Over the past three decades, immigration to the United States of Asian Americans has risen by more than 400 percent. In fact, Asian Americans are one of the fastest growing minority groups in the country. Cultural beliefs, as well as linguistic and other barriers, make providing quality care for Asian Americans a unique challenge.
A study supported by the Agency for Healthcare Research and Quality (HS01316) is now under way to develop a culturally sensitive questionnaire for use in evaluating the quality of health care provided to Asian Americans of Chinese and Vietnamese descent. These patients include many new immigrants who have a low income and limited English proficiency.
Deeply held cultural beliefs can present barriers to quality health care, especially if providers lack sensitivity to these concerns. Also, the health beliefs of Asian Americans are unfamiliar to many American clinicians. For example, many Asian Americans believe that health reflects the balance of yin and yang, hot and cold elements, within the body. When experiencing an upper respiratory infection, they may follow the traditional custom of rubbing the body with oil and a coin to release the "cold" element, which may result in bruises along the spine and sternum. Western health care providers often mistake these bruises for indications of abuse or signs of hematologic diseases. To care for these patients effectively, providers must be able to communicate with them about such practices.
Finding out how these patients perceive the quality of care they receive is a first step in understanding their needs. Thus, the researchers are using patient reports and ratings of their experiences to develop a questionnaire that can accurately measure quality of care from the patient's perspective. They will use patient focus groups to identify specific questionnaire items that emphasize communication and access to care. The survey will be conducted in the patients' native language. The researchers will validate the questionnaire, pilot test it among Chinese and Vietnamese American patients at four provider sites, assess its validity for use in diverse regions, and then evaluate it in a national sample.
See "Patient-centered quality measures for Asian Americans: Research in progress," by Quyen Ngo-Metzger, M.D., M.P.H., Michael P. Massagli, Ph.D., Brian Clarridge, Ph.D., and others, in the July 2000 American Journal of Medical Quality 15(4), pp. 167-173.