Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients

Abstract

BACKGROUND: Interpersonal care (IPC) is increasingly emphasize d as h ealth care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos. OBJECTIVE: To examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes selfcare activities. DESIGN: Cross-sectional survey combined with chart reviews. SETTING/PARTICIPANTS: Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties. MAIN MEASURES: Using a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patientprovider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient selfreport. The survey response rate was 68 %. KEY RESULTS: Patients with language-concordant providers had more favorable IPC ratings (20 % to 41 % of language-discordant patients had optimal scores for IPC scales vs. 35 % to 69 % of language-concordant patients, p<0.05), except with respect to discrimination. Patients with language-concordant providers reported higher levels of participation in diabetic foot care (1.4 days vs. 0.7 days per week, p value 0.01) compared to patients with language discordance. There was no association between language concordance and participation in other self-care activities. CONCLUSION: This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.

Patients’ perceptions of patient–provider communication and diabetes care: A systematic review of quantitative and qualitative studies

“…A total of 22 studies met the review criteria and were included. Regarding the type of the studies, out of 22 reviewed articles, 16 studies were cross-sectional (Table 1) 4,9,10,[22][23][24][25][26][27][28][29][30][31][32][33][34] with the sample size ranging from 105 to 9377 patients with type 2 diabetes in which five of them were multinational or large national surveys. 10,22,23,29,35 The remaining were qualitative studies using in-depth interviews and focus group discussions ( Table 2).…”

“…[36][37][38][39][40][41] More than half of the English language studies were conducted in United States. 4,9,10,23,25,26,29,[36][37][38] The main aims of the cross-sectional surveys were determining the patients' evaluation of their provider communication style and the association between patients' perceptions of communication quality and patient-reported outcomes.…”

Influence of Language and Culture in the Primary Care of Spanish-Speaking Latino Adults with Poorly Controlled Diabetes: A Qualitative Study

“…Cultural differences between non-US born Latino patients and the common cultural norms of the US health system may represent a potentially ameliorable barrier to optimal care. 22 Prior research has shown that language concordance is related to improved interpersonal communication 23 and several diabetes process and outcome measures. 24 We found a general consensus that language concordance was highly valued.…”

Genomic Disparities in Breast Cancer among Latinas

“…249 Elements that appear to bolster success include partnership with community-based organizations that provide services to Latinas and the provision of language-concurrent clinical care. 250–252 The heterogeneity of the US Latina population must also be considered, because different cultural influences, levels of awareness of, and interest in genetic and genomic services appear to vary by country of origin. 110 …”