A Common Language or Common Ground? Language Concordance in Healthcare Encounters in the U.S. Mexico Border Region

Xochitl Pablos-Velez, Jose Gomez, and Yissela Escobedo

University of Texas – Pan American

 

Language concordance (LC) has long been identified as the gold standard in eliminating language barriers in healthcare (Brach 2005; Downing & Roat 2002). Research has shown that physicians in LC encounters are more likely to provide lifestyle counseling (Eamranond 2009) and that patients in LC encounters are less likely to perceive discrimination (Schenker 2010). A recent study of LC among diabetes patients in northern California found that patients with LC physicians had better overall management of the disease than those who used an interpreter (Fernandez 2010). While the benefits of LC are indisputable, the sociolinguistic characteristics of LC encounters are poorly understood. The present paper seeks to shed light on these characteristics through a comparison of two diabetes education courses facilitated by bilingual nurses in the South Texas border region. The courses are based on a common curriculum and take place at a community health center in Hidalgo County Texas that serves the majority of uninsured, undocumented, and limited English proficient patients in the region. The study first describes the language use of both nurses. Using methods of critical discourse analysis focused on the exercise of power in and behind discourse (Fairclough 2001), we will demonstrate key differences in the Spanish language discourse styles of each nurse facilitator. After establishing discursive differences, we will determine the effectiveness of each Spanish language discourse style in changing the behavioral and biochemical characteristics of the program participants. We will measure and compare changes in attitudes towards foods, medicines, and physical activity in both groups. We will also measure and compare changes in biochemical markers such as lipids, body mass index, and hemoglobin A1C in each group. Through these findings, our study seeks to shed light on the discourse features that best promote health behavior change in a language contact environment. At the same time, our study contributes to the theoretical understanding of the use of Spanish in institutional settings in the U.S.-Mexico border region.

 

References

Brach, C., Frazer, I. & Paez, K. (2005). Crossing the language chasm. Health Affairs 24: 424-434.

Downing, B. & Roat, C. (2002). Models for the Provision of Language Access in Healthcare Settings.

National Council on Interpreting in Health Care. 

Eamranond, P. R., Davis, R. B., Phillips, R. S., & Wee, C. C. (2009). Patient-Physician Language

Concordance and Lifestyle Counseling Among Spanish-Speaking Patients. Journal of Immigrant Minority Health 11: 494-498.

Fairclough, N. (2001). Language and Power. 2nd Edition. London: Longman.

Fernández, A, Schillinger, D, Warton, M et al (2010). Language barriers, physician-patient language

concordance, and glycemic control among insured Latinos with diabetes. Journal of General Internal Medicine 26: 170-176.

Schenker, Y, Karter, A, Schillinger, D et al (2010). The impact of limited English proficiency and physician

language concordance on reports of clinical interactions among patients with diabetes. Patient Education and Counseling 81: 222-228.