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Advancing Health Disparities Research: Can We Afford to Ignore Measurement Issues?

Stewart, Anita L. PhD*†; Nápoles-Springer, Anna M. PhD*‡

doi: 10.1097/01.MLR.0000093420.27745.48
Original Articles

Background.  Research on racial and ethnic health disparities in the United States requires that self-report measures, developed primarily in mainstream samples, are appropriate when applied in diverse groups. To compare groups, mean scores must reflect true scores and have minimal bias, assumptions that have not been tested for many self-report measures used in this research.

Objective.  To identify conceptual and psychometric issues that need to be addressed to assure the quality of self-report measures being used in health disparities research.

Methods.  We present 2 broad conceptual frameworks for health disparities research and describe the main research questions and measurement issues for 4 key concepts hypothesized as potential mechanisms of health disparities: socioeconomic status, discrimination, acculturation, and quality of care. This article is based on a small conference convened by 6 Resource Centers for Minority Aging Research (RCMAR) measurement cores. We integrate written materials prepared for the conference by quantitative and qualitative measurement specialists and cross-cultural researchers, conference discussions, and current literature.

Results.  Problems in the quality of the conceptualizations and measures were found for all 4 concepts, and little is known about the extent to which measures of these concepts can be interpreted similarly across diverse groups. Many problems also apply to other concepts relevant to health disparities. We propose an agenda for accomplishing this challenging measurement research.

Conclusions.  The current national commitment to reduce health disparities may be compromised without more research on measurement quality. Integrated, systematic efforts are needed to move this work forward, including collaborative efforts and special initiatives.

From the *Center for Aging in Diverse Communities and Medical Effectiveness Research Center, University of California San Francisco, San Francisco, California.

From the †Institute for Health & Aging, University of California San Francisco, San Francisco, California.

From the ‡Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California.

Address correspondence and reprint requests to: Anita L. Stewart, PhD, Professor, University of California San Francisco, Institute for Health & Aging, Box 0646, San Francisco, CA 94143. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.