. Occupational therapists recognize
multiple methods for gathering inforrnation such as
criterion referenced and norm referenced tests, inter-
views and skilled observations. We gather information
from a variety of sources: from clients, caregivers,
peers, the physical and social environment, and client
records. We are also skilled in direct observation of
functional performance and in constructing compre-
hensive task analysis. Regardless of the methods used
for evaluative purposes, the culture of the clients plays
a very important role in the interpretation of the data.
Lately researchers such as Fisher & Short-Degraff
(1993), Christiansen (1993), Trombly(1993) and Law et
al (1990) have all emphasized the need for improving
the existing functional assessment tools in occupa-
tional therapy and the need for newer accurate mea-
surement tools. Researchers are atternpting to develop
unifying occupational therapy intake assessment tool(s)
which can be used across different cultural groups and
different occupational therapy specialty areas. An
example of such a possibility is the ongoing develop-
ment of the Canadian Occupational Performance Mea-
sure (COPM) (Law et al., 1990).
Many of the evaluation and functional assessment
tools used in occupational therapy including motor,
developmental and sensory integrative tests, are based
largely on the sociocultural norms of a w hite middle-
class population (Skawski, 1987). This has resulted
from occupational therapy's incorporation of western
middle-class values into its theory and practice. These
norms may not stand true for minority groups and may
in turn affect occupational therapy management based
on such interpretation.
In order for evaluation tools to be used across
different cultural populations, they need to be free of
cultural bias. However, since altering the past sociocul-
tural conditions is irnpossible researchers agree that
cultural bias may be minimized but never eliminated
altogether. The terms culture-fair and culture-free are
often used interchangeably in the literature. Assess-
ment tools, tests, and evaluation tools are terrns used
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interchangeably in the occupational therapy literature.
A culture-fair test reveals the true inherent abilities of
the individual devoid of his/her cultural veneer (Van
de Vijver & Poortinga, 1991). According to Kline
(1986), culture-fair tests supposedly contain test items
which are common to all different cultures and the
rationale behind "culture-fair" test items is to include
only those tasks which reflect the experiences, knowl-
edge, and skills common to all different cultures.
Culture-specificity is the opposite of culture-fairness.
Culture- specific tests contain items relevant to a spe-
cific cultural group and such tests are exclusively
devised for usage with such specific groups. Some
examples of evaluation tools standardized for the
North American white middle-class are, the Functional
Independence Measure (FIM) (Granger, Hamilton, &
Sherwin, 1988), Klein-Bell ADL Scale (Klein & Bell,
1988), Barthel Index (Mahoney & Barthel, 1965), and
the Classroom Environment Scale (Trickett & Moos,
1973).
This paper discusses the importance, advantages,
and disadvantages of both culture-fair and culture-
specific tests and evaluation tools. Mainstream North
American community is referred to in this paper as
white middle-class North Americans of European ori-
gin. Cultural minority refers to Canadians and Ameri-
cans of African descend, native North Americans, and
other groups including non-European immigrants.
Non-European immigrants mostly refers but is not
limited to, Asians, Latin Americans, and people of the
Caribbean and Pacific islands which are the largest
immigrant groups in the past five years.
Culture and its role in Occupational Therapy
Culture is a process of behaviour and communication
that has been learned by persons in the context of their
past experience (Krefting & Krefting, 1991). One's
culture determines one's way of thinking, feeling and
behaving. Mosey (1980 describes culture as a set of
understandings shared by members of a group about
how things should be done and what is desirable and
good. Culture has a pervasive influence on a client's
values, goals, interests, roles, habits, and performance
and it can be seen as a filter through which clients
determine their direction and degree of involvement in
self care, work and leisure activities (Levine, 1984).
Areas of cross cultural difference include beliefs about
the inherent nature of the person, language, work,
leisure, food, and historical heritage (Mosey, 1986).
Ogbu, in cultural difference theory, argued that the
skills and attitudes of people of various cultures differ
because each culture has distinct values and goals
(Patton, 1985).
