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Addressing Cultural Determinants of Health for Latino and Hmong Patients with Limited English Proficiency: Practical Strategies to Reduce Health Disparities

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Abstract

We explored how addressing culture may improve patient-provider relationships and reduce health disparities for racial and ethnic individuals with limited English proficiency (LEP). We analyzed qualitative data collected to explore health disparities in preventive cancer screenings for Hmong and Spanish-speaking LEP patients in a large Midwest healthcare system. We interviewed 20 participants (10 from each group) and the audiotaped interviews were transcribed verbatim, then back translated focusing on meaning. Data was analyzed using content analysis. Two themes are: conversation is relational and quality time is valued. Good communication skills involve the amount of conversation, clear explanations, and engaging with the patient. Quality of time meant physical time spent with patient and the task-oriented nature of the encounter. Cultural literacy in healthcare practice helps to understand the whole patient rather than focusing on the symptoms of illness. Patients should not be treated in isolation of their culture. A patient-centered approach to care means physicians should not remain culturally neutral but be more culturally sensitive. We propose steps to reduce disparities by increasing the awareness of cultural literacy for physicians to improve patient-provider relationship.

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References

  1. Lie D, Carter-Pokras O, Braun B, Coleman C. What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy. J Health Commun. 2012;17:13–22.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Panya C, McHugh M, Batalova J. Limited English proficient individuals in the United States: Number, share, growth, and linguistic diversity. Retrieved from Washington, DC; 2011. file://C:/Users?khbruce/Downloads/LEPdatabrif.pdf.

  3. Sentell T, Braun KL. Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. J Health Commun. 2012;17:82–99.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Saha S, Fernandez A, Perez-Stable E. Reducing language barriers and racial/ethnic disparities in health care: an investment in our future. J Gen Intern Med. 22 (suppl 2):371–372.

  5. Silva I. Addressing language and culture differences in health care settings. Disparities National Coordinating Center. 2014.

  6. Fernandez A, Schillinger D, Warton EM, Adler N, Moffet HH, Schenker Y, et al. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the diabetes study of Northen California (DISTANCE). J Gen Intern Med. 2011;26:170–6.

    Article  PubMed  Google Scholar 

  7. Goold SD, Lipkin M. The doctor-patient relationship—challenges, opportunities, and strategies. J Gen Intern Med. 1999;14:S26–33.

    Article  PubMed Central  Google Scholar 

  8. Gordon HS, Gerber BS. What we’ve got here is a failure to communicate. J Gen Intern Med. 2011;26:104–6.

    Article  PubMed  Google Scholar 

  9. Linksy A, McIntosh N, Cabral H, Kazis LE. Patient-provider language concordance and colorectal cancer screening. J Gen Intern Med. 2011;26:142–7.

    Article  Google Scholar 

  10. McAlearney AS, Oliveri JM, Post DM, Song PH, Jacobs EA, Waibel J, et al. Trust and Distrust among Appalachian women regarding cervical cancer screening: A qualitative study. Patient Educ Couns. 2012; doi:10.1016/j.pec.2011.02.023.

  11. Anderson KM, Olson S. Leveraging culture to address health inequalities: examples from native communities: workshop summary. Institute of Medicine, Board on Population Health and Public Health Practice, Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities. National Academies Press; 2013.

  12. Busse-Jones J, Genao I. Impact of culture on health care. J Natl Med Assoc. 2003;95:732–4.

    Google Scholar 

  13. Shaw SJ, Heubner C, Armin J, Orzech K, Vivian J. The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health. 2009;11:460–7.

    Article  PubMed  Google Scholar 

  14. Singer MK, Dressler W, George S, The NIH Expert Panel. Culture: the missing link in health research. Soc Sci Med. 2016;170:237–46.

    Article  Google Scholar 

  15. Zong J, Batalova J. The limited English proficient population in the United States. Migration Policy Institute, Migration Information Source 8. 2015. http://www.migrationpolicy.org/article/limited-english-proficient-population-united-states.

