Beyond demographics: differences in patient activation across new immigrant, diverse language subgroups

Area of Science:

• Health Services Research
• Patient Engagement
• Health Disparities

Background:

• Patient-centered medical homes aim to align care with patient values and promote self-care.
• Patient activation, defined as the knowledge, skills, and confidence to manage one's own health, is crucial for effective self-care.
• Understanding factors influencing patient activation across diverse linguistic groups is essential for equitable healthcare delivery.

Purpose of the Study:

• To measure and compare patient activation scores among English-, Spanish-, and Haitian Creole-speaking patients.
• To investigate the influence of language, country of birth, and duration of US residency on patient activation.
• To identify potential disparities in patient activation based on linguistic and cultural backgrounds.

Main Methods:

• The study utilized the Patient Activation Measure (PAM) to assess patient activation levels.
• Surveys were administered in English, Spanish, and Haitian Creole to patients at an inner-city hospital ambulatory care practice.
• Statistical analyses compared mean PAM scores and activation levels across different language groups, including race and ethnicity.

Main Results:

• Significant differences in mean PAM scores and activation levels were observed based on the language of the survey.
• US-born participants and those residing longer in the US demonstrated higher mean PAM scores.
• Patients more comfortable with English showed increased levels of activation. Haitian Creole speakers had lower mean PAM scores than English-speaking Caribbean Blacks.
• Spanish and Haitian Creole speakers exhibited lower mean PAM scores compared to English speakers, irrespective of race or Hispanic ethnicity.

Conclusions:

• Language proficiency and cultural background are significant determinants of patient activation.
• Lower patient activation scores in Spanish and Haitian Creole speakers highlight potential barriers to self-care and engagement.
• Healthcare practices should consider language and cultural nuances to effectively support patient self-care and promote health equity.