Cultural competency, patient- physician communication and gender disparities in patient satisfaction Alice F. Yan, MD; Desiree Rivers, Ph.D., M.S.P.H.; Carolyn C. Voorhees, Ph.D.; Valerie Scott

Background Numerous studies have demonstrated that the quality of health care in the United States varies according to patients’ race and ethnicity. Studies have consistently found that Black and Hispanics/Latinos receive lower- quality care than the majority White population.

Latinos in the US: Rapidly Growing Population “The population of senior Latinos is expected to increase 400% by 2030”. - American Association for World Health. (1999). Healthy Aging, Healthy Living - Start Now. Resource Book. Washington: American Association for World Health TOTAL White/NonHispanic All Minorities Black Native American Asian & Pacific Islander Percent Change in 65 + Population by Race and Hispanic Origin,

Why measures Latinos' satisfaction with Health Care Services? Growing Latino Population –Healthcare providers are interacting with more elderly Latino immigrants, refugees, and multi-ethnic populations. Prevalence of Chronic Disease –Diabetes is twice as common in Mexican-Americans as in non- Latino whites. Disparities in Receiving Preventive Health Services –Elderly Latinos receive preventive services for diabetes, mammography, and immunization at rates lower than their white counterparts. National Diabetes Information Clearinghouse. National diabetes statistics. NIH publication US Department of Commerce. Hispanic Population Reaches All-Time High of 38.8 Million, New Census Bureau Estimates Show Current Population Survey, March 2000, PGP-4

Patient Physician Treatment Decision Study Protocol Communication Family Member Model of Patient Decision Making

Background- Literature review Previous research on physician-patient communication has found that physicians stated more information to Whites than to Blacks and Hispanics (Sleath et al. 2003) Physicians exhibited better question- asking skills with non-Hispanic whites compared to Hispanics (Hooper et al.1982).

Purpose 1.To measure Latino patients’ satisfaction with the quality of health care. 2.To determine how disparities in the measures of satisfaction with the quality of health care are explained by patient-physician communication, physician’s cultural competency, patients’ health literacy, and health care access and utilization.

Purpose 3.To examine gender differences in the relationships between satisfaction with the quality of health care and an array of predictors.

Methods Data Source: Commonwealth Fund survey on Disparities in Quality of Health Care Sample: n=1153 Latinos Gender: Male=443(45.9%) Female=710(54.1%) Education level: HS incomplete=340(39.4%) HS diploma or some college=610(50.1%) College graduate or more=198(10.5%)

Methods Cross sectional design Data Analysis: 1.Frequency and percentage Using SAS statistical software with multi-stage sampling option by including the design factor (i.e., Stratum, PSU levels) and takes weight into consideration. 2. Univariate logistic model 3. Multivariate logistic model

Methods Study variables: 1. DV global satisfaction with health care and use of health care services 2. IVs Patient-provider communication Physician’s cultural competency and patients’ experiences Health literacy Health care access and utilization

Results Frequency table-- Prevalence of global satisfaction (very Satisfied) with health care and use of health care services Graphs -- modeling the relationship between less than very satisfied and an array of predictors (stratified by gender) Patient-provider communication Cultural competency Health literacy Health care access and utilization

Demographic variablesVery satisfied N(%) Gender Male166 (53.5) Female367 (59.1) Age 18~29153 (47.2) 30~39134 (51.0) 40~49108 (54.0) 50~64 88 (75.4) >65 48 (78.3) Region Northeast 99 (68.9) Midwest 19 (42.6) Table 1. Prevalence of global satisfaction with health care and use of health care services

Region South135 (59.1) West280 (53.1) Poverty status Below 100%103 (57.6) 100% to 199%119 (56.6) 200% +214 (61.1) Education Level HS incomplete160 (58.4) HS diploma or some college or technical280 (56.2) College graduate or more 90 (54.1)

*Some answers to how many hours worked were ancodable, which resulted in missing responses. Figure 1a — Patient-Physician Communication Figure 2—Physician's Cultural Competency OR=4.58*OR=3.06*OR=2.31*OR=3.45*OR=3.22* * p<.05

Figure 1b — Patient-Physician Communication OR=4.19*OR=3.06*OR=7.23*OR=4.53*OR=6.20* * p<.05

Figure 2a — Physician's Cultural Competency

Figure 2b — Physician's Cultural Competency

Figure 3a — Health literacy

Figure 3b — Health literacy

Figure 4 — Health care access and utilization

Results Table 2: Adjusted OR

Limitations 1.Self reported data 2.Cross sectional study design as well as the time frame of behaviors 3.Cultural competency complex to measure

Implications 1.Train health care professionals to be more “culturally competent”. 2.Focusing on patient-centeredness and awareness of affective will benefit minority patients in particular. 3.Improving the health literacy of patients. 4.Developing appropriate preventive health messages and communicating them effectively

Cultural competency, patient-physician communication and gender disparities in patient satisfaction Muchas Gracias!