Document Type


Date of Degree Completion

Summer 2021

Degree Name

Master of Public Health (MPH)


Health Sciences

Committee Chair

Melody Madlem

Second Committee Member

Tishra Beeson

Third Committee Member

Amie Wojtyna



The hierarchy of the medical system and its lack of racial and cultural inclusiveness has created systematically inequitable healthcare with direct outcomes to health disparities. Inequitable non-inclusive healthcare perpetuated and negatively impacted health disparities among minorities and has been a major preventable public health problem. Research studies have established a correlation between racism and various adverse health outcomes, including higher mortality, lower rates of cancer screening, elevated blood pressure, higher C-reactive protein levels, substance use, and mental health conditions (Shavers et al, 2012). Measuring exposure to racism has been essential to establishing racism’s influence on equitable, inclusive healthcare and continues to be a research challenge.


To develop a tool for a Federally Qualified Healthcare Center (FQHC), Community Health of Central Washington, to assess racial and cultural inclusiveness within their organization.

Research Question:

This study aimed to answer the research questions: what are employee perceptions of racial and cultural inclusiveness within Community Health of Central Washington? How can these perceptions inform a customized survey instrument to measure racial and cultural inclusiveness in an FQHC organization?

Study Design:

A mixed-methods study of healthcare workers qualitatively gathered and analyzed data from 28 individual interviews of healthcare workers to inform and design a survey instrument to quantitatively measure cultural/racial inclusiveness within an FQHC setting. Four coders analyzed and gleaned interpretations from transcripts using the grounded theory approach.


Individual interviews identified five themes of racial and cultural inclusiveness from healthcare workers' collective experiences and perceptions. First, racism was a detractor in the healthcare setting and presented itself in many forms. Secondly, the ambiguity of policy surrounding racism detracted from transparent processes and procedures for addressing racism. Thirdly, cultural humility supported racial and cultural inclusion. Fourth, equity and language access have been critical to inclusive racial and cultural healthcare; lastly, empowerment and safety encouraged racial and cultural inclusiveness in a healthcare setting. The researcher used qualitative data from this study to develop a customized survey instrument.