Article Title

Acculturation and Patient-Reported Experience With Health Care: An In-Depth Examination Using CG-CAHPS Surveys, Electronic Health Records, and Patient Surveys

Publication Date



communication, patients, providers, racial/ethnic differences in health and health care, patient experience/satisfaction


Background: Asians in the United States, particularly South Asians and Chinese (ie, groups of more recent immigration history), report poorer health care experiences than non-Hispanic whites. Few studies have examined the variation in patient-reported experience in relation to acculturation. This study aims to fill this gap using data from the CAHPS® Clinician and Group Survey (CG-CAHPS), linked electronic health records (EHR) and a patient acculturation survey to provide an in-depth understanding of the role of acculturation in evaluating health care experiences among South Asian and Chinese patients.

Methods: A random sample of South Asian, Chinese and non-Hispanic white patients in a multispecialty ambulatory practice in California were selected for recruitment. A total of 69 Chinese, 40 South Asians and 22 non-Hispanic whites completed the CG-CAHPS survey evaluating their most recent visit. South Asian and Chinese patients also completed a 12-item validated acculturation survey that assesses language use, media use and social relationships. We conducted multivariate logistic regression models to evaluate the effect of acculturation on patients’ on CG-CAHPS reports regarding “see the provider within 15 minutes,” “provider spend enough time with you,” “provider explain in an way that was easy to understand” and “overall ratings of provider,” taking into account the actual wait time, type of visit, history with provider recorded in the EHR of the surveyed visit, and patient’s self-rated health status.

Results: South Asians and Chinese reported poorer experience than non-Hispanic whites in multiple aspects of care assessed by the CG-CAPHS survey, given similar care provided (eg, actual wait time and time with provider). Acculturation appeared to be a significant predictor of their reported experience, with varying effects between South Asians and Chinese. With regard to doctor-patient communication and overall ratings of providers, acculturation has a positive effect on Chinese patients’ reported experiences but exerts no significant effects on South Asians. In terms of wait time and time spent with providers, however, acculturation has no significant effects on Chinese patients but exerts a slightly positive effect on South Asian patients.

Conclusion: Acculturation affects South Asian and Chinese to varying extents across different aspects of care. Health systems may consider targeted strategies to expand culturally competent care for different Asian populations.




June 30th, 2017


August 10th, 2017