UCSF

BACKGROUND: Patient-reported measures of clinicians' cultural sensitivity are important to assess comprehensively quality of care among ethnically diverse patients and may help address persistent health inequities. OBJECTIVE: Create a patient-reported, multidimensional survey of clinicians' cultural sensitivity to cultural factors affecting quality of care. DESIGN: Using a comprehensive conceptual framework, items were written and field-tested in a cross-sectional telephone survey. Multitrait scaling and factor analyses were used to develop measures. SETTING AND PARTICIPANTS: Latino patients age ≥50 from primary care practices in California. MAIN VARIABLES STUDIED: Thirty-five items hypothesized to assess clinicians' sensitivity. MAIN OUTCOMES MEASURES: Validity and reliability of cultural sensitivity measures. RESULTS: Twenty-nine of 35 items measuring 14 constructs were retained. Eleven measures assessed sensitivity issues relevant to all participants: complementary and alternative medicine, mind-body connections, causal attributions, preventive care, family involvement, modesty, prescription medications, spirituality, physician discrimination due to education, physician discrimination due to race/ethnicity and staff discrimination due to race/ethnicity. Three measures were group specific: two to limited English proficient patients (sensitivity to language needs and discrimination due to language) and one to immigrants (sensitivity to immigrant status). Twelve multi-item scales demonstrated adequate reliability (alpha ≥0.68 except for Spanish discrimination due to education) and evidence of construct validity (item-scale correlations for all scales >0.40 except for sensitivity to immigrant status). Two single-item measures demonstrated sufficient construct validity to retain for further development. DISCUSSION AND CONCLUSIONS: The Clinicians' Cultural Sensitivity Survey can be used to assess the quality of care of older Latino patients.