Consideration of the role of culture in occupational
therapy practice is vital in an increasingly multi-
cultural population. Occupational therapists face new
AOOT 1995 • 155
 CJOT
challenges in assessment and treatment planning with
clients vvho do not share with a therapist a common
language, differ in health-related beliefs and values,
and have different understandings of the nature of
work, leisure, and self-care (Skawski, 1987). Sanchez
(1964) was among the first in the literature to call
attention to the white middle-class bias of the health
professions. He proposed that occupational therapy
should incorporate the patients' cultural background
into treatment in order for therapy to be effective.
Klavins (1972) posed a general question to the profes-
sion of occupational therapy, asking how much we
know about the cultural beliefs and values of a great
variety of people we work with and its influence on
their therapeutic process. This question is yet to be
fully answered.
There have been calls for changes in the norms and
values underpinning occupational therapy evaluation,
treatment planning and implementation. Many occu-
pational therapy educators and researchers found the
norms and values of our profession to create obstacles
to cross-cultural care (Kinebanian & Stomp, 1992;
Krefting, 1992; Miller, 1992; Weiringa & McColl, 1987).
Mann and Klyczek (1988) called for revision and
refinement of the existing occupational therapy mea-
surement instruments and evaluation tools if they are
to be used for the purpose of meaningful comparison
between groups. Some researchers have tested stan-
dardized assessment tools in order to evaluate their
usage across different cultural populations (Fisher, Liu,
Velozo, & Pan, 1992; Jungersen, 1992).
Culture-fair tests: A critical analysis
Although the idea of developing a true culture-fair test
had great intuitive appeal, to date it has proven to be
a practical impossibility. The label "cultural minority"
is used to designate individuals who belong to a
recognized ethnic group and whose values, customs,
patterns of thought, or language are significantly
different from those of the majority of the society in
which they live. Attempts to produce educational
measures and intelligence tests in which people from
cultural minority populations perform as well as those
from white middle-class have been largely unsuccess-
ful. A test developed by Mercer (1977) proposed a
System of Multicultural Pluralistic Assessment (SOMPA)
that in effect, used two sets of norms in assessing each
examinee: the national norm group and a comparison
group similar to the examinee in social and cultural
background. Samuda (1982) concluded that SOMPA
had all the weaknesses of the previous tests, plus a host
of new weaknesses, not the least of which was the
absence of any construct validity. Later results with
other tests have been similar (Aiken, 1991). The Davis-
Eells Test of General Intelligence, an intended culture-
fair intelligence test which contained a series of group
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VOLUME 62 NO 3
tests for elementary school age levels, failed to mea-
sure the IQ scores as predicted by the developers. A
clear socioeconomic status difference in response to
the test items persisted on virtually all items, regardless
of their form (Van de Vijver & Poortinga, 1991).
Developing evaluation tools is a complex process.
There are many variables which can make it impos-
sible to devise a culture-fair test. For example, devel-
oping culture-fair test items is not an easy task even
within the mainstream white middle-class North Ameri-
can society because test users do not constitute a
homogeneous group. Studies done on social classes in
American communities indicated that cultural patterns
among various social classes of the North American
community are very diverse. Even though some of
these cultural patterns were shared and sirnilar, the
differences in their values, beliefs, customs, and reli-
gious practices were sufficiently divergent to warrant
regarding them as sub-populations within the main-
stream North American society (Gregory, 1992; Silva,
1993). When there are many sub-populations even
within mainstream North American society, develop-
ing culture-fair test items to evaluate diverse cultural
populations including other than North American and
European cultures will be impossible. Whenever some-
one wants to develop a cross-cultural evaluation to be
used across different cultural groups they should
consider the values, beliefs, language, historical heri-
tage, work, leisure and even food habits of the cultural
groups in mind. Test performance can be influenced
by any or all of these factors. So, developing culture-
fair evaluation tools is very much desirable but hardly
possible.
