Clinicians Cultural Sensitivity Survey

What is Cultural Sensitivity?

We conceptualize cultural sensitivity as multidimensional, consisting of domains of culture affecting the medical encounter.  The initial conceptual framework was developed based on the cultural competence literature and focus groups with African American, Latino (English and Spanish speaking), and White adults from community settings.  The framework consists of 11 domains:

  • Complementary and alternative medicine
  • Discrimination
  • Doctor culture
  • Ethnic concordance of physician and patient
  • Family
  • Immigration
  • Language
  • Modesty
  • Nutrition
  • Patient submissiveness
  • Spirituality

Citation: Nápoles-Springer AM, Santoyo J, Houston K, Pérez-Stable EJ, Stewart AL. Patients’ perceptions of cultural factors affecting the quality of their medical encounters. Health Expectations, 2005:8(1):4-17.  PMCID: PMC5060265

What is the Clinicians’ Cultural Sensitivity Survey?

The Clinicians’ Cultural Sensitivity Survey (CCSS) is a 29-item multidimensional questionnaire developed to assess a subset of the domains identified above pertaining to interpersonal processes of care.  It is interviewer-administered but can be self-administered, and is available in Spanish and English.  The survey was administered to 505 older English- and Spanish-speaking Latino patients and tested empirically to identify the final measurement model.  The CCSS assesses 14 domains of cultural sensitivity.  Eleven are relevant for all patients, two for patients with limited English proficiency, and two for immigrants (# items in parentheses).

All Patients

  • Complementary and alternative medicine (2)
  • Mind-body connections (2)
  • Causal attributions of health problem (2)
  • Preventive care (2)
  • Family involvement (2)
  • Modesty (2)
  • Prescription medications (1)
  • Spirituality (1)
  • MD discrimination due to education (2)
  • MD discrimination due to race/ethnicity (2)
  • Staff discrimination due to race/ethnicity (2)

Limited English proficient

  • Discrimination due to language needs (3)
  • Sensitivity to language needs (3)


  • Sensitivity to immigration status (3)

The CCSS can be used to assess the quality of care of older Latino patients.  Its development and testing can be found in the following publication:

Citation: Nápoles AM, Santoyo-Olsson J, Farren G, Olmstead J, Cabral R, Ross B, Gregorich SE, Stewart AL. The patient-reported Clinicians' Cultural Sensitivity Survey: a field test among older Latino primary care patients. Health Expectations, 2012; 15(1):63-77.  PMCID: PMC3570254.

Permission and Copyright

Although the CCSS English and Spanish surveys are copyrighted, they are available without charge and no written permission is required for their use.

Download the CCSS and Scoring Instructions

The CCSS survey is designed to be interviewer-administered but it can be self-administered.


The CCS measurement development was supported by grant no. R21CA121176 from the National Cancer Institute; grant no. P30-AG15272 from the Resource Centers for Minority Aging Research program of the National Institute on Aging, the National Institute of Nursing Research, and the National Center on Minority Health and Health Disparities; and grant no. U01-CA86117 from the National Cancer Institute; National Institutes of Health.