BACKGROUND: Interpersonal care (IPC) is increasingly emphasize d as h ealth care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos. OBJECTIVE: To examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes selfcare activities. DESIGN: Cross-sectional survey combined with chart reviews. SETTING/PARTICIPANTS: Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties. MAIN MEASURES: Using a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patientprovider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient selfreport. The survey response rate was 68 %. KEY RESULTS: Patients with language-concordant providers had more favorable IPC ratings (20 % to 41 % of language-discordant patients had optimal scores for IPC scales vs. 35 % to 69 % of language-concordant patients, p<0.05), except with respect to discrimination. Patients with language-concordant providers reported higher levels of participation in diabetic foot care (1.4 days vs. 0.7 days per week, p value 0.01) compared to patients with language discordance. There was no association between language concordance and participation in other self-care activities. CONCLUSION: This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.

Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes (LDL-c <100 mg/dl, AlC < 9.0%, and blood pressure (BP) < 140/80 mmHg), and body mass index (BMI) < 30 kg/m2. Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP < 140/80 (Adjusted odds ratio [AOR]= 0.45; 95% CI: 0.22, 0.92), and BMI < 30 (AOR=0.43; 95% CI: 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP.

Background Latinos from agricultural communities have a high prevalence of food insecurity and are at increased risk of obesity and diabetes, yet little is known about the associations between food insecurity and diabetes outcomes. Objective To examine the associations between food insecurity and diabetes outcomes among rural Latinos. Methods Cross-sectional survey with medical chart abstraction of 250 Latinos with diabetes. Primary outcomes are the control of three intermediate diabetes outcomes (hemoglobin A1C ≤ 8.0%, LDL-cholesterol ≤ 100 mg/dl, and blood pressure ≤ 140/90 mmHg), a composite of control of the three, and receipt of 6 processes of care. Secondary outcomes are cost-related medication underuse and participation in self-care activities. Results Fifty-two percent of patients reported food insecurity and one-in-four reported cost-related medication underuse. Patients with food insecurity were more likely to report cost-related medication underuse (adjusted odds ratio [AOR] =2.49; 95% confidence intervals [CI] 1.30, 4.98; p = 0.003); less likely to meet the composite measure for control of the 3 intermediate outcomes (AOR 0.24; 95% CI 0.07, 0.84; p < 0.05), and less likely to receive a dilated eye exam (AOR 0.37; 95% CI 0.18, 0.77; p < 0.05) and annual foot exams (AOR 0.42; 95% CI 0.20, 0.84; p < 0.05) compared to those who were food secure. Conclusion Among this rural Latino population, food insecurity was independently associated with not having control of the intermediate diabetes outcomes captured in the composite measure, not receiving dilated eye and foot exams, and with self-reporting cost-related medication underuse.

Summary Bilingual staff is used to provide interpreter services in community health centers. Little is known about the language proficiency of dual-role staff interpreters. Golden Valley Health Centers implemented a formal language assessment program to improve the number of qualified dual-role staff interpreters and ultimately improve the quality of patient care.

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