Healthcare provider cultural competency: development and initial validation of a patient report measure.

OBJECTIVE: Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. DESIGN: Samples of predominantly African American patients (N=310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. MAIN OUTCOME MEASURES: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. RESULTS: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. CONCLUSION: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.     

A daily diary investigation of Latino ethnic identity, discrimination, and depression

The objectives of the current study were to document the effects of discrimination on Latino mental health and to identify the circumstances by which ethnic identity serves a protective function. Instances of discrimination and depressive symptoms were measured every day for 13 days in a sample of Latino adults (N = 91). Multilevel random coefficient modeling showed a 1-day lagged effect in which increases in depression were observed the day following a discriminatory event. The findings also revealed differential effects of ethnic identity exploration and commitment. Whereas ethnic identity exploration was found to exacerbate the influence of daily discrimination on next-day depression, ethnic identity commitment operated as a stress buffer, influencing the intensity of and recovery from daily discrimination. The findings are discussed within a stress and coping perspective that identifies appropriate cultural resources for decreasing the psychological consequences associated with daily discrimination.     

Predicting risk decisions in a modified Balloon Analogue Risk Task: Conventional and single-trial ERP analyses

Event-related potential (ERP) has the potential to reveal the temporal neurophysiological dynamics of risk decision-making, but this potential has not been fully explored in previous studies. When predicting risk decision with ERPs, most studies focus on between-trial analysis that reflects feedback learning, while within-trial analysis that could directly link option assessment with behavioral output has been largely ignored. Suitable task design is crucial for applying within-trial prediction. In this study, we used a modified version of the classic Balloon Analogue Risk Task (BART). In each trial of the task, participants made multiple rounds of decisions between a risky option (pump up the balloon) and a safe option (cash out). Behavioral results show that as the level of economic risk increased, participants were less willing to make a risky decision and also needed a longer response time to do so. In general, the ERP results showed distinct characteristics compared with previous findings based on between-trial prediction, particularly about the role of the P1 component. Specifically, both the P1 (amplitude and latency) and P3 (amplitude) components evoked by current outcomes predicted subsequent decisions. We suggest that these findings indicate the importance of selective attention (indexed by the P1) and motivational functions (indexed by the P3), which may help clarify the cognitive mechanism of risk decision-making. The theoretical significance of these findings is discussed.     

How Does More Attention to Subjective Well-Being Affect Subjective Well-Being?

There is an ongoing debate as to whether pursuing happiness is beneficial for people’s subjective well-being (SWB). To address this question, we tested whether attention to SWB – measured by participation in SWB surveys – is related to experienced SWB in two longitudinal studies. The initial study was conducted from November to December 2013 (N?=?129), and the replication study, three years later from November to December 2016 (N?=?120). The studies include two groups: one group (the control group) answered three SWB surveys over 4 weeks, and the other group (the experimental group) followed the same procedure but additionally tracked their SWB in detail using the experience sampling method four times a day and the day reconstruction method once a day using a smartphone application for two weeks to heighten their attention to their SWB. Both studies show higher SWB scores at later measurements compared to the first ones.