title: Patient predictors of colposcopy comprehension of consent among English- and Spanish-speaking women.
abstract: OBJECTIVE
  patients with limited English proficiency may be at increased risk for diminished understanding of clinical procedures. This study sought to assess patient predictors of comprehension of colposcopy information during informed consent and to assess differences in understanding between English and Spanish speakers.
  
  
  METHODS
  between June and August 2007, English- and Spanish-speaking colposcopy patients at two Boston hospitals were surveyed to assess their understanding of the purpose, risks, benefits, alternatives, and nature of colposcopy. Patient demographic information was collected.
  
  
  RESULTS
  there were 183 women who consented to participate in the study. We obtained complete data on 111 English speakers and 38 Spanish speakers. English speakers were more likely to have a higher education, greater household income, and private insurance. Subjects correctly answered an average of 7.91 ± 2.16 (72%) of 11 colposcopy survey questions. English speakers answered more questions correctly than Spanish speakers (8.50 ± 1.92 [77%] vs 6.21 ± 1.93 [56%]; p < .001). Using linear regression to adjust for confounding variables, we found that language was not significantly associated with greater understanding (p = .46). Rather, education was the most significant predictor of colposcopy knowledge (p < .001).
  
  
  CONCLUSIONS
  many colposcopy patients did not understand the procedure well enough to give informed consent. The observed differences in colposcopy comprehension based on language were a proxy for differences in education. Education, not language, predicted subjects' understanding of colposcopy. These results demonstrate the need for greater attention to patients' educational background to ensure adequate understanding of clinical information.
authors.affiliation: Harvard Medical School, Boston, Massachusetts 02120-1613, USA.
authors.forename: Julia Tatum
authors.initials: JT
authors.lastname: Krankl
authors.forename: Shimon
authors.initials: S
authors.lastname: Shaykevich
authors.forename: Stuart
authors.initials: S
authors.lastname: Lipsitz
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D001741:Black or African American; D001900:Boston; D003127:Colposcopy; D003142:Communication; D032882:Comprehension; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D007258:Informed Consent; D007802:Language; D008875:Middle Aged; D015999:Multivariate Analysis; D044465:White People; D055815:Young Adult