November 6, 2012

University of Maryland study is first to examine why Spanish-speaking U.S. Hispanics report lower satisfaction with provider communication

Hispanic patients perceive their health care providers’ communication skills differently according to their English language proficiency. Offering cultural competency training programs to providers and providing interpreter services for patients are ways for health care organizations to demonstrate a commitment to improving the health care experience for Hispanics.

College Park, Md.--Hispanics report the lowest satisfaction with health care provider communication compared to whites and blacks, with Spanish-speaking Hispanics reporting lower satisfaction with provider communication than English-speaking Hispanics. A new study from the University of Maryland School of Public Health examined the reasons for this disparity and found that it is largely attributable to differences in health insurance, acculturation, and education. Using data from the 2007-2009 Medical Expenditure Panel Survey, Dr. Jennifer Villani and Dr. Karoline Mortensen, assistant professor, both in the Department of Health Services Administration, identified and quantified the components that constitute the gap in satisfaction with provider communication between English- and Spanish-speaking Hispanics. The research was conducted for Dr. Villani’s doctoral dissertation; she is the first doctoral student to graduate from the Department of Health Services Administration (this December).

“This is the first study to our knowledge that examines this disparity. Because Spanish-speaking Hispanics are significantly less likely than English-speaking Hispanics to be satisfied with their provider encounters, we investigated the relationship between satisfaction and acculturation, as well as the impact of differences in race, ethnicity, gender, and language between patients and providers,” explains Dr. Mortensen.

The study found that English-speaking Hispanics are 7.3 percentage points more likely to be satisfied with the amount of time their providers spent with them compared to Spanish-speaking Hispanics. Differences in acculturation between the two groups account for 77 % of this gap. Satisfaction with provider listening is 6.8 percentage points higher for English-speaking Hispanics. Hispanics who speak English are more satisfied with provider communication.

Although previous studies found that patients prefer providers of the same race, ethnicity, gender, and language, in this analysis, differences in identity did not explain the difference in satisfaction. The patient’s level of acculturation, on the other hand, was a large component of the groups’ difference in satisfaction with the amount of time afforded to the patient. One explanation may be that the less-acculturated Spanish-speaking Hispanics expect more time than their providers give based on customs from their native countries. Therefore, when medical encounters do not meet their expectations, they are less satisfied compared to their more acculturated, English-speaking counterparts who may expect little time from providers. After acculturation, health insurance coverage and level of education are the next largest contributors to the gap in patient satisfaction with provider communication. This finding concurs with previous research demonstrating patients with private insurance or more education tend to be more satisfied.

These findings emphasize the importance of patient acculturation and have valuable implications for health care administrators and providers. As of October 2012, the Centers for Medicare & Medicaid Services (CMS) are directly linking patient satisfaction scores to hospital reimbursement, resulting in an unprecedented emphasis on patient satisfaction. Therefore, it is critical to better understand factors associated with satisfaction and to provide care that is attentive to cultural differences. Hispanic patients perceive their health care providers’ communication skills differently according to their English language proficiency. Offering cultural competency training programs to providers and providing interpreter services for patients are ways for health care organizations to demonstrate a commitment to improving the health care experience for Hispanics. Another recommendation is to increase the proportion of minorities in clinical education in order to increase diversity in the medical workforce to give Hispanic patients more choices and possibly more satisfying clinical interactions.

The study Decomposing the Gap in Satisfaction with Provider Communication Between English- and Spanish-Speaking Hispanic Patients was written by Jennifer Villani and Karoline Mortensen and published online on October 17, 2012 in the Journal of Immigrant and Minority Health.

For more information, please contact Kelly Blake, communications director for the School of Public Health at kellyb@umd.edu or (301) 405-9418.