Language concordance, interpersonal care, and diabetes self-care in rural Latino patients

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.

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.

Cross-sectional survey combined with chart reviews.

Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties.

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%.

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.

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.