Division of General Internal Medicine, University of California, San Francisco, CA 94143-1364, USA.
Med Care. 2012 Sep;50(9 Suppl 2):S56-61. doi: 10.1097/MLR.0b013e3182640adf.
The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care.
To determine characteristics of patients who identify the care they receive as less culturally competent.
Cross-sectional survey consisting of face-to-face interviews.
Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care.
Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities.
In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined.
Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.
医疗保健提供者和系统文化能力评估工具集（Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set）评估患者对其医疗保健文化能力的各个方面的看法。
确定认为自己接受的护理文化能力较低的患者的特征。
横断面调查，包括面对面访谈。
接受持续初级保健的 2 型糖尿病患者的社会医疗服务人群（n=600）。
参与者完成了医疗保健提供者和系统文化能力评估工具集（Consumer Assessment of Healthcare Providers and Systems Cultural Competency），并回答了有关其种族/民族、性别、年龄、教育程度、健康状况、抑郁症状、保险覆盖范围、英语熟练程度、与初级保健提供者关系持续时间和合并症的问题。
在调整后的模型中，抑郁症状与医生沟通-积极行为领域的文化能力较差显著相关（比值比 1.73，95%置信区间，1.11-2.69）。非裔美国人报告医生沟通-积极行为领域文化能力较差的可能性低于白人（比值比 0.52，95%可信区间，0.28-0.97）。与初级保健提供者关系持续时间较长（≥3 年）的参与者报告在医生沟通-健康促进和信任领域文化能力较差的可能性较小（比值比 0.35，95%可信区间，0.21-0.60 和 0.4，95%可信区间，0.24-0.67），而受教育程度较低的参与者报告信任领域文化能力较差的可能性较小（比值比 0.51，95%可信区间，0.30-0.86）。然而，总体而言，在接受调查的文化能力各个领域，社会人口统计学和临床差异在文化能力较差的报告中并不显著或不一致。
在社会医疗服务环境中，文化能力干预措施应面向所有人群，而不是仅仅针对特定的社会人口统计学或临床群体。
