Psychometric Properties of a Healthcare Discrimination Scale Among Young-Adult Latinos

  • Daniel F. López-CevallosEmail author
  • S. Marie Harvey



A growing body of research has found that healthcare discrimination is a significant barrier in accessing healthcare among Latino patients. Despite evidence of the effects of perceived discrimination among Latinos, psychometric testing of scales used in previous research is limited. The present study explored the psychometric properties of a healthcare discrimination scale (HDS) among young-adult Latinos.


We used data from a cross-sectional study of young-adult Latinos, primarily of Mexican heritage, living in rural Oregon. Bilingual, bicultural staff members conducted computer-assisted personal interviews matched by gender with 313 individuals who completed the interview in Spanish (n = 137) or English (n = 176). The interview guide included questions for the HDS and the experiences of discrimination (EOD) and acculturation scales, and satisfaction with healthcare services. Psychometric testing included exploratory factor analysis, internal consistency, split-half reliability, and convergent, discriminant, and predictive validity.


The HDS scale had high internal consistency (Cronbach’s α = 0.92), was strongly correlated with the EOD scale (r = 0.70, p < 0.001), and weakly correlated with the acculturation scale (r = 0.17, p < 0.01). Discriminant validity was stronger among English speakers (r = − 0.06, p = 0.422). Split-half reliability was 0.87 (p < 0.001). Confirmatory factor analysis yielded a one-factor solution for both Spanish and English language respondents. The HDS was significantly associated with satisfaction with healthcare services, indicative of good predictive validity.


These results suggest that the healthcare discrimination scale is a valid and reliable tool to use among Spanish and English-speaking young-adult Latinos. Further testing is needed among Latinos of other ages and background groups.


Healthcare discrimination Psychometrics Health disparities Race/ethnicity Latinos 



This study was funded by the cooperative agreement U01DP000123A from the Centers for Disease Control and Prevention (CDC) to S. Marie Harvey (PI). Dr. López-Cevallos was supported in part by a Summer Research Award from the College of Liberal Arts at Oregon State University.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


The views expressed in this article are the responsibility solely of the authors and do not necessarily represent the official views of the CDC.

Supplementary material

40615_2018_560_MOESM1_ESM.docx (71 kb)
ESM 1 (DOCX 71 kb)
40615_2018_560_MOESM2_ESM.docx (79 kb)
Supplemental Table 1 (DOCX 78 kb)


