title: Language concordance, interpersonal care, and diabetes self-care in rural Latino patients.
abstract: BACKGROUND
  Interpersonal care (IPC) is increasingly emphasized as health care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos.
  
  
  OBJECTIVE
  To examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes self-care activities.
  
  
  METHODS
  Cross-sectional survey combined with chart reviews.
  
  
  METHODS
  Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties.
  
  
  METHODS
  Using a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patient-provider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient self-report. The survey response rate was 68%.
  
  
  RESULTS
  Patients with language-concordant providers had more favorable IPC ratings (20% to 41% of language-discordant patients had optimal scores for IPC scales vs. 35% to 69% of language-concordant patients, p < 0.05), except with respect to discrimination. Patients with language-concordant providers reported higher levels of participation in diabetic foot care (1.4 days vs. 0.7 days per week, p value 0.01) compared to patients with language discordance. There was no association between language concordance and participation in other self-care activities.
  
  
  CONCLUSIONS
  This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, adetz@mednet.ucla.edu.
authors.forename: Alissa
authors.initials: A
authors.lastname: Detz
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Fatima
authors.initials: F
authors.lastname: Nunez de Jaimes
authors.forename: Christine
authors.initials: C
authors.lastname: Noguera
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Gerardo
authors.initials: G
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D003144:Communication Barriers; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000592:standards*; D010817:Physician-Patient Relations; D012423:Rural Health / Q000706:statistics & numerical data; D012648:Self Care / Q000592:standards*; D012959:Socioeconomic Factors