The Effect of Patient-Centered Communication and Racial Concordant Care on Care Satisfaction Among U.S. Immigrants

Abstract

Immigrants living in the United States experience disparities in satisfaction with medical care. Practicing patient-centered communication and providing racially (or race-concordant) concordant care are suggested as effective approaches to improve care satisfaction. Using the Medical Expenditure Panel Survey, we found that immigrant patients with medical providers who practiced patient-centered communication were more likely to be satisfied with the care they received regardless of patient–provider racial concordance, and that simply having racially concordant medical providers did not significantly affect the satisfaction level for immigrant patients. The findings suggest that providing patient-centered communication may mitigate racial and cultural differences between providers and patients, and is key to reducing disparities and improving immigrant patients’ satisfaction level with medical care.

Keywords

racial concordance immigrant health patient-centered communication

Introduction

The United States has more immigrants (44 million) than any other country in the world (Radford & Noe-Bustamante, 2019). With more recent immigrants coming from Asian, Central/South American, and African countries in the past 60 years, the immigrant community has become more racially and ethnically diverse (Radford & Noe-Bustamante, 2019). Despite significant population growth, immigrants in the United States continue to experience disparities in various aspects of health care they receive. Previous studies demonstrated that foreign-born patients across all races utilized less care, perceived low-quality health care, and felt less satisfied with the medical care they received (Abe-Kim et al., 2007; Becerra, Androff, Messing, Castillo, & Cimino, 2015; Lasser, Himmelstein, & Woolhandler, 2006).

As the immigrant community in the United States is becoming more diverse (Radford & Noe-Bustamante, 2019), racial and ethnic concordance has emerged as an important dimension of the patient–provider relationship that may be linked to a reduction in health care disparities among immigrants (Street, O’Malley, Cooper, & Haidet, 2008). In general, patients who received care from providers of the same race/ethnicity believed they were closer to their providers in personal beliefs, values, and ways of communicating (Street et al., 2008), and therefore reported more trust in the providers, more satisfaction with care, and were more likely to rate their providers as providing better interpersonal care than physicians of other races (Cooper-Patrick et al., 1999; Saha, Komaromy, Koepsell, & Bindman, 1999; Saha, Taggart, Komaromy, & Bindman, 2000; LaVeist & Nuru-Jeter, 2002; Johnson, Roter, Powe & Cooper, 2004; Street et al., 2008). Saha, Arbelaez, and Cooper (2003) found that non-Hispanic Black U.S. residents not only preferred to see Black physicians, they also rated Black physicians as superior to physicians of other races in patient-centered communication, which included listening, communicating, involving patients in decision making, treating patients with respect, and being accessible. However, other researchers find that patients’ perceptions of similarity to their providers in terms of race/ethnicity may not be related to patient’s communication quality and other clinical outcomes (Malhotra et al., 2017; Shen, Peterson, Costas-Muniz, Hernandez, & Jewell, 2018; Street et al., 2008; Sweeney, Zinner, Rust, & Fryer, 2016). For example, Malhotra et al. (2017) found that while patient–provider racial/ethnical concordance was not a significant predictor of screening among non-Hispanic White and non-Hispanic Black women, patient–provider ethnic discordant pairs¹ among Hispanic women had better breast and colorectal cancer screening rates compared with ethnically concordant pairs (Malhotra et al., 2017). Sweeney et al. (2016) found although non-Hispanic Black patients reported better communication with providers than White patients, patient–provider racial concordance was not attributable to such differences. Shen et al. (2018) contributed the lack of effect of racial concordance on communication quality to the broadness and variability of communication quality measures and variability of measures.

