title: Assessing culturally competent diabetes care with unannounced standardized patients.
abstract: OBJECTIVE
  More effective diabetes care is desperately needed, especially for ethnic minority populations. Provider cultural competence promises to be an important means for reducing disparities in outcomes for patients with diabetes. The objectives of this study were to understand the role of cultural competence in the diabetes office visit.
  
  
  METHODS
  Unannounced standardized patients (SPs) were sent to the offices of 29 family and internal medicine residents and practicing physicians. The SPs portrayed a Mexican American woman newly diagnosed with type 2 diabetes. Using a checklist developed with the input of experts in Hispanic/Latino health care and cultural competence, the SPs evaluated physicians' cultural competence, diabetes care, and general communications skills.
  
  
  RESULTS
  The average total SP Checklist score was 70.7-11.0%, with a range of 43.9% to 90.2%. Physicians scored highly on items that measured general communication skills (95.9%) but were less likely to ask about social history (ie, family and community support issues, 51.9% and 48.1%, respectively). Sixty-seven percent of physicians ordered a hemoglobin A1c, 44% referred to ophthalmology, and 15% performed a monofilament exam. Physicians' inquiry into SPs explanatory model of disease (ie, asking about the SPs' views regarding their disease and its treatment) correlated with the performance of several diabetes treatment-related behaviors, Spearman's rho=.466.
  
  
  CONCLUSIONS
  The findings provide support for a relationship between inquiry into patients' explanatory models of disease and effective diabetes care. Social history and explanatory model elicitation skills are vital parts of cultural competence training programs and potentially valuable tools for mitigating health disparities.
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85724, USA. rkutob@email.arizona.edu
authors.forename: Randa M
authors.initials: RM
authors.lastname: Kutob
authors.forename: John
authors.initials: J
authors.lastname: Bormanis
authors.forename: Marjorie
authors.initials: M
authors.lastname: Crago
authors.forename: Janet
authors.initials: J
authors.lastname: Senf
authors.forename: Paul
authors.initials: P
authors.lastname: Gordon
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Shisslak
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D003466:Cultural Characteristics; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans; D009819:Office Visits; D010817:Physician-Patient Relations; D014481:United States