Evaluating measurement equivalence across race and ethnicity on the CAHPS Cultural Competence Survey

The Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey assesses patients' experiences with culturally competent care. This study evaluates the equivalence of responses to this survey across different racial and ethnic subgroups. In this study, we examined whether measurement bias on the CAHPS Cultural Competence Survey impedes valid measurement across white, black, and Hispanic patients.

We used multiple group (MG) confirmatory factor analyses (CFA) to examine possible measurement bias across non-Hispanic white (n=146), non-Hispanic black (n=148), and Hispanic (n=339) adults. Participants came from 2 Medicaid managed care plans, one in New York and the other in California in 2008.

MG-CFA provided general support for the equivalence of the CAHPS Cultural Competence Survey in measuring doctor communication, health promotion, and perceived trust across groups. However, we observed statistically significant differences in the thresholds associated with the Doctor Communication--Positive Behaviors. Nevertheless, sensitivity analyses indicated that measurement bias did not meaningfully influence conclusions about average experiences with culturally competent care across non-Hispanic white, non-Hispanic black, and Hispanic patients in our sample.

Our results support the use of the CAHPS Cultural Competence Survey across non-Hispanic white, non-Hispanic black, and Hispanic patients. Though we found some statistically significant measurement bias, sensitivity analyses demonstrated that measurement bias does not substantively influence conclusions based on patients' responses. Health providers at various levels can place confidence in the CAHPS Cultural Competence Survey and use it in diverse populations to evaluate patients' experiences with culturally competent care.