Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population.
BACKGROUND
Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems 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 (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). 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.
Division of General Internal Medicine, University of California, San Francisco, CA 94143-1364, USA.
Rachel J
RJ
Stern
Alicia
A
Fernandez
Elizabeth A
EA
Jacobs
Torsten B
TB
Neilands
Robert
R
Weech-Maldonado
Judy
J
Quan
Adam
A
Carle
Hilary K
HK
Seligman
D000293:Adolescent; D000328:Adult; D003142:Communication; D054521:Cultural Competency; D003625:Data Collection / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006293:Health Promotion; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000208:ethnology; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D055815:Young Adult