Patient-centered communication can also help patients achieving perceptions of personal similarity with their medical providers (Street et al., 2008). A medical provider who is skilled in informing, showing respect, and supporting patient involvement can mitigate concerns or perceptions of racial differences to establish a connection with the patient. Stewart et al. (2000) stated that providers’ use of patient-centered communication was more related to patients’ beliefs that their providers and themselves were on the same basis of their illness. Patient-centered communication strategies appear to improve patient satisfaction, cancer screening rates, management of chronic diseases, and patient adherence to treatment guidelines (Beal, Hernandez, & Doty, 2009; Falkenstein et al., 2016; Isaac, Zaslavsky, Cleary, & Landon, 2010; Issel, 2019; Li, Barth, Garman, Anderson, & Butler, 2017).

New Contributions

Prior research suggests that patient-centered communication and racially concordant care are important in evaluating the patient experience. However, no studies have examined their relationship or independence for immigrant populations. Immigrants experience unique burdens such as cultural differences and language barriers that impede their ability to obtain high-quality health care. It is unclear if immigrant patients react differently to components of patient-centered communication and racially concordant care (McDonald & Kennedy, 2004; Mui, Kang, Kang, & Domanski, 2007; Salant & Lauderdale, 2003; Woloshin, Schwartz, Katz, & Welch, 1997). In addition, immigrants from different racial/ethnic groups may react to patient-centered communication or racially concordant care differently. It is difficult for immigrants to resonate with nonimmigrants and immigrants of other racial/ethnic groups due to cultural differences (Phinney, Ong, & Madden, 2000). Cultural norms around communication and interaction with providers, along with perceptions about discrimination, racism, and power dynamics could result in differences in how immigrant groups seek care, who they prefer to receive care from, and how that care is perceived (Derose, Escarce & Lurie, 2007; Ransford, Carrillo, & Rivera, 2010; Tsoh et al., 2016).

We used data from the national 2007 to 2016 Medical Expenditure Panel Survey (MEPS), to examine if and how immigrants’ satisfaction with care is influenced by patient-centered communication and racially concordant care. In addition, we examined if any specific component of the care experience may lead to increases in care satisfaction in specific racial/ethnic groups.

Conceptual Framework

The conceptual framework for this study is based on Street et al.’s (2008) approach to concordance in the patient–provider relationship. This model states that the patient–provider relationship is strengthened when patients see themselves as similar to their providers in personal beliefs, values, and communication. The perceived personal similarity is associated with higher ratings of trust, satisfaction, and intention to adhere (Street et al., 2008). While race concordance is the primary predictor of perceived ethnic similarity, several factors can affect perceived personal similarity, including physicians’ use of patient-centered communication. Our empirical analyses use this framework to guide model-specification. Thus, we include strategies of patient-centered communication and race concordance in our model, while controlling for characteristics of patients such as age, gender, marital status, education, employment status, income, insurance status, and self-perceived health status. In addition, we control for language proficiency and years of U.S. residency, two characteristics that are unique to immigrant populations.

Method

Data

We used data from the 2007 to 2016 MEPS. MEPS uses a panel survey design to follow a subset of National Health Interview Survey (NHIS) respondents over a 24-month period of time. MEPS uses a Computer-Assisted Personal Interviewing approach to conduct the surveys and oversample Blacks, Latinos, and Asians, which addresses coverage for immigrant populations. Because MEPS is conducted based on the NHIS sample and interviews are conducted in a face-to-face format, it also included respondents who are cell phone-only households. The Household Component provides estimates of respondents’ health status, demographic and socioeconomic characteristics, employment, access to care, and estimated utilization of health care.

We limited the study sample to adults between 18 and 64 years old, who were born outside of the United States, had a usual source of care (USC) that is not an Emergency Department (ED), and listed the name of the care providers they see in their USCs. The reason for excluding patients who used the ED as their USC is because those patients do not report names or races of the medical providers that they see, unlike other respondents. Also, patients who report the ED as their USC are often unlikely to have regular access to care and may have different characteristics that patients who can access care through other, more traditional settings. Sampled adults had at least one encounter with their USC provider in the past 12 months.

