Unraveling the relationship between literacy, language proficiency, and patient–physician communication

• Published in: Patient education and counseling 2009-06, Vol.75 (3), p.398-402
• Main Authors: Sudore, Rebecca L, Landefeld, C. Seth, Pérez-Stable, Eliseo J, Bibbins-Domingo, Kirsten, Williams, Brie A, Schillinger, Dean
• Format: Article
• Language: English
• Subjects: Chronic Disease; Communication; Concordance; Confidence Intervals; Cross-Sectional Studies; Data Collection; Doctor-Patient communication; Doctors; Educational Status; Female; Health disparities; Health education; Health literacy; Health Status Disparities; Hispanic Americans; Humans; Internal Medicine; Language; Limited English proficiency; Male; Middle Aged; Models, Statistical; Multivariate Analysis; Nursing; Odds Ratio; Physician-Patient Relations; Proficiency; United States; Women
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2009.02.019

Abstract Objective To examine whether the effect of health literacy (HL) on patient–physician communication varies with patient–physician language concordance and communication type. Methods 771 outpatients rated three types of patient–physician communication: receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication. We assessed HL and language categories including: English-speakers, Spanish-speakers with Spanish-speaking physicians (Spanish-concordant), and Spanish-speakers without Spanish-speaking physicians (Spanish-discordant). Results Overall, the mean age of participants was 56 years, 58% were women, 53% were English-speakers, 23% Spanish-concordant, 24% Spanish-discordant, and 51% had limited HL. Thirty percent reported poor receptive, 28% poor proactive, and 56% poor interactive communication. In multivariable analyses, limited HL was associated with poor receptive and proactive communication. Spanish-concordance and discordance was associated with poor interactive communication. In stratified analyses, among English-speakers, limited HL was associated with poor receptive and proactive, but not interactive communication. Among Spanish-concordant participants, limited HL was associated with poor proactive and interactive, but not receptive communication. Spanish-discordant participants reported the worst communication for all types, independent of HL. Conclusion Limited health literacy impedes patient–physician communication, but its effects vary with language concordance and communication type. For language discordant dyads, language barriers may supersede limited HL in impeding interactive communication. Practice implications Patient–physician communication interventions for diverse populations need to consider HL, language concordance, and communication type.