Different perceptions of healthcare by two immigrant groups in a Massachusetts clinic for medically underserved patients

BACKGROUND: Much of the research on Vietnamese immigrants and Latinos as underserved populations has (justifiably) placed them together under the heading of racial minorities to examine disparities in the health care system in the U.S. Fewer studies have considered the differences between these two groups in perceptions of health care, especially as related to patient satisfaction.

OBJECTIVE: To describe the attitudes that Latino and Vietnamese patients reported about visits with doctors and medical staff at a community health center in a medically underserved area.

METHODS: In the Culture and Health Literacy Project's four-year, multi-method study, epidemiological surveys were completed by 291 patients from four ethnic groups (Latino, Vietnamese, African-American, White). In addition, in-depth interviews (total N=18) and focus groups (total N=43) were conducted with participants. Patient satisfaction was assessed using items from the Chao Patient Perception Instrument and AHRQ's Consumer Assessment of Health Plans.

FINDINGS: During focus groups, Latino participants frequently commented on elements of their dissatisfaction with health care, including a lack of trust, and “time famine” with their doctors. Many Latino participants focused specifically on the health care system as an extra burden in addition to their multiple and complicated chronic health conditions. In dramatic contrast, Vietnamese participants tended to trust their doctors more, had fewer complaints—especially in qualitative interviews—and frequently reported that they had no major problems in dealing with the health care system. Statistical data from surveys show that Latino participants tend to rate their doctors and the care and attention they received more negatively than Vietnamese participants. For example, one-fifth (21%) of Latinos felt that their doctor did not “spend enough time with me,” compared to 2.3% of Vietnamese. A similar proportion of Latino participants (18%) denied feeling “comfortable asking questions of my health care provider,” compared with 5.4% of Vietnamese participants.

DISCUSSION: Culture seems to be a mediating factor in the perception of these experiences. As members of immigrant populations Vietnamese and Latino participants often face similar obstacles to health care and daily life due to language and cultural barriers. The fact that there are significant differences in the way that these two groups experience or feel about the health care system despite seeing the same doctors speaks to important differences in patients' cultural orientations towards biomedical care.