By Edward T. Rincón, Ph.D.
It is a common situation faced by healthcare providers today. A patient, unable to communicate well in English, arrives for treatment and often waits longer than other patients to receive treatment, may not fully understand the treatment that they are receiving, and sometimes brings a different set of cultural values and experiences with health care providers. Depending on the language and staffing support available, the outcome for the patient becomes a risky situation.
As the Affordable Health Care Act expands its reach into American homes, medical professionals will be faced with a more diverse group of patients that are likely to challenge their use of traditional treatment approaches.
Many of these new patients are likely to communicate better in a language other than English, and may have cultural or religious values that conflict with medical advice. To evaluate how well health care providers are serving their respective communities, the federal government came up with a great idea – to conduct periodic surveys of community members to assess their satisfaction and experiences with healthcare providers.
This community feedback, in turn, would be used to improve the quality of healthcare services across all communities. Great concept, but my experience in survey research tells me that there is a major roadblock lurking down the road.
This roadblock, in my opinion, lies with a survey industry that has failed to update its practices to the needs of our rapidly changing population. Let me share with you six disturbing trends that I believe should concern healthcare providers as they attempt to capture feedback from our diverse communities:
- Opinion polls or surveys are still conducted primarily in English, despite the fact that more than half of U.S Latino and Asian adults prefer to communicate in their native language. Immigrants, in particular, may know some English but they comprehend medical terminology much better in their native language.
- Most survey respondents are provided only one mode (mail, telephone or online) to complete a survey, a practice that unnecessarily excludes persons who lack access to a telephone or the Internet, or have a limitation that prevents them from reading, speaking or hearing well. A mixed-mode methodology that offers all three modes in one survey is the best solution.
- When selecting Latinos, African Americans and Asians in community surveys, pollsters often select zip codes where these groups are highly concentrated, a practice that over-represents the poor and less educated community members.
- Considerable uncertainty remains about the use of race-ethnic labels, such as black or African American, Hispanic or Latino, Asian or more specific countries of origin. The careless use of race or ethnic labels can offend respondents, lead to classification errors, and discourage survey participation.
- Lacking the required staff, polling companies have grown accustomed to out-sourcing surveys to low-wage shops in foreign countries with little knowledge about U.S. brand names, institutions, and geography.
- The survey industry is being saturated by “pseudo” survey companies – that is, telemarketers and call centers – that are passing themselves off as professional survey companies. While they provide the needed language support, such companies have little or no training in survey research methodology.
- And lastly, our academic institutions have contributed to the maintenance of these trends because they have failed to update their research courses with more contemporary knowledge about best practices in designing surveys for diverse communities.
Of course, these trends are impacting the quality of the information produced by surveys in many industries other than healthcare. However, since the stakes for our quality of life are clearly greater in matters that affect community health, it is imperative that all stakeholders – including healthcare providers, survey companies, and academic institutions – raise the bar a little higher in surveys that target diverse communities.
Edward T. Rincón, Ph.D. is a research psychologist with Rincón & Associates LLC, a research firm that specializes in studies of U.S. multicultural populations. His research interests have focused on the biases associated with high-stakes measurement systems. He may be contacted at firstname.lastname@example.org