title: Beyond literacy and numeracy in patient provider communication: focus groups suggest roles for empowerment, provider attitude and language.
abstract: BACKGROUND
  Although the number of people living in the United States with limited English proficiency (LEP) is substantial, the impact of language on patients' experience of provider-patient communication has been little explored.
  
  
  METHODS
  We conducted a series of 12 exploratory focus groups in English, Spanish and Cantonese to elicit discussion about patient-provider communication, particularly with respect to the concerns of the health literacy framework, i.e. ability to accurately understand, interpret and apply information given by providers. Within each language, 2 groups had high education and 2 had low education participants to partially account for literacy levels, which cannot be assessed consistently across three languages. Eighty-five (85) adults enrolled in the focus groups. The resulting video tapes were transcribed, translated and analyzed via content analysis.
  
  
  RESULTS
  We identified 5 themes: 1) language discordant communication; 2) language concordant communication; 3) empowerment; 4) providers' attitudes; 5) issues with the health care system. Despite efforts by facilitators to elicit responses related to cognitive understanding, issues of interpersonal process were more salient, and respondents did not readily separate issues of accurate understanding from their overall narratives of experience with health care and illness. Thematic codes often appeared to be associated with education level, language and/or culture.
  
  
  CONCLUSIONS
  Our most salient finding was that for most of our participants there was no clear demarcation between literacy and numeracy, language interpretation, health communication, interpersonal relations with their provider and the rest of their experience with the health care system.
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA. dbrugge@aol.com
authors.forename: Doug
authors.initials: D
authors.lastname: Brugge
authors.forename: Timothy
authors.initials: T
authors.lastname: Edgar
authors.forename: Kelly
authors.initials: K
authors.lastname: George
authors.forename: Janette
authors.initials: J
authors.lastname: Heung
authors.forename: M Barton
authors.initials: MB
authors.lastname: Laws
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D004522:Educational Status; D005260:Female; D017144:Focus Groups / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008297:Male; D010817:Physician-Patient Relations; D011209:Power, Psychological; D024382:Professional Role; D014741:Video Recording