Application of the Spanish-Language Consultation and Relational Empathy (CARE) Measure to Assess Patient-Centered Care Among Latino Populations

Abstract

Introduction:

Reliable and valid measures are needed to assess the patient-centeredness of clinical care among Latino populations.

Methods:

We translated the Consultation and Relational Empathy (CARE) measure from English to Spanish and assessed its psychometric properties using data from 349 Latino parents/guardians visiting a pediatric clinic. Using confirmatory factor analysis, we examined the psychometric properties of the Spanish CARE measure.

Results:

Internal reliability of the Spanish CARE measure was high (Omega coefficient = 0.95). Similar to the English-language CARE measure, factor analysis of the Spanish CARE measure yielded a single domain of patient-centeredness with high item loadings (factor loadings range from 0.79 to 0.96).

Conclusion:

This preliminary analysis supports the reliability and validity of the Spanish version of the CARE measure among Latinos in pediatric care settings. With further testing, the Spanish CARE measure may be a useful tool for tracking and improving the health care delivered to Latino populations.

Keywords

Hispanic Americans methodology and measurement psychometric evaluation of translated and adapted surveys quality of care Spanish

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References

Alegría

Sribney

Perez

Laderman

Keefe

(2009). The role of patient activation on patient–provider communication and quality of care for US and foreign born Latino patients. Journal of General Internal Medicine, 24, 534–541.

Attanasio

Kozhimannil

K. B.

(2015). Patient-reported communication quality and perceived discrimination in maternity care. Medical Care, 53, 863–871.

Beal

Hernandez

Doty

(2009). Latino access to the patient-centered medical home. Journal of General Internal Medicine, 24(Suppl 3), 514–520.

Betancourt

J. R.

(2003). Cross-cultural medical education: Conceptual approaches and frameworks for evaluation. Academic Medicine, 78, 560–569.

Bikker

A. P.

Fitzpatrick

Murphy

Forster

Mercer

S. W.

(2017). Assessing the Consultation and Relational Empathy (CARE) measure in sexual health nurses’ consultations. BMC Nursing, 16(71), 1–9.

Bikker

A. P.

Fitzpatrick

Murphy

Mercer

S. W.

(2015). Measuring empathic, person-centred communication in primary care nurses: validity and reliability of the consultation and relational empathy (CARE) measure. BMC Family Practice, 6(149), 1–9.

Blair

I. V.

Havranek

E. P.

Price

D. W.

Hanratty

Fairclough

D. L.

Farley

Hirsh

H. K.

Steiner

J. F.

(2013). Assessment of biases against Latinos and African Americans among primary care providers and community members. American Journal of Public Health, 103, 92–98.

Blair

I. V.

Steiner

J. F.

Fairclough

D. L.

Hanratty

Price

D. W.

Hirsh

H. K.

Wright

L. A.

Bronsert

Karimkhani

Magid

D. J.

Havranek

E. P.

(2013). Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Annals of Family Medicine, 11, 43–52.

Brown

J. D.

Wissow

L. S.

Cook

B. L.

Longway

Caffery

Pefaure

(2013). Mental health communications skills training for medical assistants in pediatric primary care. The Journal of Behavioral Health Services & Research, 40, 20–35.

10.

Christensen

A. L.

Brown

J. D.

Wissow

L. S.

Cook

(2016). Spillover of ratings of patient-and family-centered care. Journal of Ambulatory Care Management, 39, 308–315.

11.

DeCamp

L. R.

Choi

Davis

M. M.

(2011). Medical home disparities for Latino children by parental language of interview. Journal of Health Care for the Poor and Underserved, 22, 1151–1166.

12.

Derose

K. P.

Baker

D. W.

(2000). Limited English proficiency and Latinos’ use of physician services. Medical Care Research and Review, 57, 76–91.

13.

Dovidio

J. F.

Kawakami

Gaertner

S. L.

(2002). Implicit and explicit prejudice and interracial interaction. Journal of Personality and Social Psychology, 82(1), 62–68.

14.

Epstein

R. M.

Fiscella

Lesser

C. S.

Stange

K. C.

(2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29, 1489–1495.

15.

Epstein

R. M.

Franks

Fiscella

Shields

C. G.

Meldrum

S. C.

Kravitz

R. L.

Duberstein

P. R.

(2005). Measuring patient-centered communication in patient–physician consultations: theoretical and practical issues. Social Science & Medicine, 61, 1516–1528.

16.

