Physician language ability and cultural competence -: An exploratory study of communication with Spanish-speaking patients
Physician language ability and cultural competence -: An exploratory study of communication with Spanish-speaking patients
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DOI：
10.1111/j.1525-1497.2004.30266.x
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发表时间：
2004-02-01
影响因子：
5.7
通讯作者：
Pérez-Stable, EJ
中科院分区：
文献类型：
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作者：
Fernandez, A;Schillinger, D;Pérez-Stable, EJ
目的：我们研究了医患二元组，以确定医生自评的西班牙语能力和文化能力如何影响西班牙语患者对护理人际过程的报告。 地点/参与者：对公立医院的 116 名西班牙语糖尿病患者和 48 名提供口译服务的初级保健医生 (PCP) 进行问卷调查。 测量：初级保健医生按照 5 分制评估他们的西班牙语能力和文化能力通过评级：1）他们对西班牙语患者的健康相关文化信仰的理解； 2) 它们对拉丁裔患者的有效性，每项均采用 4 分制。我们使用不同人群的人际护理流程 (IPC) 工具评估了患者的体验。初级保健医生的反应分为两类，IPC 量表评分也是如此（最佳与非最佳）。我们分析了语言与两个文化能力项目和 IPC 之间的关系，以及总结量表和 IPC 之间的关系，使用多变量模型来调整已知的沟通混杂因素。结果：更高的语言流利度与在患者、问题和担忧的引发和响应领域中的最佳 IPC 分数密切相关[调整优势比 [AOR]，5.25； 95% 置信区间 [CI]，1.59 至 17.27]。语言文化总结量表上的较高分数与三个 IPC 领域相关：启发/响应（AOR，6.34；95% CI，2.1 至 19.3）、病情解释（AOR，2.7；95% CI，1.0 至 7.34）和患者赋权（AOR，3.13；95% CI，1.2 至 8.19）与两个技术性更强的沟通领域无关。结论：医生自评的语言能力和文化能力与患者在以患者为中心的领域中的人际护理过程的报告独立相关。我们的研究为西班牙语患者初级护理中语言和文化能力的重要性提供了经验支持。
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.