Test of a patient-centered culturally sensitive health care model for understanding treatment adherence among a national sample of hispanic patients

Due to the growing numbers of Hispanics living in the U.S., increasing numbers of these individuals will be negatively impacted by health disparities. The purpose of this study tested the impact of components of a model that explains general treatment adherence. Specifically, the objective of the present study was to determine whether the processes through which patient-perceived cultural sensitivity, trust in physician, satisfaction with physician care, and patient control in the treatment decision-making process affect general treatment adherence similarly or differently in primarily English-speaking and primarily Spanish-speaking Hispanic patients. Data from 194 primarily English-speaking and 361 primarily Spanish-speaking Hispanic patients were utilized and analyzed to test the effects of the constructs using multi-group structural equation modeling. No significant direct effects of provider culturally sensitive behaviors and attitudes on general treatment adherence were found, however several significant indirect effects emerged. Language appeared to have moderating effects on the relationships between patient-perceived provider cultural sensitivity and general treatment adherence. Specifically, patient-perceived provider cultural sensitivity, trust in physician, and satisfaction with physician care have effects on general treatment adherence in English-speaking and Spanish-speaking Hispanic patients, but the processes and mechanisms through which they exert their effects differed among the groups. The differences may be related to language barriers as well as socioeconomic disadvantages disproportionately experienced by Spanish-speaking Hispanics living in the U.S. It was also found that both male and female English-speaking Hispanics had significantly higher general treatment adherence scores than their Spanish-speaking counterparts. These results suggest that interventions to address limited English proficiency may be important in improving the quality of primary care for this rapidly growing population.