Introduction
Several population-based studies show that Latinos in the United States are disproportionately affected by diabetes type-2 and that they have poor glycemic control. As a result, Latinos face more complications arising from diabetes compared to their white counterparts (Fernandez et al., 2010). The authors point out that many social factors cause poor glycemic control among Latinos. More specifically, language barriers play a key role among the social factors that influence health care access in Latinos with type-2 diabetes. Moreover, Fernandez and her colleagues note that Latinos, more than any other group in the U.S., are more likely to have limited English proficiency (LEP) with 39% of Latinos speaking the English language poorly.
In this study, Fernandez et al. (2010) sought to examine the relationship between LEP and glycemic control relative to whether this association is affected by having a language concordant physician. The study employed a cross-sectional observational method of data collection based on the results of a previous study (the 2005-2006 Diabetes Study of Northern California-DISTANCE). The diabetic patients received medical services in a managed setting involving high-quality interpreters to whom the patients reported their English skills as well as those of their primary care physicians (PCPs).
The study found cases of poor glycemic control in Latinos with LEP (21%) and English-proficient Latinos (18%) compared to their white counterparts (10%). Additionally, in the presence of a language-discordant physician, patients with LEP were more likely to have poor glycemic control (27.8%), which contrasts with that of their counterparts assigned to a language-concordant physician (16.8%). These figures clearly show that English proficiency is a strong predictor of healthcare outcomes among diabetic Latinos because Latinos with LEP have poor glycemic control compared to English-speaking Latinos and whites.
Literature Review
The study provides a review of previous studies concerning the same topic. Accordingly, Fernandez and her colleagues point out that there are major disparities concerning glycemic control between Latinos and whites. The authors also refer to the findings of similar studies, especially those that are population-based to highlight the existing problem and justify the need for the current study. Here, note that a limited number of previous studies establish the impact of language barriers on poor glycemic control, and thus, a review of the existing literature on the same subject reveals gaps in the previous studies and gives direction as well as a platform for the current and future studies.
Relevance of the Study
The study carried out by Fernandez and her colleagues are relevant to the health issues existing in contemporary society. This is because diabetes, as shown by population-based studies, affects Latinos more than their white counterparts. However, as shown earlier, previous studies did not focus on the effects of language barriers on healthcare access among diabetic Latinos. To address the issue of language barriers in healthcare access among Latinos, Fernandez et al. (2010) examine the association among LEP, glycemic control, and a language-concordant physician.
As mentioned earlier, the results reveal that Latinos with LEP have poor glycemic index compared to English-speaking Latinos and whites and that the availability of a language-concordant physician leads to better glycemic control in Latinos with LEP. These findings are relevant to healthcare practice because they provide an understanding of the problems facing diabetic Latinos. Moreover, the research findings can go a long way in terms of addressing disparities in health care access among diabetic Latinos experiencing language barriers.
Research Design
This was an observational study based on data from a previous study called Diabetes Study of Northern Carolina (DISTANCE). The participants included insured patients with diabetes who received health care services in a controlled care setting. The patients were assessed on their English proficiency skills with the use of an interpreter in cases whereby the respondents did not understand English. Additionally, the patients were evaluated on their knowledge about the Spanish proficiency skills of their PCPs.
To understand the patients’ glycemic control, the researchers used the glycosylated hemoglobin AIc test. Further, the study defined poor glycemic control as AIc values that are greater than 9%. The research design used is effective because it involves first-hand information from the respondents. Additionally, glycemic control was measured in diabetic Latinos who had uniform access to health care insurance, and therefore, the outcome is not affected by dissimilarities involving health care coverage. Further, interpreter services were offered by KPNC, a non-profit integrated health care delivery system, which offers high-quality interpreter services to clients.
Sample Characteristics
Out of about 20,000 respondents drawn from the DISTANCE study, the current study recruited 8,397 patients of which 3,877were of Latino origin and 4,520 were whites. The selection criteria involved diabetic patients with a health enrollment plan of more than 30 days before the study. Moreover, patients were supposed to have had at least one AIc measure in the year preceding the study. Additionally, the respondents who failed to answer about their English proficiency skills were excluded. Further, concerning physician-concordance, only those patients with an assigned medical facility and a primary care physician were included.
The final sample size included 6,738 patients of which the majority were whites (3,545) followed by English proficient Latinos (2,663), and then Latinos with LEP (510). Out of the 510 Latino patients with LEP, 137 had a language-concordant PCP compared to 115 patients who had a language-discordant PCP.
Most of the Latinos involved in the study were of Mexican origin. On the other hand, the patients had different socio-economic statuses with the whites having better incomes, and they consisted of more males compared to the Latinos. Moreover, the English-proficient Latinos comprised more males compared to the Latinos with LEP. Moreover, English-speaking Latinos had a higher annual income compared to the Latinos with LEP.
The sample chosen in this study is appropriate to meet the objectives of the study since it focuses on the language barriers in health care access, and it shows uniformity because all patients had a health insurance cover. However, the target population of Latinos with LEP was too small compared to the whites. In addition, most of the Latinos in the study were of Mexican origin, and therefore, the results may not be generalized to Latinos from other nationalities.
Applicability of the Research Findings
The findings of this study are applicable in improving health care access among diabetic Latinos. Accordingly, Fernandez et al. (2010) recommend that there is a need to improve glycemic control among diabetic Latinos. Additionally, health care institutions should consider offering patients with LEP the opportunity to choose language-concordant physicians to improve health care access. Moreover, the increased number of patients with LEP calls for an increased workforce of health care professionals with bilingual skills. From a personal perspective, the findings of this research can go a long way in terms of informing the development of language-sensitive diabetes self-care programs for Latinos with LEP to improve their well-being.
Moreover, the findings that Latinos with LEP have poor glycemic control provide a platform for further research. As a result, future research can include strategies of linking Latino patients with language-concordant PCPs to alleviate language barriers and enhance glycemic control in diabetic patients.
Recommendations and Conclusion
The study is limited because most of the Latinos recruited were of Mexican origin, and therefore, the findings of the current research cannot be generalized to Latinos from other nationalities. This limitation can be improved in the future by incorporating respondents from other nationalities. Overall, this study was presented professionally, and it meets the minimum standards required to present a scientific research paper.
Reference
Fernandez, A., et al. (2010). Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: The diabetes study of Northern California (DISTANCE). Journal of General Internal Medicine, 26(2), 170-176.