Conferences

During the early 19th century, European social observers (Marx, et al.) recognized the critical role played by the construct of individualism in the emergence and instantiation of capitalist production. In the United States, where capitalism has been so integral to our cultural and historical development, the ideology of the individual frequently obscures our ability to recognize the social whole. Because social science research is merely one facet of the larger American political economy, psychological theories (“mind,” “self,” “cognition”) and research methods often have trumped those drawn from anthropology and sociology (“culture,” “context,” “situated meaning”). As cultural distinctions play an ever-increasing role in American society and politics, however, social science research must adapt accordingly. The goal of this presentation is to demonstrate how the methods and findings of cognitive interviewing – theoretically rooted in the science of cognition (memory, retrieval, information processing) – can be made even more robust through the careful application of anthropological and sociological approaches.

The Medicare Consumer Assessment of Health Plans Survey (MCAHPS) is a standardized, self-administered consumer survey used annually by the Centers for Medicare and Medicaid Services (CMS) to rank Medicare plans around the country. In 2002, statistical analyses conducted by CMS evinced differences in health plan ratings across U.S. geographic regions. While the regional differences were of interest, even more compelling was that the region (California) in which beneficiaries gave their plans the lowest satisfaction scores was the same region that received the highest Federal ratings in terms of quality of care. Because plan ratings emerged from individuals completing a standard questionnaire, one approach to solving the puzzle could have been to cognitively test the survey items among Medicare beneficiaries. Yet the statistical data indicated that we were not witnessing a psychological event, but rather a “social fact.” And Emile Durkheim pointed out more than a century ago:

“The determining course of a social fact must be sought among antecedent social facts, and not among the states of the individual consciousness.”

The MCAHPS data thus suggested the need for a research approach that could account for the social whole.

This presentation thus has three main objectives: First, the presenter will describe the data collection method, specifically, conducting cognitive testing within the context of a small-group discussion. Secondly, the presentation will describe how socio-cultural theories were used in data analysis to understand the historical and cultural context in which California seniors were assessing their Medicare health plans. A final objective of the presentation is to encourage researchers to recognize the inherent limitations of any field of social science and to borrow techniques and ideas across field boundaries where appropriate.