Does the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Survey Provide Equivalent Measurement Across English and Spanish Versions?

Abstract

The English and Spanish versions of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey (CAHPS-CC) assess patients' experiences with culturally competent care. The possibility exists that even when Spanish and English speakers experience the same levels of culturally competent care, responses describing their care may differ. This is called measurement bias. To deliver reliable and valid information across language, responses must provide equivalent measurement across both versions. In this study, we examined whether measurement bias on the CAHPS-CC impedes valid measurement across the English and Spanish versions. We used multiple group (MG) confirmatory factor analyses (CFA) to examine measurement bias across English (n=851) and Spanish (n=113) speakers. Participants came from a 2008 sample of 2 Medicaid managed care plans in New York and California. MG-CFA provided general support for the equivalence of the CAHPS-CC in measuring doctor communication-positive behaviors, doctor communication-negative behaviors, doctor communication-preventative care, equitable treatment, and trust. We did observe statistically significant differences in the thresholds associated with the item asking whether a doctor gave easier to understand instructions. However, analyses indicated that bias did not meaningfully influence conclusions about average experiences using the English and Spanish versions of the CAHPS-CC. Our results support the use of the English and Spanish versions of the CAHPS-CC. Though we found some bias, analyses demonstrated that it did not substantively impact conclusions for the studied domains. Health providers can place confidence in the 2 different CAHPS-CC translations.