Language, culture and emotions: exploring ethnic minority patients' emotional expressions in primary healthcare consultations

Patient Educ Couns. 2011 Sep;84(3):406-12. doi: 10.1016/j.pec.2011.04.021. Epub 2011 Jul 5.


Objective: This study explores ethnic minority patients' expression of emotional cues and concerns in primary healthcare, and examines relationships with patient, provider and consultation attributes.

Methods: 191 video-recorded consultations were analyzed using the VR-CoDES. Patients were interviewed before the consultation. Generalized Estimating Equations models (GEE) were used to test for associations.

Results: Psychosocial versus bio-medically oriented encounters contained significantly more cues (p≤0.05). Patients with poor versus good language proficiency expressed significantly less cues (p≤0.001). No significant correlations were found with patients' cultural values, patients' or physicians' gender or the presence of an interpreter. Female patients express more concerns (p≤0.05), female physicians have a higher number of concerns expressed by patients (p≤0.02).

Conclusion: This study shows that independent of physician and diagnosis, patients' language proficiency has a more important impact on the number of cues expressed by the patient than cultural difference.

Practice implications: Medical schools and Continuing Medical Education should focus on training programs for recognizing and handling linguistic barriers between physicians and patients. Patient education programs should encourage patients who experience language barriers to open up to physicians. In situations where language is a barrier, physicians and patients should be encouraged to use interpreters to enhance the expression of emotions.

MeSH terms

  • Adult
  • Cues
  • Cultural Competency*
  • Cultural Diversity
  • Emotions*
  • Facial Expression*
  • Female
  • Humans
  • Language*
  • Logistic Models
  • Male
  • Minority Groups / psychology*
  • Models, Statistical
  • Physician-Patient Relations*
  • Primary Health Care
  • Referral and Consultation
  • Statistics as Topic
  • Surveys and Questionnaires
  • Videotape Recording