Measuring acculturation in Asian Indian Survey Respondents

J Immigr Minor Health. 2013 May 7. [Epub ahead of print]

Validity of Temporal Measures as Proxies for Measuring Acculturation in Asian Indian Survey Respondents.

Bharmal N, Hays RD, McCarthy WJ.

Abstract

There are few validated acculturation measures for Asian Indians in the U.S. We used the 2004 California Asian Indian Tobacco Survey to examine the relationship between temporal measures and eleven self-reported measures of acculturation. These items were combined to form an acculturation scale. We performed psychometric analysis of scale properties. Greater duration of residence in the U.S., greater percentage of lifetime in the U.S., and younger age at immigration were associated with more acculturated responses to the items for Asian Indians. Item-scale correlations for the 11-item acculturation scale ranged from 0.28-0.55 and internal consistency reliability was 0.73. Some support was found for a two-factor solution; one factor corresponding to cultural activities (α = 0.70) and the other to social behaviors (α = 0.59). Temporal measures only partially capture the full dimensions of acculturation. Our scale captured several domains and possibly two dimensions of acculturation.

Quigley, D. D., Martino, S. C., Brown, J. A., & Hays, R.D.  (in press).  Confirmation and supplementation of CAHPS® Clinician and Group Survey communication items using feedback from high-performing physicians.  The Patient: Patient­Centered Outcomes
Research.

ABSTRACT

Background. A doctor’s ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS®) Clinician and Group Survey is the standard for collecting and reporting information about patients’ experiences of care in the United States.

Objective. To evaluate how well CAHPS® Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication.

Data Sources/Study Setting. Eleven of the forty highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan.

Study Design. Data were obtained via semi-structured interviews. Specific behaviors, practices and opinions about doctor communication were coded and compared to the CG-CAHPS items.

Principal Findings. CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of non-verbal communication; greeting patients and introducing oneself; and tracking personal information about patients.

Conclusions. CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Non-verbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patient’s perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health care organizations improve doctor-patient communication and interactions.