Computer use, language, and literacy in safety net clinic communication

doi:10.1093/jamia/ocw062

Observational Study

. 2017 Jan;24(1):106-112.

doi: 10.1093/jamia/ocw062. Epub 2016 Jun 6.

Computer use, language, and literacy in safety net clinic communication

Neda Ratanawongsa^{1

2}, Jennifer L Barton³, Courtney R Lyles^{4

2}, Michael Wu⁵, Edward H Yelin^{6

7}, Diana Martinez^{4

2}, Dean Schillinger^{4

2}

Affiliations

¹ Division of General Internal Medicine, University of California, San Francisco neda.ratanawongsa@ucsf.edu.
² UCSF Center for Vulnerable Populations at San Francisco General Hospital.
³ Department of Medicine at Oregon Health and Science University and VA Portland Health Care System.
⁴ Division of General Internal Medicine, University of California, San Francisco.
⁵ John Burns School of Medicine, University of Hawaii.
⁶ Division of Rheumatology, University of California, San Francisco.
⁷ Institute for Health Policy Studies, University of California, San Francisco.

PMID: 27274017
PMCID: PMC5201183
DOI: 10.1093/jamia/ocw062

Observational Study

Computer use, language, and literacy in safety net clinic communication

Neda Ratanawongsa et al. J Am Med Inform Assoc. 2017 Jan.

. 2017 Jan;24(1):106-112.

doi: 10.1093/jamia/ocw062. Epub 2016 Jun 6.

Authors

Neda Ratanawongsa^{1

2}, Jennifer L Barton³, Courtney R Lyles^{4

2}, Michael Wu⁵, Edward H Yelin^{6

7}, Diana Martinez^{4

2}, Dean Schillinger^{4

2}

Affiliations

¹ Division of General Internal Medicine, University of California, San Francisco neda.ratanawongsa@ucsf.edu.
² UCSF Center for Vulnerable Populations at San Francisco General Hospital.
³ Department of Medicine at Oregon Health and Science University and VA Portland Health Care System.
⁴ Division of General Internal Medicine, University of California, San Francisco.
⁵ John Burns School of Medicine, University of Hawaii.
⁶ Division of Rheumatology, University of California, San Francisco.
⁷ Institute for Health Policy Studies, University of California, San Francisco.

PMID: 27274017
PMCID: PMC5201183
DOI: 10.1093/jamia/ocw062

Abstract

Objective: Patients with limited health literacy (LHL) and limited English proficiency (LEP) experience suboptimal communication and health outcomes. Electronic health record implementation in safety net clinics may affect communication with LHL and LEP patients.We investigated the associations between safety net clinician computer use and patient-provider communication for patients with LEP and LHL.

Materials and methods: We video-recorded encounters at 5 academically affiliated US public hospital clinics between English- and Spanish-speaking patients with chronic conditions and their primary and specialty care clinicians. We analyzed changes in communication behaviors (coded with the Roter Interaction Analysis System) with each additional point on a clinician computer use score, controlling for clinician type and visit length and stratified by English proficiency and health literacy status.

Results: Greater clinician computer use was associated with more biomedical statements (+12.4, P = .03) and less positive affect (-0.6, P < .01) from LEP/LHL patients. In visits with patients with adequate English proficiency/health literacy, greater clinician computer use was associated with less positive patient affect (-0.9, P < .01), fewer clinician psychosocial statements (-3.5, P < .05), greater clinician verbal dominance (+0.09, P < .01), and lower ratings on quality of care and communication.

Conclusion: Higher clinician computer use was associated with more biomedical focus with LEP/LHL patients, and clinician verbal dominance and lower ratings with patients with adequate English proficiency and health literacy.

Discussion: Implementation research should explore interventions to enhance relationship-centered communication for diverse patient populations in the computer era.

Keywords: chronic disease; electronic health records; health communication; health literacy; limited English proficiency; primary care; safety net providers; specialty care.

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References

1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107. - PubMed
1. Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20:800–806. - PMC - PubMed
1. Lopez-Quintero C, Berry EM, Neumark Y. Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States. J Am Diet Assoc. 2009;109:1769–1774. - PubMed
1. DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98:2021–2028. - PMC - PubMed
1. Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95:1410–1416. - PMC - PubMed

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[1] Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107. - PubMed

[2] Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107. - PubMed

[3] Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20:800–806. - PMC - PubMed

[4] Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20:800–806. - PMC - PubMed

[5] Lopez-Quintero C, Berry EM, Neumark Y. Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States. J Am Diet Assoc. 2009;109:1769–1774. - PubMed

[6] Lopez-Quintero C, Berry EM, Neumark Y. Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States. J Am Diet Assoc. 2009;109:1769–1774. - PubMed

[7] DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98:2021–2028. - PMC - PubMed

[8] DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98:2021–2028. - PMC - PubMed

[9] Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95:1410–1416. - PMC - PubMed

[10] Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95:1410–1416. - PMC - PubMed

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Computer use, language, and literacy in safety net clinic communication

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Computer use, language, and literacy in safety net clinic communication

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