Risk factors for reporting poor cultural competency among patients with diabetes in safety net clinics.
BACKGROUND
The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care.


OBJECTIVE
To determine characteristics of patients who identify the care they receive as less culturally competent.


METHODS
Cross-sectional survey consisting of face-to-face interviews.


METHODS
Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care.


METHODS
Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities.


RESULTS
In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined.


CONCLUSIONS
Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.
Division of General Internal Medicine, University of California, San Francisco, CA 94143-1364, USA. hseligman@medsfgh.ucsf.edu
Hilary K
HK
Seligman
Alicia
A
Fernandez
Rachel J
RJ
Stern
Robert
R
Weech-Maldonado
Judy
J
Quan
Elizabeth A
EA
Jacobs
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003142:Communication; D015897:Comorbidity; D003430:Cross-Sectional Studies; D054521:Cultural Competency; D003863:Depression / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult