Patient-reported Measures of Cultural and Linguistic Competence

描述(由申请人提供)：患者报告的文化和语言能力测量结直肠癌(CRC)筛查和适当的生活方式行为对于降低与CRC相关的发病率和死亡率至关重要。与非拉丁裔白人相比，拉丁裔结直肠癌筛查率较低，相关生活方式也较差。这可能部分是由于拉美裔在接受和贯彻医生关于结直肠癌筛查和改变生活方式的建议时面临的文化和语言障碍。许多医生缺乏必要的技能和知识，无法弥合文化和语言差异，无法有效地建议拉丁裔患者采用定期结直肠癌筛查和其他相关生活方式改变，以降低结直肠癌的风险。许多文化、家庭和社会经济因素都会影响拉美裔人群的结直肠癌筛查。医生对这些因素的敏感性，也被称为文化能力，可能有助于激励拉美裔患者进行积极的结直肠癌筛查和生活方式的改变。需要从患者的角度衡量卫生保健提供者的文化和语言能力，以确定提供更有文化能力的护理是否提高了拉丁裔患者的结直肠癌筛查率，以及患者与医生讨论结直肠筛查和相关生活方式的改变。这项横断面研究的具体目的是：1)基于拉丁裔关于文化如何影响医疗接触的现有定性数据，制定调查项目以运作代表文化和语言能力的概念；2)预测和修订项目，并在250名55岁及以上讲英语和西班牙语的拉丁裔普通医学患者中进行实地测试；3)对这些措施进行心理测量分析，以得出一套推荐的调查措施；以及4)评估文化能力指标是否可预测结直肠癌筛查以及患者与提供者之间关于结直肠癌筛查和相关生活方式行为的讨论。该项目具有创新性，不同于国家癌症研究所(NCI)资助的其他研究，因为它将产生患者报告的文化能力测量，这些测量在拉美裔患者样本中是有效和可靠的，并将试图将文化和语言能力的具体组成部分与所提供的癌症护理质量(即结直肠癌筛查)联系起来。如果这些措施被证明是可靠和有效的，如果文化能力的特定维度预测了拉丁裔的结直肠癌筛查，我们将继续进行一项更大的研究，以测试这些措施，并使用纵向设计评估它们与其他种族多元化群体的癌症筛查的关系。这项未来研究的结果将为文化和语言能力的特定组成部分提供经验证据，这些成分预测不同种族患者中更好的护理质量和癌症筛查结果。

DESCRIPTION (provided by applicant): 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.