Patient-reported Measures of Cultural and Linguistic Competence

Investigator: Anna M. Napoles, PhD, MPH
Sponsor: NIH National Cancer Institute

Location(s): United States


Patient-reported Measures of Cultural and Linguistic Competence Colorectal cancer (CRC) screening and appropriate lifestyle behaviors are essential for reducing morbidity and mortality associated with CRC. Latinos have lower rates of colorectal cancer screening and poorer relevant lifestyle practices than their non-Latino White counterparts. This could partially be due to cultural and linguistic barriers Latinos face in receiving and following through on physician recommendations for colorectal cancer screening and lifestyle modification. Many physicians lack the necessary skills and knowledge to bridge cultural and language differences to effectively counsel Latino patients on adopting regular colorectal cancer screening and other relevant lifestyle changes to reduce the risk of colorectal cancer. Numerous cultural, family, and socioeconomic factors can affect CRC screening in Latino populations. Physicians' sensitivity to these factors, also referred to as cultural competence, may help motivate positive CRC screening and lifestyle changes in their Latino patients. Measures of cultural and linguistic competence of health care providers from the patient's perspective are needed to determine if providing more culturally competent care improves rates of CRC screening among Latino patients, and patient-physician discussion of colorectal screening and relevant lifestyle changes. The specific aims of this cross-sectional study are to: 1) based on existing qualitative data from Latinos pertaining to how culture affects the medical encounter, develop survey items to operationalize the constructs representing cultural and linguistic competence; 2) pretest and revise the items, and field test the survey among 250 English- and 250 Spanish-speaking Latino general medicine patients age 55 and older; 3) conduct psychometric analyses of the measures to derive a recommended set of survey measures; and 4) assess whether measures of cultural competence predict screening for colorectal cancer and patient-provider discussion of colorectal cancer screening and relevant lifestyle behaviors. This project is innovative and distinct from other National Cancer Institute (NCI)-funded research because it will result in patient-reported measures of cultural competence that are valid and reliable among a sample of Latino patients, and will attempt to link specific components of cultural and linguistic competence to the quality of cancer care provided (i.e., colorectal cancer screening). If the measures prove to be reliable and valid, and if specific dimensions of cultural competence predict colorectal screening among Latinos, we will proceed with a larger study to test the measures and assess their relationship to cancer screening in other ethnically diverse groups using a longitudinal design. Results of this future study will provide empirical evidence of the specific components of cultural and linguistic competence that predict better quality of care and cancer screening outcomes among ethnically diverse patients.