Unraveling the relationship between literacy, language proficiency, and patient-physician communication.
OBJECTIVE
To examine whether the effect of health literacy (HL) on patient-physician communication varies with patient-physician language concordance and communication type.


METHODS
771 outpatients rated three types of patient-physician communication: receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication. We assessed HL and language categories including: English-speakers, Spanish-speakers with Spanish-speaking physicians (Spanish-concordant), and Spanish-speakers without Spanish-speaking physicians (Spanish-discordant).


RESULTS
Overall, the mean age of participants was 56 years, 58% were women, 53% were English-speakers, 23% Spanish-concordant, 24% Spanish-discordant, and 51% had limited HL. Thirty percent reported poor receptive, 28% poor proactive, and 56% poor interactive communication. In multivariable analyses, limited HL was associated with poor receptive and proactive communication. Spanish-concordance and discordance was associated with poor interactive communication. In stratified analyses, among English-speakers, limited HL was associated with poor receptive and proactive, but not interactive communication. Among Spanish-concordant participants, limited HL was associated with poor proactive and interactive, but not receptive communication. Spanish-discordant participants reported the worst communication for all types, independent of HL.


CONCLUSIONS
Limited health literacy impedes patient-physician communication, but its effects vary with language concordance and communication type. For language discordant dyads, language barriers may supersede limited HL in impeding interactive communication.


CONCLUSIONS
Patient-physician communication interventions for diverse populations need to consider HL, language concordance, and communication type.
San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. rsucsf@yahoo.com
Rebecca L
RL
Sudore
C Seth
CS
Landefeld
Eliseo J
EJ
Pérez-Stable
Kirsten
K
Bibbins-Domingo
Brie A
BA
Williams
Dean
D
Schillinger
D002908:Chronic Disease; D003142:Communication; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003625:Data Collection; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D010817:Physician-Patient Relations; D014481:United States