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.
Similar content being viewed by others
References
Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.
Hsiao CJ, Boult C. Effects of quality on outcomes in primary care: a review of the literature. Am J Med Qual. 2008;23(4):302–310.
Stewart AL, Napoles-Springer AM, Gregorich SE, Santoyo-Olsson J. Interpersonal processes of care survey: patient-reported measures for diverse groups. Health Serv Res. 2007;42(3 Pt 1):1235–1256.
Napoles AM, Gregorich SE, Santoyo-Olsson J, O'Brien H, Stewart AL. Interpersonal processes of care and patient satisfaction: do associations differ by race, ethnicity, and language? Health Serv Res. 2009;44(4):1326–1344.
Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445–451.
Cooper LA, Roter DL, Carson KA, et al. The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–987.
Fernandez A, Schillinger D, Grumbach K, et al. Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004;19(2):167–174.
Ryan C. Language Use in the United States: 2011, American Community Survey Reports: United States Census Bureau;2013
The National CLAS Standards. US Department of Health and Human Services Office of Minority Health. http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Accessed Aug 2014
Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–754.
Fernandez A, Schillinger D, Warton EM, et al. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med. 2011;26(2):170–176.
Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI. Interpreter services, language concordance, and health care quality. Experiences of Asian Americans with limited English proficiency. J Gen Intern Med. 2005;20(11):1050–1056.
Ngo-Metzger Q, Sorkin DH, Phillips RS, et al. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007;22(Suppl 2):324–330.
Schenker Y, Karter AJ, Schillinger D, et al. The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study. Patient Educ Couns. 2010;81(2):222–228.
Lasater LM, Davidson AJ, Steiner JF, Mehler PS. Glycemic control in English- vs Spanish-speaking Hispanic patients with type 2 diabetes mellitus. Arch Intern Med. 2001;161(1):77–82.
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: US trends from 1999 to 2006 and effects of Medicare coverage. Ann Intern Med. 2009;150(8):505–515.
Mainous AG 3rd, Diaz VA, Koopman RJ, Everett CJ. Quality of care for Hispanic adults with diabetes. Fam Med. 2007;39(5):351–356.
Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV. Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care. 2000;23(4):477–483.
Hacker K, Choi YS, Trebino L, et al. Exploring the impact of language services on utilization and clinical outcomes for diabetics. PLoS One. 2012;7(6):e38507.
Arcury TA, Quandt SA. Delivery of health services to migrant and seasonal farmworkers. Annu Rev Public Health. 2007;28:345–363.
Daviglus ML, Talavera GA, Aviles-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. Jama. 2012;308(17):1775–1784.
Blewett LA, Smaida SA, Fuentes C, Zuehlke EU. Health care needs of the growing Latino population in rural America: focus group findings in one midwestern state. J Rural Health. 2003;19(1):33–41.
Villarejo D. The health of US hired farm workers. Annu Rev Public Health. 2003;24:175–193.
Wu S, Ridgely MS, Escarce JJ, Morales LS. Language access services for Latinos with limited English proficiency: lessons learned from Hablamos Juntos. J Gen Intern Med. 2007;22(Suppl 2):350–355.
Diamant AL, Babey SH, Hastert TA, Brown ER. Diabetes: the growing epidemic. Policy Brief UCLA Cent Health Policy Res. 2007;(PB2007-9):1–12
Diabetes in California Counties: Prevalence, Risk Factors and Resources. Sacramento, CA: California Diabetes Control Program, California Department of Health Services 2005
Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–950.
Piette JD, Schillinger D, Potter MB, Heisler M. Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population. J Gen Intern Med. 2003;18(8):624–633.
Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–1292.
Nunnally JC Jr. Psychometric Methods. New York: McGraw-Hill; 1978.
Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77(3):305–339. 274.
Schwarte L, Samuels SE, Capitman J, Ruwe M, Boyle M, Flores G. The Central California Regional Obesity Prevention Program: changing nutrition and physical activity environments in California's heartland. Am J Public Health. 2010;100(11):2124–2128.
Odom Walker K, Ryan G, Ramey R, et al. Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve. Am J Public Health. 2010;100(11):2168–2175.
Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter? J Gen Intern Med. 2010;25(11):1172–1177.
Mehler PS, Lundgren RA, Pines I, Doll K. A community study of language concordance in Russian patients with diabetes. Ethn Dis. 2004;14(4):584–588.
Hofer TP, Hayward RA, Greenfield S, Wagner EH, Kaplan SH, Manning WG. The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease. JAMA J Am Med Assoc. 1999;281(22):2098–2105.
Krein SL, Hofer TP, Kerr EA, Hayward RA. Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups, and health care facilities. Health Serv Res. 2002;37(5):1159–1180.
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabet Metab Disord. 2013;12(1):14.
Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17(4):243–252.
de Jaimes FN, Batts F, Noguera C, Guerrero L, Moreno G. Implementation of language assessments for staff interpreters in community health centers. J Health Care Poor Underserved. 2013;24(3):1002–1009.
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.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOC 28 kb)
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-014-3006-7