Satisfaction With Care

The outcome is the respondents’ global satisfaction with health care over the past 12 months, which includes visits to their USC (Saha et al., 2003). Survey respondents are asked to rate their overall satisfaction with all health care in the past 12 months, with 0 the least satisfied, and 10 being most satisfied. Patients tend to report high levels of patient satisfaction with health care (Xiao & Barber, 2008). Therefore, we dichotomized satisfaction level into very satisfied with scores of 9 or higher and not very satisfied with 8 or less (Xiao & Barber, 2008).

Explanatory Variables

Patient-Centered Communication

We used previously established assessments of patient-centered communication with care by Beal et al. (2009) to measure the quality of patient–provider interaction. The assessments of patient-centered communication are based on responses of “always” or “usually” relative to “sometimes” or “never” when being asked how often have your providers: (a) listened carefully to you, (b) explained things so you understood, (c) spent enough time with you, (d) showed respect for what you had to say, and (e) involved patients when making medical decisions. We categorized patients who answered “always” or “usually” to each of the five questions as ones with providers that do practice patient-centered communication.

Racial Concordance

Using Saha et al.’s (2003) definition of patient–provider racial concordance, we assessed whether respondents had a USC that was the same race as their own. We categorized individuals and their medical providers into the following: non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian. We considered racial concordance to be present when the respondent and provider were in the same racial/ethnic group.

Other Covariates

We included factors that were unique to the immigrant population such as limited English proficiency (LEP) and years of U.S. residency. Immigrants are defined as having LEP if they report speaking English less than “very well.” In addition, we controlled for covariates that had been identified to affect patient satisfaction in the previous literature, including demographic characteristics such as age, sex, race/ethnicity, marital status, and region of residence; socioeconomic factors including health insurance coverage, poverty status, employment status; and measures of health including self-reported health status (Falkenstein et al., 2016; Li et al., 2017; Saha et al., 2000; Saha et al., 2003). Last, we included fixed effects for the survey years to adjust for possible annual shocks, with 2007 as the reference year.

Statistical Analyses

We compared the bivariate characteristics of respondents, components of patient-centered communication and racially concordant care using the chi-square test. We then examined the association of the patient’s care satisfaction, components of patient-centered communication and racially concordant care using logistic regression while adjusting for explanatory variables. Last, to examine whether the relative importance of patient experiences (patient-centered communication and racially concordant care) varied by race/ethnicity, we stratified immigrants by their race/ethnicity and repeated the logistic regression analysis using the aforementioned logistic regression model for each race/ethnicity to examine the independent effect of racial concordance and communication within racial/ethnic groups.

Results

Overall, less than half of all immigrants perceive that their providers spent enough time with them, while less than 60% of immigrants reported that their providers listened when the patients spoke, explained things well, or asked patients to participate in making decisions during treatment (Table 1). Compared with other immigrants, fewer Hispanic immigrants perceive that their medical providers listen to them, spend enough time, explain things well, and ask them to participate in making decisions. While over half of non-Hispanic White immigrants had race-concordant providers, the percentage is lower for other racial/ethnic groups: only 15.08% of Black immigrants, 21.77% Hispanic immigrants, and 38.00% Asian immigrants had racially concordant medical providers. Black and Hispanic immigrants reported lower levels of education, private insurance, employment, income over 400% FPL, and self-perceived health status than White and Asian immigrants.

Table 1.

Descriptive Statistics of Analysis Variables.

