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Factor Structure of the Cultural Competence Items in the National Home and Hospice Care Survey

AbuDagga, Azza MHA, PhD*; Mara, Constance A. MA, PhD†,‡; Carle, Adam C. MA, PhD‡,§,∥; Weech-Maldonado, Robert MBA, PhD

doi: 10.1097/MLR.0000000000000714
Applied Methods: PDF Only

Background: There is a need for validated measures of cultural competency practices in home health and hospice care (HHHC).

Objective: To establish the factor structure of the cultural competency items included in the agency-component of the 2007 public-use National Home and Hospice Care Survey file.

Data Source: We used weighted survey data from 1036 HHHC agencies.

Research Design and Participants: We used exploratory factor analyses to identify a preliminary factor structure, and then performed confirmatory factor analysis to provide further support for identified factor structure.

Measures: We examined 9 cultural competency items.

Results: Exploratory factor analyses suggested an interpretable 2-factor solution: (1) the provision of mandatory cultural competency training; and (2) the provision of cultural competency communication practices. Each factor consisted of 3 items. The remaining 3 items did not load well on these factors. A similar, but more restrictive, confirmatory factor analysis model without cross-loadings supported the 2-factor model: χ2 8=9.50, P=0.30, root mean square error of approximation (RMSEA)=0.01, comparative fit index (CFI)=0.99, Tucker-Lewis Index (TLI)=0.99.

Conclusions: Two constructs with 3 items each appeared to be internally valid measures of cultural competency in this nationally representative survey of HHHC agencies: cultural competency training and cultural competency communication practices. These measures could be used by HHHC managers in quality improvement efforts and by policy makers in monitoring cultural competency practices.

*Health Research Group, Public Citizen, Washington, DC

Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center

Department of Pediatrics, College of Medicine, University of Cincinnati

§James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center

Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH

Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL

The authors declare no conflict of interest.

Reprints: Azza AbuDagga, MHA, PhD, Health Research Group, Public Citizen, 1600 20th Street NW, Washington DC 20009. E-mail:

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