Differences by Survey Language and Mode Among Chinese Respondents to a CAHPS Health Plan Survey

Published In: Public Opinion Quarterly, v. 76, no. 2, Summer 2012, p. 238-264

Posted on RAND.org on January 01, 2012

by Marc N. Elliott, W. Sherman Edwards, David J. Klein, Amy Heller

Read More

Access further information on this document at by Oxford University Press

This article was published outside of RAND. The full text of the article can be found at the link above.

As efforts to measure, compare, and report patients' health care experiences expand in scope and importance, corresponding efforts have been underway to expand the reach of the underlying survey instruments to patients who prefer languages other than English. One challenge in the expansion of these surveys to such populations, when comparing to English-preferring populations, is that there may be differences in (a) actual health care experiences; (b) expectations, cultural norms, and preferences regarding health care; and (c) survey response tendencies that are a function of cultural differences and/or the language of survey administration. We consider these issues in a quantitative case study of a single Medicare-managed care plan with predominantly Chinese enrollees. Of 961 sampled members, 481 responded to bilingual mailings (323 responding in English, 158 in Chinese) and 170 responded to bilingual telephone follow-up (151 in Chinese). Unadjusted scores showed notable differences by language; adjusted analyses showed few language/mode differences for "objective" items, but dramatic differences remained for subjective rating items, casting doubt on their appropriateness for cross-cultural comparisons. We provide some evidence that previously observed general population mode effects for this survey (telephone positivity) may not exist in the Chinese language. Additionally, we find some evidence that previously observed negative response tendencies among Asians in assessments of health care relative to non-Hispanic whites may not be consistent across languages of response, with more positive Chinese than English subjective ratings.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.