Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marcella Nunez-Smith

Subject Area(s)

Language, Hispanic American studies

Abstract

Hispanic/Latinos are the fastest growing racial/ethnic minority in the US and are often treated as a monolithic group in health disparities research. Language ability and preference, two distinct linguistic constructs, are some of the factors that contribute to intra-group diversity. Yet, these factors are understudied. To fill this gap, we embarked on multiple research methodologies with the goal to better understand the influence of language factors in the health experiences and health outcomes of the largest ethnic/linguistic minority in the nation.

Specifically, we explored two research questions:

1. Among Hispanic/Latino community residents with varying degrees of English language proficiency, we sought to better understand their experience of healthcare discrimination.

2. Among Hispanic/Latino legal immigrants, we sought to understand if language ability and language preference are independent predictors of self reported health at the population level.

We conducted two studies to research these questions:

1. We used a qualitative design with six online modified focus groups to explore healthcare discrimination amongst 33 Hispanic/Latino participants from Connecticut and Texas. Three groups consisting of self-identified English language proficient participants and three groups consisting of self-identified limited English proficient participants were empaneled for three days of discussion on healthcare experiences.

2. We conducted a cross sectional analytical study using the 2003 New Immigrant Survey, a nationally representative sample of adult legal Hispanic/Latino immigrants and limited the analysis to those born in Latin America (n=2885. 36.7% of total sample). The main dependent variable on our multivariate analysis was self-rated health. The main independent predictors in two models were self rated language proficiency and language preference at home respectively.

Our results showed:

1. Four novel themes captured unique perspectives of healthcare discrimination of our study participants across all focus groups. 1) Participants reported experiencing and observing healthcare discrimination; 2) Participants were motivated advocates for high quality care; 3) Participants prioritized several essential components in the provider-patient interaction beyond ethnic or language concordance; 4) Participants articulated clear standards to assess quality of care in healthcare interactions.

2. In our quantitative study, we found that among Hispanic/Latino legal immigrants, limited English proficiency status is a predictor of poor current self-rated health (unadjusted OR=2.9; 95% 2.2-3.7), even after adjusting for the effect of age at immigration, time of residency in the US, years of education and having a chronic disease (adjusted OR=1.6; 95% CI 1.1-2.3). Language preference was not associated with current self-rated health among Hispanic/Latino immigrants, after adjusting for confounding.

The conclusions from our study were:

1. Our findings highlight the broad diversity of knowledge and expectations that exist within this population. They can inform patient-provider interactions and increase satisfaction among the Hispanic/Latino population receiving healthcare and help mitigate the discrimination experiences.

2. The type of reported language measures made a difference to independently predict SHR among Hispanic/Latino immigrants. Speaking language preference at home may not be a valid measure of language barriers in health. The single item to measure English language proficiency appears as a simple and consistent measure to predict immigrant population health.

Comments

This is an Open Access Thesis.

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