Planning, Development, Design, and Operation of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians

Abstract

Objectives: This report describes the development and operations of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians (National CLAS Physician Survey). The survey was developed to understand awareness, adoption, and implementation of the National CLAS Standards in health and health care among office-based physicians.

Methods: Survey development included a literature review of survey and assessment instruments that evaluated cultural and linguistic appropriateness in health care. Survey questions were pretested during a cognitive interview study of 20 office-based physicians in the District of Columbia metropolitan area. The cognitive interviews were analyzed using a grounded theory approach. The final survey was administered via web, mail, and computer-assisted telephone interview to 2,400 sampled physicians between August 2016 and December 2016. A nonresponse bias assessment was conducted.

Results: The literature review identified five survey and assessment instruments. Collectively, survey content included: cultural competency training, cultural awareness, and adoption of the National CLAS Standards. Cognitive interviews showed respondent difficulty in question interpretation and survey completion of some items. Survey revisions addressed these issues. The final overall weighted survey response rate was 33.8%. Final weights produced a lower standardized bias than base weights.

Conclusions: The National CLAS Physician Survey is the first nationally representative survey to describe the use and implementation of culturally and linguistically appropriate services by office-based physicians. Data can serve as a baseline for future studies and as a benchmark for meeting the key objectives of the National CLAS Standards.