Patient-clinician ethnic concordance and communication in mental health intake visits

Patient Educ Couns. 2013 Nov;93(2):188-96. doi: 10.1016/j.pec.2013.07.001. Epub 2013 Jul 27.


Objective: This study examines how communication patterns vary across racial and ethnic patient-clinician dyads in mental health intake sessions and its relation to continuance in treatment, defined as attending the next scheduled appointment.

Methods: Observational study of communication patterns among ethnically/racially concordant and discordant patient-clinician dyads. Primary analysis included 93 patients with 38 clinicians in race/ethnic concordant and discordant dyads. Communication was coded using the Roter Interaction Analysis System (RIAS) and the Working Alliance Inventory Observer (WAI-O) bond scale; continuance in care was derived from chart reviews.

Results: Latino concordant dyad patients were more verbally dominant (p<.05), engaged in more patient-centered communication (p<.05) and scored higher on the (WAI-O) bond scale (all p<.05) than other groups. Latino patients had higher continuance rates than other patients in models that adjusted for non-communication variables. When communication, global affect, and therapeutic process variables were adjusted for, differences were reversed and white dyad patients had higher continuance in care rates than other dyad patients.

Conclusion: Communication patterns seem to explain the role of ethnic concordance for continuance in care.

Practice implications: Improve intercultural communication in cross cultural encounters appears significant for retaining minorities in care.

Keywords: Concordance; Patient–clinician communication; RIAS; Therapeutic alliance.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Communication*
  • Continuity of Patient Care*
  • Cultural Diversity
  • Female
  • Humans
  • Male
  • Mental Disorders / ethnology*
  • Mental Disorders / therapy*
  • Middle Aged
  • Patient Satisfaction / ethnology*
  • Professional-Patient Relations*