  16. Norton B. Language, identity, and the ownership of English. TESOL Q. 1997;31:409–29.

    Article  Google Scholar 

  17. Singleton K, Krause E. Understanding cultural and linguistic barriers to health literacy. OJIN: Online J Issues Nurs. 2009; doi:10.3912/OJIN.vol14No03Man04.

  18. Institute of Medicine. Health literacy: A prescription to end confusion, Board on Neuroscience and Behavioral Health, Nielson-Bohlman, L., Panzer, Am., Kindig, D. (eds.), Institute of Medicine and the National Academies. The National Academies Press: Washington, DC.; 2004.

  19. Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95:1410–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chang E, Simon M, Dong XQ. Integrating cultural humility into health care professional education and training. Adv Health Sci Educ. 2012;17:269–78.

    Article  Google Scholar 

  21. Eckersley R. Is modern western culture a health hazard? Int J Epidemiol Assoc. 2006;35:252–8.

    Article  Google Scholar 

  22. Hall ET. Beyond culture. Garden City: Anchor Press/Doubleday; 1976.

    Google Scholar 

  23. Hofstede G, Hofstede GJ. Cultures and organizations: software of the mind: intercultural cooperation and its importance for survival. New York: McGraw Hill; 2005.

    Google Scholar 

  24. Triandis HC. Individualism-collectivism and personality. J Pers. 2001;69:907–24.

    Article  PubMed  CAS  Google Scholar 

  25. Hofstede GH. Dimensionalizing cultures: The Hofstede model in context. Online Readings in Psychology and Culture; The Berkeley Electronic Press; 2011.

  26. Shim TY, Kim MS. Changing Korea: understanding culture and communication. NY: Peter Lang Publishing, Inc.; 2008.

    Google Scholar 

  27. Knibb-Lamouche J. Culture as a social determinant of health. Commissioned paper prepare for the Institute on Medicine, Roundtable on the promotion of health equity and the elimination of health disparities. Seattle, Washington; 2012.

  28. Uba L. Cultural barriers to health care for Southeast Asian refugees. Public Health Rep. 1992;107:544–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  29. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatr. 2001;158:29–35.

    Article  PubMed  CAS  Google Scholar 

  30. Meredith LS, Orlando M, Humphrey N, Camp P, Sherbourne CD. Are better ratings of the patient-provider relationship associated with higher quality care for depression? Med Care. 2001;39:349–60.

    Article  PubMed  CAS  Google Scholar 

  31. Russell J, Krantz S, Neville S. The patient-provider relationship and adherence to highly active antiretroviral therapy. J Assoc Nurses AIDS Care. 2004;15:40–7.

    Article  PubMed  Google Scholar 

  32. Michalec B, Maiden KM, Ortiz J, Bell AV, Ehrenthal B. Provider’s perceptions of medical interpreter services and limited English proficiency (LEP) patients: understanding the bigger picture. J Appl Soc Sci. 2014; doi:10.1177/1936724414550247.

  33. Brennan N, Barnes R, Calnan M, Corrigan O, Dieppe P, Entwistle V. Trust in the health-care provider-patient relationship: a systematic mapping review of the evidence base. Int J Qual Health Care. 2013;25:682–8.

    Article  PubMed  Google Scholar 

  34. Gerrero N, Mendes de Leon CF, Evans DA, Jacobs EA. Determinants of trust in health care in an older population. J Am Geriatr Soc. 2015;63:553–7.

    Article  Google Scholar 

  35. Kaiser K, Rauscher GH, Jacobs EA, Strenski TA, Errans CE, Warnecke RB. The import of trust in regular providers to trust in cancer physicians among white, African American, and Hispanic cancer patients. J Gen Intern Med. 2010;26:51–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Salt E, Rayens MK, Kerr AM, Alikhan M, Crofford LJ. Examining rheumatoid arthritis patients’ trust in their provider over time: the effects of demographic factors and accessing sources of information. Orthop Nurs. 2015;34:159–65.