Making a test culture-fair involves a procedure of
removing culturally biased items from existing evalu-
ation tools. For example, in order to utilize a North
American developed IADL scale with a recent immi-
grant from Nepal, certain items from the laundry sub-
section may be omitted from the scale (e.g. washer and
dryer are extremely rare in a Nepali household as they
wash their clothes with their hands). While omitting a
few items from an already existing evaluation tool may
be easier to do, it is important to investigate the
differences between the Nepali culture and the norm
group of the IADL scale. When a test is developed for
a specific population the items and materials are the
reflection of that population. This is called culture-
relevancy of test items. Van de Vijver and Poortinga
(1991) concluded that test performance depends upon
the experience the individuals bring with them and
upon psychological factors in the testing situation
itself. Just removing some so called culturally-biased
items from a test does not necessarily eliminate cultural
differences in behaviour. In fact, tampering with the
test items only compromises the validity of the test.
Another method of constructing a culture-fair test
 CJOT • VOLUME 62 • NO 3
involves combining test items representing different
cultural groups. One procedure long in use for making
tests bi-cultural (for use with only two distinct cultural
groups) is by adding items of a certain kind which
favour an otherwise unfavoured group. For example,
in an effort to make an ADL evaluation tool usable for
both North Arnerican mainstream society and Chinese
immigrants, certain items appropriate to Chinese cul-
ture may be added to the test. In this way, the
composite performance score is adjusted until it is
"fair" to each group. The inherent danger is that
combining different cultural items can only affect the
meaningful interpretation of data and ultimately, it may
not truly reflect any one of those groups. Even if a test
could be developed with such items it would be
extremely difficult to devise criteria against which the
test could be validated. This method also reduces the
constructive and predictive validity of the evaluation
tools (Reynolds, 1982; Silva, 1993). Anastasi (1988)
commented that the criteria against which tests are
validated are themselves culturally loaded and any test
is operationally meaningless unless defined in terms of
such criteria. All tests and evaluation tools, to a greater
or lesser degree, reflect the majority of the population
in which they were devised and will be used. In places
like Canada and the United States there are many
different minority groups. It would be expected that
members of minority groups would score lower in
those tests because of their unfamiliarity with the test
items and test environrnents. Other factors such as the
rater bias which is caused by the cultural background
of the raters may also influence the scores.
There can be little doubt that among groups vast
differences exist in values and beliefs. But there is no
virtue in developing instruments so blunted that they
decrease the amount of information. Any standardized
evaluation tool may not be accurate when used to
evaluate people of a distinct cultural group (Gregory,
1992). Tests are designed to show what an individual
can do at a given point in time. They cannot tell us why
they perform as they do. To answer that question, we
need to investigate their background, motivations, and
other pertinent circumstances. Nor can tests tell us how
able culturally or educationally disadvantaged people
might have been if they had been reared in a more
favourable environment. Moreover, tests cannot com-
pensate for cultural deprivation by eliminating its effect
from their scores. On the contrary, tests should reveal
such effects, so that appropriate remedial steps can be
taken. Test scores of ethnic minorities are useful
indices of immediate or present functioning. Tests
provide valuable information about their strengths and
weaknesses. Doing away with tests will only deprive
clinicians and educators of vital inforrnation needed to
assist these individuals. To conceal the effects of
cultural disadvantages or differences by rejecting tests
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or by trying to devise tests that, are insensitive to such
effects can only retard progress toward a genuine
solution of social problems. However small the scope
may be, as long as a test or evaluation tool measures
whatever it proposes to measure in an accurate man-
ner, its purpose is served.
By emphasizing culture-fairness we should not
undermine the development of effective culture-spe-
cific evaluation tools. Frustrated by their seeming
inability to develop culture-fair equivalents of tradi-
tional educational and psychological measures, some
test developers atternpted to develop tests that were
culture specific; the assumption here being that a test
developed exclusively for members of the minority
groups might yield a more valid measure (Anastasi,
1988).
Culture-specific evaluation tools:
How useful are they?
