 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
David Thom, MD, PhD, Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 80/83, San Francisco, CA 94110, 415-206-4239, dthom@itsa.ucsf.edu and Miguel Tirado, PhD, Institute for Community Collaborative Studies, California State University, Monterey Bay, 100 Campus Center, Bldg 86D, Seaside, CA 93922.
BACKGROUND: Cultural competency training is being widely promoted as a means to improve the quality of health care for ethnic minorities. However, relatively little work has been done to develop a valid and reliable measure of cultural competency or to investigate the relationship between cultural competence and the quality of health care. METHODS: We developed a measure of physician cultural competence based on patient report of physician behaviors. Items for our measure were adapted from a set of surveys developed by one of us (Dr. Tirado) for assessing cultural competence in a managed care setting. Items were piloted, translated into Spanish and Chinese, and evaluated using English and Spanish-speaking focus groups. The final scale had 15 physician behavior items answered on a 5 point Likert scale (never, seldom, sometimes, usually, always). A companion survey asked physicians to self-assess how often they performed the same 15 behaviors. To validate our measure, we enrolled 53 primary care physicians and 423 patients age 40 and older with diabetes and/or hypertension from 4 practice sites and followed them for 12 to 18 months. Additional measures included patient and physician characteristics, patient trust, satisfaction, continuity with the physician, adherence to treatment, processes of care (e.g., testing, referral and education) and outcomes (blood glucose and blood pressure control). We evaluated the structure and internal reliability of the measure with primary components analysis, and construct validity using correlation coefficients. RESULTS: Factor analysis revealed a 3 factor structure with 2 items related to use of a translator (for patients with a language barrier), 5 items related to eliciting patient beliefs and preferences, and 8 items related to providing information and facilitating decision making. Internal reliability for the combined scale was 0.89 and item-scale correlations ranged form 0.48 to 0.74. Internal reliability for each subscale was good (Cronbach’s alpha of 0.75 to 0.88) and item-scale correlations were 0.48 to 0.78. When converted to a 0 to 100 scale, mean subscale scores were 32.2+25.7 for eliciting beliefs, 66.8+25.2 for providing information and 49.4+36.9 for use of translator. Construct validity was supported by the expected moderate correlation of cultural competency with patient trust (r=.41) and satisfaction (r=.59). Physician self-assessment of cultural competency was only slightly correlated with patient assessment (r=.06). CONCLUSION: Our new measure of physician cultural competency has 3 factors, reasonable psychometric properties and construct validity. Further analyses will be conducted to assess its predictive validity.
Learning Objectives:
Keywords: Cultural Competency, Assessments
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Not applicable
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.