  1. 1.
    FFF: Hispanic Heritage Month 2015. Accessed 1 Sept 2018
  2. 2.
    Krogstad JM, Lopez MH. Hispanic Nativity Shift: U.S. births drive population growth as immigration stalls. Washington, DC: Pew Research Center; 2014. 8pGoogle Scholar
  3. 3.
    Motel S, Patten E. Statistical portrait of Hispanics in the United States, 2011. Washington, DC: Pew Research Hispanic Center; 2013. p. 45.Google Scholar
  4. 4.
    Kandel W, Cromartie J. New patterns of Hispanic settlement in rural America. Washington, DC: Economic Research Service, US Department of Agriculture; 2004.Google Scholar
  5. 5.
    Vásquez MA, Seales CE, Marquardt MF. New Latino destinations. In: Rodríguez CE, Saenz R, Menjivar C, editors. Latinas/os in the United States: Changing the Face of America. New York: Springer; 2008. p. 19–35.Google Scholar
  6. 6.
    Suro R, Tafoya S. Dispersal and concentration: patterns of Latino residential settlement. Washington, DC: Pew Research Hispanic Center; 2004. p. 23.Google Scholar
  7. 7.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2009.Google Scholar
  8. 8.
    Betancourt JR, Maina A, Cervantes MC. Perspective: barriers to eliminating disparities in clinical practice – lessons from the IOM report “unequal treatment”. In: Williams RA, editor. Healthcare Disparities at the Crossroads with Healthcare Reform. New York: Springer US; 2011. p. 97–114.CrossRefGoogle Scholar
  9. 9.
    Armstrong K, Putt M, Halbert CH, Grande D, Schwartz JS, Liao K, et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care. 2013;51(2):144–50.CrossRefGoogle Scholar
  10. 10.
    Bachhuber MA, Tschannerl A, Lechuga C, Anderson M. Racial discrimination in health care settings: does insurance matter? Am J Public Health. 2014;104:e10–1. Scholar
  11. 11.
    Benjamins MR. Race/ethnic discrimination and preventive service utilization in a sample of Whites, Blacks, Mexicans, and Puerto Ricans. Med Care. 2012;50(10):870–6.CrossRefGoogle Scholar
  12. 12.
    Cuffee YL, Hargraves JL, Rosal M, Briesacher BA, Schoenthaler A, Person S, et al. Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with hypertension. Am J Public Health. 2013;103(11):e55–62.CrossRefGoogle Scholar
  13. 13.
    Gonzales KL, Harding AK, Lambert WE, Fu R, Henderson WG. Perceived experiences of discrimination in health care: a barrier for cancer screening among American Indian women with type 2 diabetes. Womens Health Issues. 2013;23(1):e61–7.CrossRefGoogle Scholar
  14. 14.
    Bird ST, Bogart LM. Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis. 2001;11(3):554–63.Google Scholar
  15. 15.
    Peek ME, Wagner J, Tang H, Baker DC, Chin MH. Self-reported racial/ethnic discrimination in healthcare and diabetes outcomes. Med Care. 2011;49(7):618–25.CrossRefGoogle Scholar
  16. 16.
    Gonzales KL, Lambert WE, Fu R, Jacob M, Harding AK. Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women. Diabetes Educ. 2014;40(6):747–55.CrossRefGoogle Scholar
  17. 17.
    Rosenbaum S. The patient protection and affordable care act: implications for public health policy and practice. Public Health Rep. 2011;126:130–5.CrossRefGoogle Scholar
  18. 18.
    Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA. 2015;314(4):366–74.CrossRefGoogle Scholar
  19. 19.
    Shavers VL, Fagan P, Jones D, Klein WMP, Boyington J, Moten C, et al. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66.CrossRefGoogle Scholar
  20. 20.
    Abraído-Lanza AF, Céspedes A, Daya S, Flórez KR, White K. Satisfaction with health care among Latinas. J Health Care Poor Underserved. 2011;22(2):491–505.CrossRefGoogle Scholar
  21. 21.
    LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44(6):2093–105.CrossRefGoogle Scholar
  22. 22.
    Weech-Maldonado R, Hall A, Bryant T, Jenkins KA, Elliott MN. The relationship between perceived discrimination and patient experiences with health care. Med Care. 2012;50:S62–8.CrossRefGoogle Scholar
  23. 23.
    Perez DJ, Sribney W, Rodríguez M. Perceived discrimination and self-reported quality of care among Latinos in the United States. J Gen Intern Med. 2009;24(3):548–54.CrossRefGoogle Scholar
  24. 24.
    López-Cevallos DF, Harvey SM, Warren JT. Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. J Rural Health. 2014;30(4):344–51.CrossRefGoogle Scholar
  25. 25.
    Sheppard VB, Wang J, Yi B, Harrison TM, Feng S, Huerta EE, et al. Are health-care relationships important for mammography adherence in Latinas? J Gen Intern Med. 2008;23(12):2024–30.CrossRefGoogle Scholar
  26. 26.
    Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethn Dis. 2011;21(4):502–9.Google Scholar
  27. 27.
    Hambleton RK, Lee MK. Methods for translating and adapting tests to increase cross-language validity. In: Saklofske DH, Reynolds CR, Schwean VL, editors. The Oxford handbook of child psychological assessment. New York: Oxford University Press; 2013. p. 172–81.Google Scholar
  28. 28.
    Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576–96.CrossRefGoogle Scholar
  29. 29.
    Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9(2):183–205.CrossRefGoogle Scholar
  30. 30.
    Brown TA. Confirmatory Factor Analysis for Applied Research. New York: Guilford Press; 2015.Google Scholar
  31. 31.
    Stöber J. The social desirability Scale-17 (SDS-17): convergent validity, discriminant validity, and relationship with age. Eur J Psychol Assess. 2001;17(3):222–32.CrossRefGoogle Scholar
  32. 32.
    Dovidio JF, Gluszek A, John MS, Ditlmann R, Lagunes P. Understanding bias toward Latinos: discrimination, dimensions of difference, and experience of exclusion. J Soc Issues. 2010;66(1):59–78.CrossRefGoogle Scholar
  33. 33.
    Cristancho S, Peters KE, Garcés DM. Latinos in Rural Areas: Addressing Mental Health Disparities in New Growth Communities. In: Buki LP, Piedra LM, editors. Creating Infrastructures for Latino Mental Health. New York: Springer; 2011. p. 215–231.Google Scholar
  34. 34.
    Harvey SM, Branch MR, Hudson D, Torres A. Listening to immigrant Latino men in rural Oregon exploring connections between culture and sexual and reproductive health services. Am J Mens Health. 2013;7(2):142–54.CrossRefGoogle Scholar
  35. 35.
    Viruell-Fuentes EA. Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States. Soc Sci Med. 2007;65(7):1524–35.CrossRefGoogle Scholar
  36. 36.
    Zambrana RE, Carter-Pokras O. Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos. Am J Public Health. 2010;100(1):18–23.CrossRefGoogle Scholar
  37. 37.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.Google Scholar
  38. 38.
    National Healthcare Quality and Disparities Report. Accessed 10 Sep 2018.

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.School of Language, Culture, and Society, College of Liberal ArtsOregon State UniversityCorvallisUSA
  2. 2.College of Public Health and Human SciencesOregon State UniversityCorvallisUSA

Personalised recommendations