Evans and Salim (1992) in a study conducted to find
out the cross-cultural usefulness of occupational therapy
assessments with clients with schizophrenia in Tanza-
nia, Africa, concluded that the most effective way to
measure performance dysfunction was through the
use of culture-specific tests. In their study, they used a
daily activity, work, and leisure activity interview
based on the Model of Human Occupation (Kielhofner,
1985) and the Schroeder, Block, Campbell Adult
Psychiatric Integration Evaluation(SBC) (Schroeder,
Block, Trottier, & Campbell, 1978). But both of these
tools were found to show their North American bias in
the form of test itern inappropriateness. I3ut the cul-
ture-specific Zanzibar functional activity test (Evans &
Salim,1992) designed for the Tanzanian population
was found to be more valuable in the form of its
consistency with their material culture and sex-role
expectations.
A study by Spadone (1992) which examined ethnic
group differences with the use of the Model of Human
Occupation (Kielhofner, 1985) between first genera-
tion immigrants from Thailand & Cambodia and white
Americans has brought mixed results. The study com-
pared internal and external control and temporal
orientation among southeast Asians and white Ameri-
cans. No differences could be established for locus of
control between any of these groups but differences in
temporal beliefs were found between Thai and white
Americans. Miller (1992) from her experience in work-
ing with Cambodian orphan children pointed out that
she was unable to use standardized tests such as Birth
to Three, and the Peabody Test for Motor Develop-
ment with Cambodian children. The Cambodian or-
phan children were physically and environmentally
deprived. These children did not meet the motor
development norms standardized on the North Ameri-
can children. They were unfarniliar with typical toys
AOÛT 1995 • 157
 CJOT
used in paediatrics in North Arnerica (balls, blocks,
markers, Rubik's cube, stacking toys, and puzzles).
Miller developed an alternative questionnaire and
format in order to fit their needs (Orphan checklist,
Miller 1992). Evans and Salim (1992) warn that even
qualitative methods, such interviewing, should not
be scored according to assumptions about human
adaptations to time, self-will, and control that are not
universal. They encourage investigators, theorists and
therapists to design evaluation and treatment strategies
that are congruent with specific populations. Consid-
ering the experiences of these researchers it may be
appropriate for occupational therapists to develop
culture-specific tests and evaluation tools rather than
developing culture fairness in tests and evaluation
tools.
Can we use standardized tests and
evaluation tools with different populations?
With respect to the application of tests, it has been
argued that tests are often useless as predictors of
behaviour, that they are unfair to minority groups, that
the results are frequently misinterpreted and misused,
and that they promote a narrow and rigid classification
of people according to supposedly static characteris-
tics (Aiken, 1991). Much of the concern centres on the
differences in the test scores brought about by various
cultural conditions of minority group members. How-
ever, some of the proposed solutions for this problem
reflect misunderstandings about the nature and func-
tion of evaluation tools. Differences in the experiential
backgrounds of groups of individuals are inevitably
manifested in test perfortnance. Every evaluation tool
measures a behaviour (performance) sample. In so far
as culture affects behaviour, its influence will and
should be detected by evaluation tools. If all cultural
differentials from an evaluation tool are ruled out its
validity as a measure of the behaviour domain it was
designed to assess tnay be lowered. In that case, the
evaluation tool will fail to provide the kind of informa-
tion needed to correct the very condition that impaired
performance. When combined with information about
experiential background, test scores should facilitate
effective planning for the optimal development of the
individual.
