Interpersonal Processes of Care

Two-phased development

First, we developed a comprehensive conceptual framework of interpersonal processes of care based on literature, existing measures, formative research, and clinical experience with minority patients.  We administered a 41-item self-report instrument to 603 ethnically diverse patients to confirm the framework.  We did not publish the instrument per se.  In phase two, with a grant from AHRQ, we revised the framework and developed and tested a more comprehensive survey with 1,664 ethnically diverse patients.  The Interpersonal Processes of Care (IPC) Survey is the result of the second phase. 

The Concept: What are Interpersonal Processes of Care?

Quality of care is one hypothesized mechanism to explain findings that persons of lower socioeconomic status and members of racial and ethnic minority groups experience poorer health and increased risk factors.  Interpersonal processes of care are components of quality, defined as the social-psychological aspects of the patient-physician interaction.  We conceptualize interpersonal processes as multidimensional and focus on perspectives of diverse racial and ethnic and socioeconomic groups.  We define three key domains, each with subdomains: communication, decision making, and interpersonal style. 

Our first conceptual framework was developed in phase one (Stewart et al., 1999).  During phase two, we revised the framework based on new formative research, and tested a more comprehensive survey.  The revised framework reflects the resulting measurement model (Stewart et al., 2007). 

  • Citation: Stewart AL, Nápoles-Springer A, Pérez-Stable EJ, Posner S, Bindman AB, Pinderhughes HL, and Washington AE, Interpersonal processes of care in diverse populations.  The Milbank Quarterly. 77:305-39, 1999. PMCID: PMC2751132
  • Citation: Stewart AL, Nápoles-Springer AL, Gregorich SE and Santoyo-Olsson J.  Interpersonal processes of care survey: Patient-reported measures for diverse groups.  Health Services Research, 2007; 42 (3, Part I):1235-56.  PMCID: PMC1955252

A table can be downloaded that summarizes and compares the original and revised frameworks, enabling visualization of the changes.  The original framework is more comprehensive and we recommend its use as a basis for continued development of concepts and measures of interpersonal processes of care for disparities research. 

What is the Interpersonal Processes of Care (IPC) Survey?

The Interpersonal Processes of Care (IPC) Survey is a 29-item patient-reported, multi-dimensional instrument assessing subdomains of communication, patient-centered decision making, and interpersonal style.  It is appropriate for patients from diverse racial/ethnic groups and is available in Spanish and English.  Psychometric validation of the IPC Survey was demonstrated with data from a sample of 1,664 African American, Spanish- and English-speaking Latino, and white patients. 

  • Citation: Stewart AL, Nápoles-Springer AL, Gregorich SE and Santoyo-Olsson J.  Interpersonal processes of care survey: Patient-reported measures for diverse groups.  Health Services Research, 2007; 42 (3, Part I):1235-56.  PMCID: PMC1955252

The 29-item IPC Survey comprises 12 first-order and 7 second-order factors with equivalent meaning (metric invariance) across the four sampled racial/ethnic groups; derived scores are based primarily on the 2nd-order factors (see scoring below).  An 18-item shorter version (IPC-18), also with seven factors, allows unbiased comparison of observed means (scalar invariance) across the four groups (IPC-18).  The content of the IPC-29 and the IPC-18 differs slightly. 

Both surveys can be used to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes of quality improvement efforts to reduce health care disparities. Both surveys performed well within each racial/ethnic/language group represented in the study sample. Contact the authors for information about the appropriate choice for your particular study.

Permission and Copyright

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

Download IPC Surveys and Scoring Instructions

The IPC surveys are designed to be interviewer-administered (by telephone or in person) but can be self-administered. 

Evidence for the Validity of the IPC Survey.

The well-fitting 2nd-order factor model demonstrating conceptually coherent factors as well as key features of measurement invariance across four racial/ethnic groups provides evidence of construct validity.  We reported further evidence of construct validity of the IPC-18 short form by examining associations of IPC-18 scales with measures of patient satisfaction, including whether associations vary by race, ethnicity, and language.

  • Citation: Nápoles AM, Gregorich SE, Santoyo-Olsson J, O’Brien H, and Stewart AL.  Interpersonal processes of care and patient satisfaction: do associations differ by race, ethnicity, and language? Health Services Research, 2009;44(4):1326-44. PMCID: PMC2714869


The IPC measurement development was supported by grant R01 HS10599 from the Agency for Healthcare Research and Quality.  It also was supported through a Resource Center on Minority Aging Research grant (P30 AG15272) from the National Institute on Aging, the National Institutes of Nursing research and the National Center on Minority Heath and Health Disparities, National Institutes of Health.