How responding in Spanish affects CAHPS results.

BACKGROUND: The most widely used surveys for assessing patient health care experiences in the U.S. are the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies examining the associations of language and ethnicity with responses to CAHPS surveys have yielded inconsistent findings. More research is needed to assess the effect of responding to CAHPS surveys in Spanish. METHODS: Subjects were patients who had received care at a study community health center in Connecticut within 6 or 12 months of being sent a CAHPS survey that asks about care experiences. The survey included four multi-item measures of care plus an overall rating of the provider. Sampled patients were mailed dual language (English and Spanish) cover letters and questionnaires. Those who did not respond after follow-up mailings were contacted by bilingual interviewers to complete the survey by telephone. We tested three hypotheses for any observed differences by ethnicity and language: 1. Spanish speakers are more likely than others to choose extreme response options. 2. The semantic meaning of the Spanish translation is not the same as the English version of the questions, resulting in Spanish speakers giving different answers because of meaning differences. 3. Spanish speakers have different expectations regarding their health care than those who answer in English. Analyses compared the answers on the survey measures for three groups: non-Hispanics answering in English, Hispanics answering in English, and Hispanics answering in Spanish. RESULTS: The overall response rate was 45%. After adjusting for differences in demographic characteristics and self-rated health, those answering in Spanish gave significantly more positive reports than the other two groups on three of the five measures, and higher than the non-Hispanic respondents on a fourth. CONCLUSIONS: Those answering in Spanish gave more positive reports of their medical experiences than Hispanics and non-Hispanics answering in English. Whether these results reflect different response tendencies, different standards for care, or better care experiences is a key issue in whether CAHPS responses in Spanish need adjustment to make them comparable to responses in English.

Patient perceptions of in-home urgent care via mobile integrated health.

OBJECTIVES: Emergency department (ED) crowding poses a severe public health threat, and identifying acceptable means of treating medical conditions in alternative sites of care is imperative. We compared patients' experiences with in-home urgent care via mobile integrated health (MIH) vs urgent care provided in EDs. STUDY DESIGN: Survey, completed on paper, online, or by telephone. We surveyed all patients who received MIH care for an urgent health problem (n = 443) and consecutive patients who visited EDs for urgent care (n = 1436). METHODS: Study participants were members of a managed care plan who were dually eligible for Medicare and Medicaid, 21 years or older, and treated either by MIH or in an ED for nonemergent conditions around Boston, Massachusetts, between February 2017 and June 2018. The survey assessed patients' perceptions of their urgent care experiences. RESULTS: A total of 206 patients treated by community paramedics and 718 patients treated in EDs completed surveys (estimated 66% and 62% response rates, respectively). Patients treated by MIH perceived higher-quality care, more frequently reporting "excellent" (54.7%) or "very good" (32.4%) care compared with ED patients (40.7% and 24.3%, respectively; P < .0001), and were significantly more likely to report that decisions made about their care were "definitely right" compared with patients treated in the ED (66.1% vs 55.6%; P = .02). CONCLUSIONS: Patients appear satisfied with receiving paramedic-delivered urgent care in their homes rather than EDs, perceiving higher-quality care. This suggests that in-home urgent care via MIH may be acceptable for patients with nonemergent conditions.

Comparing Web and Mail Protocols for Administering Hospital Consumer Assessment of Healthcare Providers and Systems Surveys.

OBJECTIVE: The objective of this study was to compare results of using web-based and mail (postal) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data collection protocols. RESEARCH DESIGN: Patients who had been hospitalized in a New England Hospital were surveyed about their hospital experience. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-alone, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed using postal mail only. Analyses compared response rates, respondent characteristics, and patient-reported experiences. SUBJECTS: For an 8-week period, patients were discharged from the study hospital to home. MEASURES: Measures included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and 2 ratings of the hospital. RESULTS: Response rates were significantly lower for the web-only protocol than the mail or combined protocols, and those who had not provided email addresses had lower response rates. Those over 65 were more likely than others to respond to all protocols, especially for the mail-only protocols. Respondents without email addresses were older, less educated, and reported worse health than those who provided email addresses. After adjusting for respondent differences, those in the combined protocol differed significantly from the mail (postal) only respondents on 2 measures of patient experience; those in the web-only protocol differed on one. Those not providing an email address differed from those who did on one measure. CONCLUSION: If web-based protocols are used for HCAHPS surveys, adjustments for a mode of data collection are needed to make results comparable.