Tests and evaluation tools are not necessarily en-
emies of minority groups. Tests assessing discrete
sensorirnotor component skills such as range of mo-
tion and muscle strength evaluations may 1De used
across cultures. l3ut we should keep in mincl that
evaluation tools measuring such discrete component
skills can also produce inaccurate data. For example,
a grip strength evaluation using the JAMAR hand
dynamometer which is standardized on a North Atneri-
can sample may not hold true for an East Asian
immigrant. If tools measuring such discrete sensorimo-
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VOLUME 62 NO 3
tor components can produce inaccurate data, more
complex ADL, IADL, and other functional performance
evaluations developed for the mainstrearn North Ameri-
can population add questions of credibility if tised with
diverse cultural populations. Society in Canada and the
United States is diverse. Because of the diversity
involved, one suggested method is to use the tools
normed on the dominant culture but apply them very
cautiously since the client may not match the expecta-
tions of the testing tool. Anastasi (1988, p.66) com-
mented that, "To conceal the effects of cultural differ-
ences by rejecting tests or by trying to devise tests that
are insensitive to such effects can only retard progress
toward a genuine solution of social problems". The fact
that undernourished children weigh less than those
who are well fed hardly builds a case for banning
scales. In the same vein, Clifford, an African-American
educator, stated that "To disparage tests for revealing
inequalities is as erroneous as for the residents of
Bismarck, North Dakota, to condemn the use of
thermometers as biased because when it was -11
degrees there, it was 73 degrees in Miami, Florida"
(Clifford & Fishman, 1963, p.87). Tests can provide a
safeguard against decisions informed by social stereo-
types and prejudice. Tests should be used as an aid to
understanding clients. Therapists choosing to use a
standardized evaluation tool on a different population
need to take an individual's sociocultural background
into consideration in interpreting its score. For ex-
arnple if a therapist uses a North American devised
kitchen evaluation in order to measure a cooking task
with an Indo-Canadian woman, the therapist should
take into consideration the client's cooking habits,
familiarity with different North American dishes, famil-
iarity with North Arnerican kitchen set up, and various
kitchen appliances. If not, the therapist runs the risk of
misinterpreting her cooking skills. If the client is not
familiar with North American kitchen set up and North
American style cooking, a simple orientation to North
American kitchen set up, utensils and appliances could
minimize the misinterpretation of her skill level. On the
other hand, simply asking her to cook a traditional
Indian dish could assess her cooking skills more
effectively.
One possible reason for difficulties encountered by
therapists in using tools normed on the dorninant
culture is problems with following the instructions and
cautionary notes. Those who use tests are cautioned to
interpret test scores in the light of a variety of factors,
such as sex, age, race, language, and socio-economic
status. Inevitably some users treated test scores as
absolute determinations about individuals or groups
(Gregory, 1992). Examiners from different cultural
backgrounds use different social and cultural norms
and expectations while assessing individuals. The
definition of functional independence and appropriate
 CJOT • VOLUME 62 • NO 3
behaviour may vary in different cultural groups. For
example, a husband with spinal cord injury expecting
his wife to attend to all his ADL needs, may be
considered normal in eastern cultures whereas it may
be considered as over-dependence in western cul-
tures. Van de Vijver and Poortinga (1991) pointed out
that the bias in various evaluation tools and tests
resides not in thern but in those who interpret the
scores regarding them as an absolute determination of
whatever it is that they are measuring. Such costly
mistakes can be greatly redt iced by gaining knowledge
about, awareness of and exposure to different cultural
minority groups within the North American society.
Occupational therapy and cultural
awareness
The holistic nature of occupational therapy encour-
ages therapists to respond to all the needs of a client
including sociocultural traits that may affect evaluation
and treatment (Skawski, 1987). As a society becomes
multicultural, its various minority populations demand
recognition. They demand cultural cornpetence in
health professionals. Recognizing the urgency of this
situation our leaders such as Mirkopoulos & Evert
(1994) and Dyck (1989) both from Canada and the
United States encourage all therapists to explore
multicultural values and strive to enhance awareness
and sensitivity toward other cultures. Cultural compe-
tence is defined as an awareness of, sensitivity to, and
knowledge of the rneaning of culture, and the differ-
ences between different cultural groups (Dillard, et al.,
1992). Terms such as culturally disadvantaged, or
culturally deprived have to be used very cautiously
since they have value implications. No one has the
right to degrade a subculture that does not conform to
the patterns of the majority group. Certain behaviours
in minority groups may be both healthy and justified,
because life conditions of these groups differ remarkedly
from those of the dominant culture (Silva, 1993). We
also should not view culture as a fixed, static, or natural
phenomenon. Cultural characteristics such as colour,
national origin, or ethnic identification are not static or
stereotypical. In fact, culture is dynamic and ever
changing. For example, the second generation immi-
grants of various cultural groups identify themselves as
part of the main stream North American society.