    Article  PubMed  Google Scholar 

  37. Schwei RJ, Kadunc K, Nguyen AL, Jacobs EA. Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups. Patient Educ Couns. 2014;96:333–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Becerra BJ, Arias D, Becerra MB. Low health literacy among immigrant Hispanics. J Racial Ethn Health Disparities. 2016; doi:10.1007/s40615-016-0249-5.

  39. Juckett G. Cross-cultural medicine. Am Fam Physician. 2005;72:2267–74.

    PubMed  Google Scholar 

  40. Larson M. Meaning-based translation: a guide to cross-language equivalence. MD: University Press of America; 1998.

    Google Scholar 

  41. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures, and measure to achieve trustworthiness. Nurse Educ Today. 2004;24:105–12.

    Article  PubMed  CAS  Google Scholar 

  42. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.

    Article  PubMed  Google Scholar 

  43. Duggan A. Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade. J Health Commun. 2006;11:93–108.

    Article  PubMed  Google Scholar 

  44. Culhane-Pera KA, Her C, Her B. “we are out of balance here”: a Hmong cultural model of diabetes. J Immigr Minor Health. 2012;9:179–90.

    Article  Google Scholar 

  45. Lee SM. A review of language and other communication barriers in health care. Office of Minority Health (OMH), Office of Public Health and Science (OPHS), US Department of Health and Human Services (USDHHS); 2003; 3–28.

  46. Xiong P, Westberg SM. Perspectives from the Hmong population on type 2 diabetes. Innov Pharm. 2012;3:1–5.

    Google Scholar 

  47. Sinclair AJ, Armes DG, Randhaw G, Bayer AJ. Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities. Diabet Med. 2010;27:1055–9.

    Article  PubMed  CAS  Google Scholar 

  48. Washington KT, Meadows SE, Elliot SG, Koopman RJ. Information needs of informal caregivers of older adults with chronic health conditions. Patient Educ Couns. 2011;83:37–44.

    Article  PubMed  Google Scholar 

  49. LeFebvre R, Franke V. Culture matters: individualism vs collectivism in conflict decision-making. For Soc. 2013;3:128–46.

    Google Scholar 

  50. Masuda T, Nisbett RE. Attending holistically versus analytically: comparing the context sensitivity of Japanese and Americans. J Pers Soc Psychol. 2001;81:922–34.

    Article  PubMed  CAS  Google Scholar 

  51. Nisbett RE. The geography of thought: how Asians and Westerners think differently…and why. New York: Free Press; 2003.

    Google Scholar 

  52. Oyserman D, Lee SWS. Does culture influence what and how we think? Effects of priming individualism and collectivism. Psychol Bull. 2008;134:311–42.

    Article  PubMed  Google Scholar 

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Acknowledgements

We greatly appreciate the willingness of all study participants to speak with us and grateful to all members of the research team. The authors would like to thank the University of Wisconsin Carbone Comprehensive Cancer Center (UWCCC) for the funds to complete this project. This project is also supported in part by NIH/NCI P30 CA014520-UW Comprehensive Cancer Center Support. Additional administrative support was provided by the Health Innovation Program. The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA

    Linda Park & E. A. Jacobs

  2. Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA

    R. J. Schwei

  3. School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA

    P. Xiong

  4. Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA

    E. A. Jacobs

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  1. Linda Park
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  2. R. J. Schwei
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  3. P. Xiong
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  4. E. A. Jacobs
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Correspondence to Linda Park.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards and the research protocol was approved by the University of Wisconsin-Madison Health Sciences Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. I also confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.

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Park, L., Schwei, R.J., Xiong, P. et al. Addressing Cultural Determinants of Health for Latino and Hmong Patients with Limited English Proficiency: Practical Strategies to Reduce Health Disparities. J. Racial and Ethnic Health Disparities 5, 536–544 (2018). https://doi.org/10.1007/s40615-017-0396-3

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  • DOI: https://doi.org/10.1007/s40615-017-0396-3

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