AHA Disparities - How to Ask the Questions

We recommend that health care organizations/health plans provide a rationale for why they are asking patients/enrollees for information about their demographic and communications background. Suggested wording for the rationale is:

"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care."

We have found that people feel comfortable responding to the question about race/ethnicity/sex/primary language/disability status, but they sometimes have their own questions, wish for additional clarity, or perhaps prefer to not answer the question at all.

The following link to a response matrix (PPT) provides real world examples of questions people have asked as well as suggested responses. This response matrix is not all inclusive. You may encounter different scenarios, and you may not hear any concerns from patients after asking these questions. The response matrix serves as a tool for you and your staff, and it is excellent for facilitating dialogue during training sessions.

• Race/Ethnicity
• Language
• Sex
• Disability

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Race/ethnicity

Using Broad (OMB) Categories

"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care."

Ethnicity Question

(OMB recommends asking ethnicity before race.)

• Are you Hispanic, Latino, or Spanish origin
• No, not of Hispanic, Latino, or Spanish origin
• Yes, Mexican, Mexican American, Chicano
• Yes, Puerto Rican
• Yes, Cuban
• Yes, another Hispanic, Latino, or Spanish origin
• Unavailable/Unknown
• Declined

Race Question

Which category best describes your race? (One or more categories may be marked)

• American Indian/Alaska Native
• Asian
• Black or African American
• Native Hawaiian/Other Pacific Islander
• White
• Some other race
• Declined
• Unavailable/Unknown

Using Granular Categories

"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care. I would like you to describe your race or ethnic background. You can use specific terms such as Korean, Haitian, Somali, etc..."

You can provide all or some of the granular categories based on the community you serve.

• Granular Code Set II (PPT)
• IOM Subcommittee Template of Granular Ethnicity Categories (Table E-1 in Appendix E of IOM Report)

Sex

What is your sex?

• Male
• Female
• Declined
• Unavailable

Language

1. How well do speak English?

• Very Well
• Well
• Not Well
• Not at all
• Declined
• Unavailable

2. Would you like an interpreter?

• Yes
• No
• Don't know
• Declined
• Unavailable

3. Do you speak a language other than English (5 years old or older)

• Yes
• No
• Declined
• Unavailable

4. What is this language? (5 years old or older)

• Spanish
• Other language (identify)
• Declined
• Unavailable

5. What language do you feel most comfortable speaking with your doctor or nurse?

Language categories should be based on the community you serve.

IOM Subcommittee Template of Spoken Language Categories and Coding (Table I-1 in Appendix I of IOM Report)

6. In which language would you feel most comfortable reading medical or health care instructions?

7. How satisfied are you with your ability to read English?

• Very satisfied
• Somewhat satisfied
• Satisfied
• Somewhat dissatisfied
• Very dissatisfied
• Declined
• Unavailable

Disability

Although some of these questions are not directly related to communication issues, they are required under the legislation of the ACA. They also help address accommodation issues of a patient and will help you understand what specific disabilities may ultimately impact communication with the patient and how to best meet their health needs.

1. Are you deaf or do you have serious difficulty hearing?

• Yes
• No
• Declined
• Unavailable

2. Are you blind or do you have serious difficulty seeing, even when wearing glasses?

• Yes
• No
• Declined
• Unavailable

3. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? (5 years old or older)

• Yes
• No
• Declined
• Unavailable

4. Do you have serious difficulty walking or climbing stairs? (5 years old or older)

• Yes
• No
• Declined
• Unavailable

5. Do you have difficulty dressing or bathing? (5 years old or older)

• Yes
• No
• Declined
• Unavailable

6. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping? ? (15 years old or older)

• Yes
• No
• Declined
• Unavailable