This study found that after adjusting for potential case-mix confounders, Spanish-speaking parents reported significantly lower ratings of provider communication than English-speaking parents on only 1 of the 4 items of provider satisfaction studied, that is, provider time spent with child. This relationship was explained, in part, by need for interpretive services. Spanish-speaking parents who needed interpreter services were less likely than both English speakers and Spanish speakers not needing interpretive services to report that providers spent enough time with their children. Additionally, we found no statistically significant difference in this item between Spanish-speaking parents who did not need interpretive services and English-speaking parents.
Our findings suggest that parents’ satisfaction with provider time spent with their children was most strongly influenced by whether parents were able to directly communicate with their child’s provider in the same language. This finding is consistent with that of Baker and colleagues,14
who found that patients who communicated through an interpreter were less satisfied than patients who communicated directly with their provider without an interpreter.
Spanish speakers in need of interpretive services may have perceived that not enough time was spent with their children because they didn’t understand the medical information conveyed during the medical encounter. Likewise, Spanish speakers with no need for interpretive services may have reported higher ratings because they were bilingual, or had family/friends with English competency who were able to convey medical information in a way that was understandable for the parents. It was also possible that this group was more likely to receive care from language-concordant providers. Nevertheless, other factors besides understanding information transfer during the medical encounter may have explained this finding. Spanish-speaking parents who needed interpretive services may have been less acculturated to the norms of the US health care system and have different expectations about the time necessary for a medical visit. In addition, dissatisfaction may have been influenced by the fact that the time required for interpretation essentially reduces ‘‘time’’ available for the interaction between the patient and doctor.
The study had several limitations. First, we had a relatively small sample size that reduced statistical power to detect differences in parent reports of satisfaction with provider communication. Second, important information that may explain variation in provider satisfaction, such as provider language concordance, acculturation, length of residency, language proficiency, and quality of interpretive services, was not included in the CAPHS survey. Third, we did not have data on other socioeconomic factors such as family income or occupation, both of which may have affected ratings of provider communication. Moreover, we did not have information on whether respondents differed from nonrespondents with regard to language status. The dissatisfaction finding among Spanish speakers in need of interpretive services may have been overestimated if respondents were more likely to report a need for interpretive services compared to nonrespondents. In addition, because about half the sample did not respond to the survey, an element of nonresponse bias most likely exists. However, we believe this bias is minimal since nonrespondents did not differ significantly from respondents with respect to available demographic information. Last, study results are not generalizable to Spanish-speaking parents overall, but only to parents whose children are enrolled in Medicaid managed care organizations within the state of Oregon.