Telephone health survey estimates: Effects of nonresponse and sample limitations.

OBJECTIVE: The objective of this study was to assess nonresponse error in telephone health survey data based on an address-based sample. DATA SOURCES: Telephone and in-person interviews in Greater Boston. STUDY DESIGN/DATA COLLECTION: Interviewers attempted telephone interviews at addresses that were matched to telephone numbers using questions drawn from federal health surveys. In-person household interviews were carried out with telephone nonrespondents and at addresses without matching telephone numbers. PRINCIPAL FINDINGS: After adjusting for demographic differences, only eight of 15 estimates based on the telephone interviews lay within two standard errors of the estimates when data from all three groups were included. CONCLUSIONS: For health surveys of address-based samples, many estimates based on telephone respondents differ from the total population in ways that cannot be corrected with simple demographic adjustments.

The science identity and entering a science occupation.

The initiative to increase the number of students in STEM disciplines and train them for a science-related job is a current national focus. Using longitudinal panel data from a national study that followed underrepresented college students in STEM fields, we investigate the neglected role that social psychological processes play in influencing science activity among the young. We study the impact of identity processes related to being a science student on entering a science occupation. More broadly, we examine whether an identity formulated in one institutional setting (education) has effects that persist to another institutional setting (the economy). We find that the science identity positively impacts the likelihood of entering a science occupation. It also serves as a mediator for other factors that are related to educational success. This provides insight into how an identity can guide behavior to move persons into structural positions across institutional domains.

Cross-National Trends in Religious Service Attendance.

The nature of religious change and the future of religion have been central questions of social science since its inception. But empirical research on this question has been quite American-centric, encouraged by the conventional wisdom that the United States is an outlier of religiosity in the developed world, and, more pragmatically, by the availability of survey data. The dramatic growth in the number and reach of cross-national surveys over the past two decades has offered a corrective. These data have allowed research on religious trends in the United States, Canada, and Europe, putting American trends into comparative relief. This research synthesis reviews the past quarter century of cross-national comparative survey research on religious behavior, focusing on religious service attendance as a commonly measured behavior that is arguably more equivalent across societies and cultures than other measures of religiosity. The lack of evidence for religious revival is highlighted, noting instead declining rates of attendance in the United States and Canada, and either declining rates or low "bottomed-out" stability in Western Europe, most of Eastern Europe, and Australia and New Zealand. Finally, countries in Latin America, Africa, and Asia are discussed to the extent that research allows, before a call for future research-in these places in particular-is made in order to correct for the Western and Christian focus of much of the research on cross-national religious trends.

Lies, Damned Lies, and Survey Self-Reports? Identity as a Cause of Measurement Bias.

Explanations of error in survey self-reports have focused on social desirability: that respondents answer questions about normative behavior to appear prosocial to interviewers. However, this paradigm fails to explain why bias occurs even in self-administered modes like mail and web surveys. We offer an alternative explanation rooted in identity theory that focuses on measurement directiveness as a cause of bias. After completing questions about physical exercise on a web survey, respondents completed a text message-based reporting procedure, sending updates on their major activities for five days. Random assignment was then made to one of two conditions: instructions mentioned the focus of the study, physical exercise, or not. Survey responses, text updates, and records from recreation facilities were compared. Direct measures generated bias-overreporting in survey measures and reactivity in the directive text condition-but the nondirective text condition generated unbiased measures. Findings are discussed in terms of identity.

The Causal Ordering of Prominence and Salience in Identity Theory: An Empirical Examination.

Identity theory invokes two distinct but related concepts, identity salience and prominence, to explain how the organization of identities that make up the self impacts the probability that a given identity is situationally enacted. However, much extant research has failed to clearly distinguish between salience and prominence, and their empirical relationship has not been adequately investigated, impeding a solid understanding of the significance and role of each in a general theory of the self. This study examines their causal ordering using three waves of panel data from 48 universities focusing on respondents' identities as science students. Analyses strongly support a causal ordering from prominence to salience. We provide theoretical and empirical grounds to justify this ordering while acknowledging potential variation in its strength across identities. Finally, we offer recommendations about the use of prominence and salience when measures of one or both are available or when analyses use cross-sectional data.