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的测量结直肠癌（CRC）筛查和适当的生活方式行为对于降低CRC相关的发病率和死亡率至关重要。与非拉丁裔白人相比，拉丁裔的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丁美洲人在接受和遵循医生建议的结肠直肠癌筛查和生活方式改变方面面临文化和语言障碍。许多医生缺乏必要的技能和知识来弥合文化和语言差异，以有效地建议拉丁裔患者定期进行结直肠癌筛查和其他相关的生活方式改变，以降低结直肠癌的风险。许多文化、家庭和社会经济因素可以影响拉丁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，可能有助于激励他们的拉丁裔患者进行积极的CRC筛查和改变生活方式。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，以确定是否提供更多文化上合格的护理可以提高拉丁裔患者的CRC筛查率，以及患者-医生对结直肠癌筛查和相关生活方式改变的讨论。本横断面研究的具体目的是：1)基于来自拉丁美洲人的关于文化如何影响医疗遭遇的现有定性数据，开发调查项目来操作代表文化和语言能力的构式；2)对250名55岁及以上的英语和西班牙语拉丁裔普通医学患者进行预测和修订，并进行实地测试；3)对这些措施进行心理测量分析，得出一套推荐的调查措施；4)评估文化能力指标是否能预测结直肠癌筛查以及患者与提供者对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，与其他国家癌症研究所（NCI）资助的研究不同，因为它将在拉丁裔患者样本中产生有效和可靠的患者报告的文化能力测量，并将尝试将文化和语言能力的特定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，并且如果文化能力的特定维度可以预测拉丁美洲人的结直肠癌筛查，我们将继续进行一项更大的研究来测试这些措施，并使用纵向设计来评估它们与其他不同种族群体癌症筛查的关系。这项未来研究的结果将为文化和语言能力的具体组成部分提供经验证据，这些组成部分可以预测不同种族患者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.