Physician Language Ability and Cultural Competence

An Exploratory Study of Communication with Spanish-speaking Patients


  • Alicia Fernandez MD,

    Corresponding authorSearch for more papers by this author
  • Dean Schillinger MD,

  • Kevin Grumbach MD,

  • Anne Rosenthal MD,

  • Anita L. Stewart PhD,

  • Frances Wang MS,

  • Eliseo J. Pérez-Stable MD

  • Received from Department of Medicine (AF, DS, AR, FW, EPS), Primary Care Research Center (AF, DS, KG, FW, EPS), Medical Effectiveness Research Center for Diverse Populations (AF, DS, KG, EPS), Department of Family and Community Medicine (KG), Institute for Health and Aging (ALS), Center for Aging in Diverse Communities (ALS, EPS), University of California, San Francisco, Calif.

Address correspondence and requests for reprints to Alicia Fernandez, MD, Bldg 90, Ward 95, 995 Potrero Ave, San Francisco, CA 94110 (e-mail:


OBJECTIVE:  We studied physician–patient dyads to determine how physician self-rated Spanish-language ability and cultural competence affect Spanish-speaking patients’ reports of interpersonal processes of care.

SETTING/PARTICIPANTS:  Questionnaire study of 116 Spanish-speaking patients with diabetes and 48 primary care physicians (PCPs) at a public hospital with interpreter services.

MEASURES:  Primary care physicians rated their Spanish ability on a 5-point scale and cultural competence by rating: 1) their understanding of the health-related cultural beliefs of their Spanish-speaking patients; and 2) their effectiveness with Latino patients, each on a 4-point scale. We assessed patients’ experiences using the interpersonal processes of care (IPC) in diverse populations instrument. Primary care physician responses were dichotomized, as were IPC scale scores (optimal vs nonoptimal). We analyzed the relationship between language and two cultural competence items and IPC, and a summary scale and IPC, using multivariate models to adjust for known confounders of communication.

RESULTS:  Greater language fluency was strongly associated with optimal IPC scores in the domain of elicitation of and responsiveness to patients, problems and concerns [Adjusted Odds Ratio [AOR], 5.25; 95% confidence interval [CI], 1.59 to 17.27]. Higher score on a language-culture summary scale was associated with three IPC domains – elicitation/responsiveness (AOR, 6.34; 95% CI, 2.1 to 19.3), explanation of condition (AOR, 2.7; 95% CI, 1.0 to 7.34), and patient empowerment (AOR, 3.13; 95% CI, 1.2 to 8.19)—and not associated with two more-technical communication domains.

CONCLUSION:  Physician self-rated language ability and cultural competence are independently associated with patients’ reports of interpersonal process of care in patient-centered domains. Our study provides empiric support for the importance of language and cultural competence in the primary care of Spanish-speaking patients.