THE DEVELOPMENT OF A TOOL TO ASSESS INDIVIDUAL PROVIDER'S CULTURAL COMPETENCE Public Deposited

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Last Modified
  • March 20, 2019
Creator
  • Thaker, Samruddhi
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • This study examined the validity of the policy-driven notion that patient centeredness, patient-doctor relationship, patient-doctor communication, and cultural competency represent four distinct but related domains of patient experience of care. Guided by the quality of the service experience framework, I proposed an alternative conceptualization that these domains are empirically highly related with each other and can be conceptualized as the one-dimensional construct of patient experience of the interpersonal aspects of care. Twenty-four items from the Commonwealth Fund 2001 Health Care Quality Survey were identified as measures of the four domains. Two measurement models -- four-factor and one-factor models -- were developed to represent the alternative conceptualizations. Using structural equation modeling techniques, data drawn from the Commonwealth Fund 2001 Health Care Quality Survey were analyzed to examine the factor structure underlying these items. Findings provide strong evidence that patient centeredness, patient-doctor relationship, patient-doctor communication, and cultural competency are empirically highly related and can be conceptualized as a one-dimensional construct. This one-domain conceptualization holds across males and females and across four racial/ethnic groups for the English-proficient population. It also holds for the non-English speaking/Limited English-proficient population. Construct validity of this one-domain conceptualization was supported by evidence of positive association between measures of the four domains and measures of access to care and healthcare outcomes. Drawing upon the quality of the service experience framework, I conclude that the four domains -- patient centeredness, patient-doctor relationship, patient-doctor communication, and cultural competency -- can be conceptualized as the patient experience of the interpersonal aspects of care. The measures of the four domains form a 10-item and 11-item one-dimensional scale for English-proficient and non-English speaking/Limited English-proficient populations, respectively. This scale demonstrated adequate internal consistency reliability. Taken together, the consistency of findings suggests that the one-domain conceptualization of patient centeredness, patient-doctor relationship, patient-doctor communication, and cultural competency is valid and has considerable generality. Policymakers and program developers and evaluators should define, conceptualize, and measure the four domains as the patient experience of the interpersonal aspects of care. Future studies should replicate the validity of this one-domain conceptualization and examine the dimensionality and psychometric properties of the scale.
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  • In Copyright
Advisor
  • Fried, Bruce
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2008
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