Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;38(4):946-953.
doi: 10.1007/s11606-022-07794-w. Epub 2022 Sep 20.

Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome

David S Edelman  1 , Dana M Palmer  2 , Emily K Romero  3 , Bernard P Chang  4 , Ian M Kronish  5
Affiliations

Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome

David S Edelman et al. J Gen Intern Med. 2023 Mar.

Abstract

Background: High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED).

Objective: To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED.

Design, setting, and participants: This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016.

Main measures: English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression.

Key results: Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93).

Conclusions: This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.

Keywords: Communication barriers; Culturally competent care; Healthcare disparities; Language; Social determinants of health.

PubMed Disclaimer

Conflict of interest statement

D.S.E., D.M.P., E.K.R., B.P.C., and I.M.K report no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Proportion of patients reporting of sub-optimal interpersonal care. IPC, Interpersonal Processes of Care survey score, where average item score ≤ 4 is considered sub-optimal. *p < 0.05. †p < 0.001
See this image and copyright information in PMC

References

    1. U.S. Census Bureau, 2015-2019 American Community Survey 5-Year Estimates, Table DP02: Selected Social Characteristics in the United States; using American FactFinder. Accessed 10 February 2022.
    1. Ryan C. Language Use in the United States: 2011. U.S. Census Bureau; 2013.
    1. Street RL, Jr, Makoul G, Arora NK, et al. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295–301. doi: 10.1016/j.pec.2008.11.015. - DOI - PubMed
    1. Allen ML, Cook BL, Carson N, et al. Patient-provider therapeutic alliance contributes to patient activation in community mental health clinics. Adm Policy Ment Health Ment Health Serv Res. 2017;44(4):431–440. doi: 10.1007/s10488-015-0655-8. - DOI - PMC - PubMed
    1. Alegría M, Sribney W, Perez D, et al. The role of patient activation on patient–provider communication and quality of care for US and foreign born Latino patients. J Gen Intern Med. 2009;24(3):534–541. doi: 10.1007/s11606-009-1074-x. - DOI - PMC - PubMed

Publication types

LinkOut - more resources