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Physician language ability and cultural competence

An exploratory study of communication with Spanish-speaking patients


OBJECTIVE: We studied physician-patient dyads to determine how physician self-rated Spanish-language ability and cultural competence affect Spanish-speaking patients’ reports of interpersonal processes of care.

SETTING/PARTICIPANTS: Questionnaire study of 116 Spanish-speaking patients with diabetes and 48 primary care physicians (PCPs) at a public hospital with interpreter services.

MEASURES: Primary care physicians rated their Spanish ability on a 5-point scale and cultural competence by rating: 1) their understanding of the health-related cultural beliefs of their Spanish-speaking patients; and 2) their effectiveness with Latino patients, each on a 4-point scale. We assessed patients’ experiences using the interpersonal processes of care (IPC) in diverse populations instrument. Primary care physician responses were dichotomized, as were IPC scale scores (optimal vs nonoptimal). We analyzed the relationship between language and two cultural competence items and IPC, and a summary scale and IPC, using multivariate models to adjust for known confounders of communication.

RESULTS: Greater language fluency was strongly associated with optimal IPC scores in the domain of elicitation of and responsiveness to patients, problems and concerns [Adjusted Odds Ratio [AOR], 5.25; 95% confidence interval [CI], 1.59 to 17.27]. Higher score on a language-culture summary scale was associated with three IPC domains — elicitation/responsiveness (AOR, 6.34; 95% CI, 2.1 to 19.3), explanation of condition (AOR, 2.7; 95% CI, 1.0 to 7.34), and patient empowerment (AOR, 3.13; 95% CI, 1.2 to 8.19)—and not associated with two more-technical communication domains.

CONCLUSION: Physician self-rated language ability and cultural competence are independently associated with patients’ reports of interpersonal process of care in patient-centered domains. Our study provides empiric support for the importance of language and cultural competence in the primary care of Spanish-speaking patients.

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Corresponding author

Correspondence to Alicia Fernandez MD.

Additional information

Dr Fernandez was funded in part by the UCSF/Hellman Early Family Career Award and by the UCSF Excellence Centers to Eliminate Ethnic/Racial Disparities. This project was funded in part by grant P30AG15272 under the Resource Centers for Minority Aging Research program, by the National Institute on Aging, the National Institute of Nursing Research, and The National Center on Minority Health and Health Disparities, National Institutes of Health.

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Fernandez, A., Schillinger, D., Grumbach, K. et al. Physician language ability and cultural competence. J GEN INTERN MED 19, 167–174 (2004).

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Key words

  • cultural competence
  • Latino
  • health disparities
  • language barriers
  • communication
  • Hispanic
  • interpretation