Advances in Measuring Culturally Competent Care

Abstract

Background Providing culturally competent care shows promise as a mechanism to reduce healthcare inequalities. Until the recent development of the CAHPS Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. Methods We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. Results A 7-factor model demonstrated satisfactory fit (χ2(231)=484.34, p<.0001) with significant factor loadings at p<.05. Three domains showed excellent reliability – Doctor Communication- Positive Behaviors (α=.82), Trust (α=.77), and Doctor Communication- Health Promotion (α=.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication- Negative Behaviors (α=.54), Equitable Treatment (α=.69), Doctor Communication- Alternative Medicine (α=.52), and Shared Decision-Making (α=.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. Conclusions Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.

Exploring the Impact of Health Care Provider Cultural Competence on New Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers

“…The CAHPS-CC® is noted to be a valid and reliable scale for assessing culturally competent care from the patient perspective (Stern et al, 2012;Weech-Maldonado et al, 2012). Weech-Maldonado et al (2012) confirmed the internal consistency of the original seven-factor CAHPS-CC® scale using Cronbach alphas, as well as its validity using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis.…”

“…Research has largely assessed health care providers' own perceptions of cultural competence and therefore offering biased judgments of self-perceived knowledge, skills, and attitudes (Kirmayer, 2012). This has slowed the development of patient-centered strategies aimed at improving the delivery of high-quality care (Stern et al, 2012). Understanding patients' perceptions of cultural competence is essential to improving engagement in health care services and health outcomes.…”

A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol

“…We expect an increase in satisfaction scores before and after the education sessions by 10% in post-HKTP based on prior studies [ 98 ]. Differences in CAHPS composite scores will then be compared between pre- and post-HKTP by each site using a two-sample t-test.…”

Risk Factors for Reporting Poor Cultural Competency Among Patients With Diabetes in Safety Net Clinics

“…(4) We present the three CAHPS-CC domains that were psychometrically sound among both English and Spanish speakers in our participant population. (2) These domains include Doctor Communication - Positive Behaviors (5 items), Doctor Communication - Health Promotion (4 items), and Trust (5 items).…”

“…We chose to examine the Doctor Communication – Positive Behaviors, Doctor Communication – Health Promotion, and Trust domains because these domains had acceptable psychometric properties in our participant sample based on the authors’ previous work. (2) The Doctor Communication – Positive Behaviors and Doctor Communication – Health Promotion domains measure aspects of patient-provider communication. Items in the Doctor Communication – Positive Behaviors domain ask patients the extent to which their provider exhibited various aspects of good communication, including explaining things in a way that is easy to understand, listening carefully, spending adequate time with you, and showing respect.…”