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Puerto Rican women influenced more by quality of medical care than doctor's ethnicity

Penn State

Among Puerto Rican women living in the United States, empathy (sympatia) and mutual respect (dignidad) are more important priorities in choosing a doctor than the doctor's ethnicity, according to a Penn State study.

"Only one-fifth of all Latino patients who see a Latino physician are influenced in their choice by the physician's ethnic background and only 40 percent are influenced by the ability of the physician to speak Spanish," says co-author Dr. R.S. Oropesa, associate professor of sociology and demography at Penn State. "Latino patients are attracted most by a doctor's cultural sensitivity, regardless of whether that doctor is Latino or non-Latino."

As the second largest Latino subgroup in the United States, Puerto Ricans are no exception to this rule. A careful analysis reveals that Puerto Rican women are not more satisfied with Latino physicians than with non-Latino physicians. Their level of satisfaction is, however, significantly influenced by the institutional settings where medical treatment is provided, characteristics of the medical staff, the delivery and content of care and the outcome of care.

"Two aspects of process that are especially important are the continuity and content of care. Continuity of care has to do with whether or not prenatal care was received from the same or different physicians. The content of care is reflected in the services rendered and advice given about vitamins, nutrition, breastfeeding and so forth," says co-author Dr. Nancy S. Landale, professor of sociology and demography at Penn State.

Oropesa, Landale and Tanya S. Kenkre, doctoral student in sociology at Penn State, presented their findings in the paper, "Structure, Process and Satisfaction with Obstetricians: An Analysis of Mainland Puerto Ricans," today (Aug. 19) at the annual conference of the American Sociological Association. The researchers surveyed 1,219 Puerto Rican women, weighing their levels of satisfaction with their obstetrical care in U.S. medical facilities. The public health community is increasingly aware of the need for more physicians familiar with the language, values and customs of the growing Latino population, Oropesa notes. Currently, only 5 percent of physicians in general and of obstetricians and gynecologists, in particular, is Latino.

"As a group that has traditionally had high rates of negative infant health outcomes coupled with socioeconomic disadvantage, Puerto Ricans have been singled out for special attention in health promotion efforts that draw attention to the prenatal care component of health care delivery," Landale says. She and Oropesa also are research associates affilaited with the University's Population Research Institute (PRI).

Puerto Ricans - who are mainly concentrated in major Northeastern cities -- experience comparatively low levels of educational attainment and relatively high rates of poverty, single parenthood and unemployment. As a result, they constitute one of the most underprivileged minority groups in the United States, with 25 percent of all Puerto Ricans and 37 percent of all Puerto Rican children living below the poverty line. Almost one-fourth of "mainland" Puerto Ricans receive Medicaid benefits and 15 percent have no health insurance whatsoever, the researchers say.

Puerto Ricans in the low-income category, like low-income people in general, are forced to rely on public health insurance programs such as Medicaid for their medical needs, according to the researchers. The disadvantage is a complicated application process and a scarcity of doctors willing to treat low-income patients. Finally, people of low socio-economic status, as recipients of public insurance, are usually shunted into public clinics and health centers.

"Public clinics serving low-income people can provide a wide range of services, but they often suffer from staff shortages, time pressures and appointment scheduling practices that are inefficient for patients," Oropesa says. "These structural constraints may be compounded by the inability to provide the continuity of care crucial for the development of physician-patient rapport and effective communication."

Landale adds, "Our results also suggest that the gender of the physician may be important for the satisfaction of patients who rely on public facilities or who lack continuity of care. Women in these situations who see female physicians are more satisfied than similarly situated women who see only male physicians."

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