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

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ABSTRACT

Background

Interpersonal care (IPC) is increasingly emphasized as health 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 self-care 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. Patient-provider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient self-report. 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.

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Acknowledgments

Dr. Detz is supported by the Institutional National Science Research Award fellowship at UCLA (grant no. T32-HP-19001). Dr. Moreno is supported by the Robert Wood Johnson Foundation Clinical Scholars® Program at UCLA, by the UCLA Resource Center for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA grant P30AG021684 (PI Mangione), and by the California Endowment. Dr. Mangione’s effort is supported in part by the UCLA Robert Wood Johnson Clinical Scholars Program® and the US Department of Veterans Affairs (grant no. 67799), the University of California, Los Angeles, Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA grant P30-AG021684, and from the NIH/NCATS UCLA CTSI grant no. UL1TR000124 and the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine. Dr. Morales’s effort was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award no. UL1TR000423. The content does not necessarily represent the official views of the NIA or the NIH. We acknowledge Marilu Isiordia for her assistance with data collection.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Correspondence to Alissa Detz MD, MS.

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Detz, A., Mangione, C.M., de Jaimes, F.N. et al. Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients. J GEN INTERN MED 29, 1650–1656 (2014). https://doi.org/10.1007/s11606-014-3006-7

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  • DOI: https://doi.org/10.1007/s11606-014-3006-7

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