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.