Fung

C. S.

Hua

Tam

Mercer

S. W.

(2009). Reliability and validity of the Chinese version of the CARE measure in a primary care setting in Hong Kong. Family Practice, 26, 398–406.

17.

Hasnain

Schwartz

Girotti

Bixby

Rivera

, & UIC Experiences of Care Project Group. (2013). Differences in patient-reported experiences of care by race and acculturation status. Journal of Immigrant and Minority Health, 15, 517–524.

18.

Haverfield

M. C.

Tierney

Schwartz

Bass

M. B.

Brown-Johnson

Zionts

D. L.

Safaeinili

Fischer

Shaw

J. G.

Thadaney

Piccininni

Lorenz

K. A.

Asch

S. M.

Verghese

Zulman

D. M.

(2020). Can patient-provider interpersonal interventions achieve the quadruple aim of healthcare? A systematic review. Journal of General Internal Medicine, 35(7), 2107–2117.

19.

Hemmerdinger

J. M.

Stoddart

S. D.

Lilford

R. J.

(2007). A systematic review of tests of empathy in medicine. BMC Medical Education, 7(24), 1–8.

20.

Bentler

P. M.

(2009). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.

21.

Hudon

Fortin

Haggerty

J. L.

Lambert

Poitras

M. E.

(2011). Measuring patients’ perceptions of patient-centered care: A systematic review of tools for family medicine. Annals of Family Medicine, 9, 155–164.

22.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

23.

Johnson

R. L.

Roter

Powe

N. R.

Cooper

L. A.

(2004). Patient race/ethnicity and quality of patient-physician communication during medical visits. American Journal of Public Health, 94, 2084–2090.

24.

Kline

R. B.

(2005). Principles and practice of structural equation modeling (2nd ed.). Guilford.

25.

Levinson

Lesser

C. S.

Epstein

R. M.

(2010). Developing physician communication skills for patient-centered care. Health Affairs, 29, 1310–1318.

26.

Mercer

S. W.

Maxwell

Heaney

Watt

G. C.

(2004). The Consultation and Relational Empathy (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice, 21, 699–705.

27.

Mercer

S. W.

Neumann

Wirtz

Fitzpatrick

Vojt

(2008). General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland—A pilot prospective study using structural equation modeling. Patient Education and Counseling, 73(2), 240–245.

28.

Mostow

Crosson

Gordon

Chapman

Gonzalez

Hardt

Delgado

James

David

(2010). Treating and precepting with respect: A relational model addressing race, ethnicity, and culture in medical training. Journal of General Internal Medicine, 25(Suppl 2), 146–154.

29.

Muthén

L. K.

Muthén

B. O.

(1998–2012). Mplus user’s guide (7th ed.). Muthén & Muthén.

30.

Ngui

E. M.

Flores

(2006). Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics, 117, 1184–1196.

31.

Ogur

Hirsh

(2009). Learning through longitudinal patient care-narratives from the Harvard Medical School-Cambridge Integrated Clerkship. Academic Medicine, 84, 844–850.

32.

Ogur

Hirsh

Krupat

Bor

(2007). The Harvard Medical School-Cambridge integrated clerkship: An innovative model of clinical education. Academic Medicine, 82, 397–404.

33.

Orom

(2016). Nativity and perceived healthcare quality. Journal of Immigrant and Minority Health, 18, 636–643.

34.

Rathert

Wyrwich

M. D.

Boren

S. A.

(2013). Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review, 70, 351–379.

35.

Rivadeneyra

Elderkin-Thompson

Silver

R. C.

Waitzkin

(2000). Patient centeredness in medical encounters requiring an interpreter. American Journal of Medicine, 108, 470–474.

36.

Scholl

Zill

J. M.

Härter

Dirmaier

(2014). An integrative model of patient-centeredness–a systematic review and concept analysis. PLoS One, 9(9), e107828.

37.

Street

R. L.

Jr Haidet

(2011). How well do doctors know their patients? Factors affecting physician understanding of patients’ health beliefs. Journal of General Internal Medicine, 26, 21–27.

38.

Tucker

C. M.

Marsiske

Rice

K. G.

Nielson

J. J.

Herman

(2011). Patient-centered culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3), 342–350.

39.

Wirtz

Boecker

Forkmann

Neumann

(2011). Evaluation of the “Consultation and Relational Empathy” (CARE) measure by means of Rasch-analysis at the example of cancer patients. Patient Education and Counseling, 82, 298–306.