Advances in measuring culturally competent care a confirmatory factor analysis of CAHPS-CC: In a safety-net population

Academic Article


  • 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 (X2 231 = 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 broadscale 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. Copyright © 2012 by Lippincott Williams & Wilkins.
  • Published In

  • Medical Care  Journal
  • Digital Object Identifier (doi)

    Author List

  • Stern RJ; Fernandez A; Jacobs EA; Neilands TB; Weech-Maldonado R; Quan J; Carle A; Seligman HK
  • Volume

  • 50
  • Issue

  • 9 SUPPL. 2