An important aspect of medical care is clear and effective communication
, which can be particularly challenging for individuals based on race/ethnicity
. Quality of communication
is measured systematically in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS
) survey, and analyzed frequently such as in the National Healthcare Disparities Report. Caution is needed to discern differences in communication
quality from racial/ethnic differences in perceptions about concepts or expectations about their fulfillment.
To examine assumptions about the degree of commonality across racial/ethnic groups in their perceptions and expectations, and to investigate the validity of conclusions regarding racial/ethnic differences in communication
We used 2007 HCAHPS
data from the National CAHPS Benchmarking Database to construct racial/ethnic samples that controlled for other patient characteristics (828 per group). Using multiple-groups confirmatory factor analyses, we tested whether the factor structure and model parameters (ie, factor loadings, intercepts) differed across groups.
We identified support for basic tests of equivalence across 7 racial/ethnic groups in terms of equivalent factor structure and loadings. Even stronger support was found for Communication
with Doctors and Nurses. However, potentially important nonequivalence was found for Communication
about Medicines, including instances of statistically significant differences between non-Hispanic whites and non-Hispanic blacks, Asians, and Native Hawaiian/other Pacific Islanders.
Our results provide strongest support for racial/ethnic comparisons on Communication
with Nurses and Doctors, and reason to caution against comparisons on Communication
about Medicines due to significant differences in model parameters across groups; that is, a lack of invariance in the intercept.