The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence (CC) Item Set

Background: There is a need for reliable and valid measures of cultural competence (CC) from the patient's perspective. Objective: This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) CC item set. Research Design: Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using the Cronbach alpha's and examined the validity of the measures using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis. Subjects: A random stratified sample (based on race/ethnicity and language) of 991 enrollees, younger than 65 years, from 2 Medicaid managed care plans in California and New York. Measures: CAHPS CC item set after excluding screener items and ratings. Results: Confirmatory factor analysis (Comparative Fit Index = 0.98, Tucker Lewis Index = 0.98, and Root Mean Square Error or Approximation = 0.06) provided support for a 7-factor structure: Doctor Communication-Positive Behaviors, Doctor Communication-Negative Behaviors, Doctor Communication-Health Promotion, Doctor Communication-Alternative Medicine, Shared Decision-Making, Equitable Treatment, and Trust. Item-total correlations (corrected for item overlap) for the 7 scales exceeded 0.40. Exploratory factor analysis showed support for 1 additional factor: Access to Interpreter Services. Internal consistency reliability estimates ranged from 0.58 (Alternative Medicine) to 0.92 (Positive Behaviors) and was 0.70 or higher for 4 of the 8 composites. All composites were positively and significantly associated with the overall doctor rating. Conclusions: The CAHPS CC 26-item set demonstrates adequate measurement properties and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient's perspective.