Health Communication & Health Literacy to Improve Care for Latinos with Diabetes

DESCRIPTION (provided by applicant): Diabetes disparities are common for Latino patients. Effective health communication can potentially narrow these disparities. This proposal details a career development plan that will prepare the principal investigator (PI) for success as an independent investigator with expertise in diabetes-related outcomes, health communication, and delivery of behavioral interventions for Latino diabetes patients. As an Internal Medicine- Pediatrics physician, with training in clinical investigation, the PI will gain new skills through this K23 in the areas of health disparities specific to diabetes care, enhanced Latino cultural competency, audio taping clinical encounters to assess the quality and role of health communication, and the development of a new training program for medical interpreters. The PI's immediate goals are to rigorously examine the quality of health communication between Latino diabetes patients, providers, and Spanish interpreters and the association between health communication and various diabetes-related health outcomes. To meet this goal, the PI has proposed a rigorous career development plan that incorporates additional didactic course work, regular participation in local and national meetings/seminars, a mentored research experience, and active involvement in an extremely supportive research environment. This includes an NIDDK funded Diabetes Research and Training Center (DRTC), NCRR-funded Meharry Clinical and Translational Research Center (MeTRC), Vanderbilt Program on Effective Health Communication (EHC), and an RCMI-funded Bioinformatics Core. The research specific aims are to: 1) conduct a cross-sectional, descriptive mixed-methods analysis of the quality of health communication between providers and Latino diabetes patients with particular emphasis on the role of the Spanish medical interpreter during language discordant encounters, and explore the association between baseline quality of health communication and various diabetes related health outcomes, 2) conduct an observational cohort study to examine the independent effect of provider health communication training and the use of a Spanish, literacy-sensitive educational toolkit on the quality of health communication during medical encounters, and assess the association between changes in the quality of health communication at 12 months with changes in diabetes related health outcomes, and 3) develop and pilot in a small RCT, an enhanced training program for Spanish medical interpreters geared toward improving their ability to work with providers and patients with LEP and limited health literacy during language discordant encounters. Overall, this K23 program will provide important insights into the nature of health communication with Latinos, the role of Spanish interpreters in this process, and most importantly prepare the PI for independent investigation of the role of effective health communication in addressing disparities in care for Latinos with diabetes.