Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients.
OBJECTIVE
We studied physician-patient dyads to determine how physician self-rated Spanish-language ability and cultural competence affect Spanish-speaking patients' reports of interpersonal processes of care.


METHODS
Questionnaire study of 116 Spanish-speaking patients with diabetes and 48 primary care physicians (PCPs) at a public hospital with interpreter services.


METHODS
Primary care physicians rated their Spanish ability on a 5-point scale and cultural competence by rating: 1) their understanding of the health-related cultural beliefs of their Spanish-speaking patients; and 2) their effectiveness with Latino patients, each on a 4-point scale. We assessed patients' experiences using the interpersonal processes of care (IPC) in diverse populations instrument. Primary care physician responses were dichotomized, as were IPC scale scores (optimal vs nonoptimal). We analyzed the relationship between language and two cultural competence items and IPC, and a summary scale and IPC, using multivariate models to adjust for known confounders of communication.


RESULTS
Greater language fluency was strongly associated with optimal IPC scores in the domain of elicitation of and responsiveness to patients, problems and concerns [Adjusted Odds Ratio [AOR], 5.25; 95% confidence interval [CI], 1.59 to 17.27]. Higher score on a language-culture summary scale was associated with three IPC domains - elicitation/responsiveness (AOR, 6.34; 95% CI, 2.1 to 19.3), explanation of condition (AOR, 2.7; 95% CI, 1.0 to 7.34), and patient empowerment (AOR, 3.13; 95% CI, 1.2 to 8.19)-and not associated with two more-technical communication domains.


CONCLUSIONS
Physician self-rated language ability and cultural competence are independently associated with patients' reports of interpersonal process of care in patient-centered domains. Our study provides empiric support for the importance of language and cultural competence in the primary care of Spanish-speaking patients.
Fernandez
Alicia
A
Department of Medicine, University of California, San Francisco, Calif. 94110, USA. aliciaf@itsa.ucsf.edu
Schillinger
Dean
D
Grumbach
Kevin
K
Rosenthal
Anne
A
Stewart
Anita L
AL
Wang
Frances
F
Pérez-Stable
Eliseo J
EJ
D002983:Clinical Competence; D003144:Communication Barriers; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012495:San Francisco; D011795:Surveys and Questionnaires