Journal of General Internal Medicine

, Volume 25, Issue 7, pp 682–687 | Cite as

Differences in Patient–Provider Communication for Hispanic Compared to Non-Hispanic White Patients in HIV Care

  • Mary Catherine BeachEmail author
  • Somnath Saha
  • P. Todd Korthuis
  • Victoria Sharp
  • Jonathon Cohn
  • Ira Wilson
  • Susan Eggly
  • Lisa A. Cooper
  • Debra Roter
  • Andrea Sankar
  • Richard Moore
Original Article



Hispanic Americans with HIV/AIDS experience lower quality care and worse outcomes than non-Hispanic whites. While deficits in patient–provider communication may contribute to these disparities, no studies to date have used audio recordings to examine the communication patterns of Hispanic vs. non-Hispanic white patients with their health care providers.


To explore differences in patient–provider communication for English-speaking, HIV-infected Hispanic and non-Hispanic white patients.


Cross-sectional analysis.


Two HIV care sites in the United States (New York and Portland) participating in the Enhancing Communication and HIV Outcomes (ECHO) study.


Nineteen HIV providers and 113 of their patients.


Patient interviews, provider questionnaires, and audio-recorded, routine, patient–provider encounters coded with the Roter Interaction Analysis System (RIAS).


Providers were mostly non-Hispanic white (68%) and female (63%). Patients were Hispanic (51%), and non-Hispanic white (49%); 20% were female. Visits with Hispanic patients were less patient-centered (0.75 vs. 0.90, p = 0.009), with less psychosocial talk (80 vs. 118 statements, p < 0.001). This pattern was consistent among Hispanics who spoke English very well and those with less English proficiency. There was no association between patient race/ethnicity and visit length, patients’ or providers’ emotional tone, or the total number of patient or provider statements categorized as socioemotional, question-asking, information-giving, or patient activating. Hispanic patients gave higher ratings than whites (AOR 3.05 Hispanic vs. white highest rating of providers’ interpersonal style, 95% CI 1.20-7.74).


In this exploratory study, we found less psychosocial talk in patient–provider encounters with Hispanic compared to white patients. The fact that Hispanic patients rated their visits more positively than whites raises the possibility that these differences in patient–provider interactions may reflect differences in patient preferences and communication style rather than “deficits” in communication. If these findings are replicated in future studies, efforts should be undertaken to understand the reasons underlying them and their impact on the quality and equity of care.


HIV/AIDS patient–physician relations patient–physician communication health disparities 



This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). In addition, Dr. Korthuis was supported by the National Institute of Drug Abuse (K23 DA019808). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05) and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. The authors wish also to acknowledge the helpful comments and review of John Fleishman, PhD.

Conflicts of Interest

None disclosed.


  1. 1.
    King WD, Minor P, Ramirez KC, et al. Racial, gender and geographic disparities of antiretroviral treatment among US Medicaid enrolees in 1998. J Epidemiol Community Health. 2008;62:798–803.CrossRefPubMedGoogle Scholar
  2. 2.
    Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS Behav. 2009;13:582–602.CrossRefPubMedGoogle Scholar
  3. 3.
    Sullivan PS, Campsmith ML, Nakamura GV, Begley EB, Schulden J, Nakashima AK. Patient and regimen characteristics associated with self-reported nonadherence to antiretroviral therapy. PLoS ONE. 2007;2:e552.CrossRefPubMedGoogle Scholar
  4. 4.
    Woldemichael G, Christiansen D, Thomas S, Benbow N. Demographic characteristics and survival with AIDS: health disparities in Chicago, 1993-2001. Am J Public Health. 2009;99(Suppl 1):S118–23.PubMedGoogle Scholar
  5. 5.
    Hooper EM, Comstock LM, Goodwin JM, Goodwin JS. Patient characteristics that influence physician behavior. Med Care. 1982;20:630–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Roter DL, Stewart M, Putnam SM, Lipkin M Jr, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997;277:350–56.CrossRefPubMedGoogle Scholar
  7. 7.
    Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC. Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc. 2001;93:380–85.PubMedGoogle Scholar
  9. 9.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282:583–89.CrossRefPubMedGoogle Scholar
  10. 10.
    Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE Jr. Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study. Med Care. 1995;33:1176–87.CrossRefPubMedGoogle Scholar
  11. 11.
    Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: assessing health care quality for minority Americans. New York: The Commonwealth Fund; 2002.Google Scholar
  12. 12.
    Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–10.CrossRefPubMedGoogle Scholar
  13. 13.
    Beach M, Saha S, Korthuis P et al. Does patient–provider communication differ for black compared to white HIV-infected patients? AIDS Behav. in press.Google Scholar
  14. 14.
    Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32:175–81.PubMedGoogle Scholar
  15. 15.
    Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–59.CrossRefPubMedGoogle Scholar
  16. 16.
    Roter DL. Patient participation in the patient–provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr. 1977;5:281–315.PubMedGoogle Scholar
  17. 17.
    Wissow LS, Roter D, Bauman LJ, et al. Patient–provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD. Med Care. 1998;36:1439–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Roter DL, Hall JA, Katz NR. Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions. Med Care. 1987;25:437–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305–39. 274.CrossRefPubMedGoogle Scholar
  20. 20.
    McLellan AT, Cacciola JS, Zanis D. Addiction Severity Index, Lite Version (ASI-Lite). . 1997. Center for the Studies of Addiction, University of Pennsylvania/Philadelphia VA Medical Center. 2-14-2007. Accessed February 2010.
  21. 21.
    Beach MC, Price EG, Gary TL, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43:356–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Pringle M, Stewart-Evans C. Does awareness of being video recorded affect doctors' consultation behaviour? Br J Gen Pract. 1990;40:455–58.PubMedGoogle Scholar
  23. 23.
    Wolraich ML, Albanese M, Stone G, et al. Medical communication behavior system. An interactional analysis system for medical interactions. Med Care. 1986;24:891–903.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Mary Catherine Beach
    • 1
    • 6
    Email author
  • Somnath Saha
    • 2
  • P. Todd Korthuis
    • 2
  • Victoria Sharp
    • 3
  • Jonathon Cohn
    • 4
  • Ira Wilson
    • 5
  • Susan Eggly
    • 4
  • Lisa A. Cooper
    • 1
  • Debra Roter
    • 1
  • Andrea Sankar
    • 4
  • Richard Moore
    • 1
  1. 1.Johns Hopkins UniversityBaltimoreUSA
  2. 2.Oregon Health Science UniversityPortlandUSA
  3. 3.Saint-Lukes RooseveltNew YorkUSA
  4. 4.Wayne State UniversityDetroitUSA
  5. 5.Tufts-New England Medical CenterBostonUSA
  6. 6.Associate Professor of Medicine and Health, Behavior & SocietyJohns Hopkins UniversityBaltimoreUSA

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