CAHPS Cultural Competency’s Domains, Survey Items, and Response Scales^*

Domain	Survey Item	Response Scale
Doctor Communication-Positive Behaviors	1. In the last 12 months, how often did this doctor explain things in a way that was easy to understand?	Never-Sometimes-Usually-Always
	2. In the last 12 months, how often did this doctor listen carefully to you?	Never-Sometimes-Usually-Always
	3. In the last 12 months, how often did this doctor spend enough time with you?	Never-Sometimes-Usually-Always
	4. In the last 12 months, how often did this doctor show respect for what you had to say?	Never-Sometimes-Usually-Always
	5. In the last 12 months, how often did this doctor give you easy to understand instructions about taking care of these health problems or concerns?1	Never-Sometimes-Usually-Always
Doctor Communication-Negative Behaviors	6. In the last 12 months, how often did this doctor interrupt you when you were talking?	Never-Sometimes-Usually-Always
	7. In the last 12 months, how often did this doctor talk too fast when talking with you?	Never-Sometimes-Usually-Always
	8. In the last 12 months, did this doctor ever use a condescending, sarcastic, or rude tone or manner with you?	Yes, Definitely
		Yes, Somewhat
		No
Doctor Communication-Health Promotion	9. In the last 12 months, did you and this doctor talk about a healthy diet and healthy eating habits?	Yes, Definitely
		Yes, Somewhat
		No
	10. In the last 12 months, did you and this doctor talk about the exercise or physical activity you get?	Yes, Definitely
		Yes, Somewhat
		No
	11. In the last 12 months, did you and this doctor talk about things in your life that worry you or cause you stress?	Yes, Definitely
		Yes, Somewhat
		No
	12. In the last 12 months, did this doctor ever ask you whether there was a period of time when you felt sad, empty or depressed?	Yes
		No
Doctor Communication-Alternative Medicine	13. In the last 12 months, has this doctor ever asked you if you have used these other people to help with an illness or to stay healthy (for example, acupuncturist or herbalist)?	Yes
		No
	14. In the last 12 months, has this doctor ever asked you if you used natural herbs?	Yes
		No
Shared Decision Making	15. In the last 12 months, did this doctor talk with you about the pros and cons of each choice for your treatment or health care?2	Yes
		No
	16. In the last 12 months, when there was more than one choice for your treatment or health care, did this doctor ask which choice you thought was best for you?	Yes
		No
Equitable treatment	17. In the last 12 months, how often have you been treated unfairly at this doctor’s office because of your race or ethnicity?	Never-Sometimes-Usually-Always
	18. In the last 12 months, how often have you been treated unfairly at this doctor’s office because of the type of health insurance you have or because you don’t have health insurance?	Never-Sometimes-Usually-Always
Trust	19. Do you feel you can tell this doctor anything, even things that you might not tell anyone else?	Yes
		No
	20. Do you trust this doctor with your medical care?	Yes
		No
	21. Do you feel this doctor always tells you the truth about your health, even if there is bad news?	Yes
		No
	22. Do you feel this doctor cares as much as you do about your health?	Yes
		No
	23. In the last 12 months, how often did you feel this doctor really cared about you as a person?	Never-Sometimes-Usually-Always
Access to Interpreter Services	24. In the last 12 months, did you use friends or family members as interpreters because there was no other interpreter available at this doctor’s office?3, 4	Yes
		No
	25. In the last 12 months, how often did your visit with this doctor start late because you had to wait for an interpreter? Do not include friends or family members.	Never-Sometimes-Usually-Always
	26. In the last 12 months, was there any time when you needed an interpreter and did not get one at this doctor’s office? Do not include friends or family members.	Yes
		No

^*For latest version, please see: Agency for Health Care Research and Quality (AHRQ). CAHPS Cultural Competence Item Set. Available at: https://www.cahps.ahrq.gov/Surveys-Guidance/Item-Sets/Cultural-Competence.aspx.

¹Screener item for item 5: In the last 12 months, did you talk with this doctor about any health problems or concerns? Yes, No

²Screener item for items 15 and 16: Choices for your treatment or health care can include choices about medicine, surgery, or other treatment. In the last 12 months, did this doctor tell you there was more than one choice for your treatment or health care? Yes, No

³Screener for items 24 and 25: An interpreter is someone who helps you talk with others who do not speak your language. Interpreters can include friends or family members, staff from the doctor’s office, or telephone interpreters. In the last 12 months, did you ever use an interpreter to help you talk with this doctor? Yes, No (Skip if Response= Yes)

⁴Screener for item 24: In the last 12 months, how often did you use a friend or family member as an interpreter when you talked with this doctor? Never- Always. (Skip if Response= Never)