Occupational therapists have a responsibility to
develop an awareness by being open to inspection of
their own culture and developing an interest and
knowledge base about other cultures. Education about
different cultural groups in the curricula of profes-
sional schools is needed to enhance the multicultural
knowledge of future therapists. Multicultural knowl-
edge is gained by a thorough understanding about
values, beliefs and customs of different cultural minori-
ties (Fitzgerald, 1992). Studying the self-reported
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multicultural competency of a group of occupational
therapy clinicians, Pope-Davis, Prieto, Whitaker, &
Pope-Davis (1993) found a significant positive correla-
tion between their multicultural competencies and
participation in multicultural seminars and workshops,
percentage of minority clients with whom they worked,
and multicultural course work. Other suggestions
include: multidisciplinary case conferences with atten-
tion to the client's culture, consultation with staff from
other cultures, staff education on specific issues, and
an active consideration of all clients' sociocultural
background both during the assessment and treatment
planning process. 13y accepting and understanding
clients' customs and values clinicians have a better
chance of assessing and producing more effective
outcomes. Evaluation tools can indeed be misused in
testing cultural minorities. When properly used, how-
ever, they serve an important function in preventing
irrelevant and unfair discrimination. A realistic way of
reducing culturally biased interpretations of standard-
ized tests is to use them with sufficient knowledge of
the clients' cultural background. Even qualitative mea-
surernent tools such as, the Quality of Life Interview
(Lehman, 1988) and the Play History (Behnke &
Fetkovich, 1984) can be reliably used if the examiners
possess adequate knowledge about different cultures.
Perhaps a thorough appreciation of the cultural differ-
ences of the clientele in places like Toronto and New
York or for that matter any major North American city,
should lead to the production of enough information
to rninimize bias in interpretation of standardized
occupational therapy evaluation tools.
Summary
Occupational therapy has incorporated western middle-
class values into its theory and practice. Most of our
evaluation tools and assessment procedures are based
on the sociocultural norms of a white middle-class
population. In recent years there has been an influx of
immigrant groups moving to Canada and the United
States. Therapists of different ethnic and racial back-
grounds are also increasing in number. However the
majority of occupational therapists currently practicing
in North America continue to be white and middle-
class. It is likely that most of these occupational
therapists will encounter clients from cultures with
value orientations that challenge or reject the type of
therapy routinely offered in Canada and the United
States.
In response to the growing demands of a multicultural
population, various branches of health professions
have begun reassessing the needs of culturally distinct
clients. Accurate evaluation is the first step to effective
treatment provision. However the relationship of cul-
tural background to occupational therapy evaluation
procedure and treatment planning are not well
AOCIT 1995 • 159
 CJOT • VOLUME 62 • NO 3
articulated in occupafional therapy literature. Recog-
nizing this situation many occupational therapy educa-
tors and researchers have called for revision of existing
occupational therapy evaluation tools and measure-
ment methods and the need for new evaluation tools
for usage across different cultural populations. But
continued effort to develop culture-fair evaluation
tools has proven to be largely unsuccessful due to
many sociocultural variables. Recognizing the com-
plexities involved in developing culture-fair tests some
researchers opted for the choice of developing culture-
specific evaluation tools as opposed to misinterpreting
the evaluation results with culturally distinct clients.
In the process of providing holistic treatment,
occupational therapists may eniploy various presently
available evaluation tools and assessment methods
normed on the dominant culture with various different
populations. Lack of awareness about distinct cultures
may lead to possible misinterpretation of evaluation
results which may further lead to incongruity between
the client and therapist in goal setting and treatment.
A sufficient knowledge about the clients' culture can
reduce the possibility of such misinterpretations. Con-
sidering the complexities involved in developing evalu-
ation tools perhaps a realistic way of utilizing presently
avaliable occupational therapy evaluation tools is to
continue to use them with culturally distinct clients
while taking their sociocultural background into con-
sideration. In cases where it is impossible to use
standardized evaluation tools, it is advisable to de-
velop more culture-specific evaluation tools rather
than misinterpreting the culture of the clients.
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