Although patient–provider language concordance has the potential to reduce health disparities for people with limited English proficiency, no previous work has synthesized this literature. Our systematic review sought to describe the characteristics of studies examining relationships between language concordance and health outcomes, summarize the nature of observed associations, and propose an evidence map and research agenda. A comprehensive search of published articles identified 38 quantitative studies for inclusion. Most studies were cross-sectional, conducted in primary care, concentrated in Western states, and focused on Spanish speakers and physician providers. Results were split between supporting a positive association versus no association of language concordance with patient behaviors, provider behaviors, interpersonal processes of care, and clinical outcomes. Several methodological limitations were identified. Based on these results, we developed an evidence map, identified knowledge gaps, and proposed a research agenda. There is a particular need for quasi-experimental longitudinal studies with well-characterized samples.
Aim: The purpose of this study was to explore differences in the clinical psychology PhD program admissions experience (i.e., interviewing and decision-making) by race/ ethnicity and lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity. Methods: Participants were 803 students (24% racial/ethnic minority; 19% LGBTQ) enrolled in US clinical psychology PhD programs. Two-group comparisons tested for differences in admission experiences by race/ethnicity and LGBTQ identity. Results: Racial/ethnic minority and LGBTQ students considered a programmatic commitment to diversity as more important in application decisions compared to non-Hispanic White and cisgender heterosexual students, respectively. LGBTQ students were more likely to be advised to not discuss personal information (e.g., sexual orientation) than cisgender heterosexual students. Racial/ethnic minority and LGBTQ students identified financial considerations and program outcomes as more important in their decision-making compared with non-Hispanic White and cisgender heterosexual students, respectively. Conclusion: Increasing funding and fostering authentic training environments should be prioritized in institutional conversations around recruiting racial/ethnic minority and LGBTQ trainees.
Undiagnosed diabetes disproportionately affects medically underserved groups. It is unknown whether being an immigrant confers additional risk for undiagnosed diabetes. Purpose: To examine independent associations of immigrant status and race/ethnicity with the prevalence of diagnosed and undiagnosed diabetes in a U.S.-based population sample. Methods: Respondents were 21,306 adults from the 2011-2018 National Health and Nutritional Exam Survey.Immigrant status was coded as foreign-born or U.S.-born. Six racial/ethnic categories were: White, Black, Mexican American, other Hispanic, Asian, and Other/Multi-Racial. Self-report and laboratory data yielded a three-level diabetes status outcome: no diabetes (88%), diagnosed diabetes (10%), and undiagnosed diabetes (2%). Results: Adjusted multinomial logistic regression models evaluating immigrant status and race/ethnicity as simultaneous predictors revealed that foreign-born (vs. U.S.-born) adults had a similar prevalence of diagnosed diabetes (OR=0.98, 95% CI: 0.79-1.22, p=0.84) but a higher prevalence of undiagnosed diabetes (OR=1.54, 95% CI: 1.21-1.97, p=0.004). Models showed that all racial/ethnic minority groups except the Other/Multi-Racial group (vs. Whites) had a higher prevalence of diagnosed and undiagnosed diabetes (ps<0.04). Conclusions: Immigrants and racial/ethnic minority adults have increased odds of undiagnosed diabetes, even after accounting for health insurance. These groups are likely at increased risk for diabetes complications due to prolonged periods of undetected diabetes.
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