Ensuring Cultural Competency in Evaluating Chinese Older Adults

Abstract Information: Chinese older adults face an increased risk for musculoskeletal conditions. In New York City, many in this population are marginalized by not only culture but also age and socioeconomic status, bringing an additional set of challenges with health education and access to care. Hospital for Special Surgery (HSS) developed an 8-week low-impact chair exercise program taught in Mandarin and Cantonese at senior centers in the Chinatown and Flushing neighborhoods of New York City. Ongoing program evaluation revealed that while the intervention was culturally competent, there was a gap in the evaluation strategy, overlooking the need to address the unique perspectives of the Chinese older adult population. The program was previously evaluated using surveys consisting of validated instruments in Chinese assessing changes in health outcomes, such as the SF-36, Brief Pain Inventory, and PROMIS Pain Intensity scale. However, feedback from participants and stakeholders revealed barriers around survey fatigue and literacy, in addition to the inclusion of questions were not age or culturally sensitive to the participant population. The EQ-5D-5L was identified and implemented as a culturally appropriate survey tool having been used in literature for similar interventions with the target population. The self-administered tool is validated in Chinese and English, and additional concerns on literacy were alleviated by the inclusion of simplified ordinal and visual analogue scales. However, in developing a culturally competent evaluation, we not only considered literacy. The tool was further tailored to ensure that questions accurately reflected the nature of the intervention as well as cultural and lifestyle considerations of Chinese older adults. By tailoring the survey instruments to our target audience, we were able to generate meaningful evaluation findings that provide insight on program impact. The perspective of stakeholders and participants will continue to be incorporated by seeking ongoing feedback to develop a culturally competent evaluation strategy.