Variables	All (N = 13,553), %	Immigrants’ race/ethnicity				p Value^a
Variables	All (N = 13,553), %	NH White (n = 1,254), %	NH Black (n = 1,198), %	Hispanic (n = 7,912), %	NH Asian (n = 3,189), %	p Value^a
Patient-centered communication
Listening	59.06	63.26	66.28	55.10	60.07	<.001
Time spent	48.09	54.05	50.38	43.99	48.91	<.001
Explaining	58.80	63.86	63.62	55.31	58.44	<.001
Respect	63.52	64.27	66.42	63.86	61.47	.24
Participatory decision making	56.80	63.73	57.12	54.21	55.80	<.001
Racially concordant care
Patient–provider race concordance	25.10	53.05	15.08	21.77	38.18	<.001
Sex						.07
Male	39.00	41.80	37.89	37.70	39.44
Female	61.00	58.20	62.11	62.30	60.56
Age group						.02
18-34 Years old	23.51	20.53	24.09	23.96	24.73
35-54 Years old	53.75	52.07	53.17	54.63	53.25
55-64 Years old	22.75	27.40	22.74	21.41	22.02
Marital status						<.001
Married	68.17	73.19	53.69	64.36	76.04
Not married	31.83	26.81	46.31	35.64	23.96
Education						<.001
Less than high school	12.99	2.50	6.27	24.21	4.87
High school degree	10.50	10.39	10.78	12.53	7.18
Some college, no degree	13.24	14.90	18.24	12.14	11.69
College degree or higher	63.27	72.21	64.71	51.12	76.27
LEP						<.001
Yes	19.44	2.63	2.28	36.44	10.45
No	80.56	97.37	97.72	63.56	89.55
Years of U.S. residency						<.001
Less than 5 years	4.74	3.50	4.97	4.00	7.05
5-9 Years	12.13	9.31	15.24	11.06	15.33
10-14 Years	14.49	12.79	14.31	15.43	14.92
15 Years or more	68.64	74.39	65.49	69.51	62.70
Insurance coverage						<.001
Private insurance	69.81	86.38	69.33	52.59	85.78
Public insurance	16.36	8.80	18.45	23.55	9.72
Uninsured	13.83	4.82	12.21	23.86	4.51
Employment status						<.001
Employed	71.53	75.97	77.00	66.03	75.03
Not Employed	28.47	24.03	23.00	33.97	24.97
Family poverty level (FPL)						<.001
<100% FPL	13.65	6.90	14.28	20.48	7.18
100% to 199% FPL	18.88	10.99	18.31	27.22	11.62
20 to 399% FPL	28.96	26.99	31.97	31.80	25.09
≥400% FPL	38.51	55.13	35.44	20.49	56.12
Self-reported health status						<.001
Very good/excellent	21.09	25.64	25.86	15.75	25.45
Good	63.18	63.77	64.24	61.05	65.59
Fair/poor	15.73	10.59	9.90	23.21	8.96
U.S. region						<.001
Northeast	25.04	28.05	40.63	19.98	26.62
Midwest	11.35	16.56	11.79	8.35	12.16
South	29.01	28.03	40.20	32.37	21.30
West	34.60	27.36	7.38	39.30	39.92
Survey year						.07
2007	9.98	10.49	10.44	9.92	9.50
2008	10.23	11.87	10.30	10.19	9.07
2009	9.59	9.15	9.89	9.86	9.34
2010	10.94	9.96	12.16	10.83	11.08
2011	11.76	12.31	11.60	11.82	11.02
2012	11.95	13.45	11.77	11.66	11.29
2013	5.34	6.60	4.56	5.26	4.88
2014	9.97	9.50	9.63	10.49	9.81
2015	11.56	10.18	10.46	11.84	12.62
2016	8.68	6.49	9.19	8.12	11.38

Note. NH = non-Hispanic; LEP = limited English proficiency.

Source. Medical Expenditure Panel Survey (2007-2016).

Chi-square tests among racial/ethnic groups.

Table 2 presents the results of the logistic regression with patient-centered communication and racially concordant care while controlling for other covariates. We found that immigrants who reported their providers as practicing patient-centered communication had higher odds of being very satisfied with care in the past 12 months. However, among immigrants of any racial/ethnic group, having racially concordant care does not significantly increase the likelihood of being very satisfied with care. The other significant determinants of care satisfaction among immigrants were sex, age, self-reported health status, LEP, and income. We did two sensitivity analyses, one using only patient-centered communication and other covariates, and another using only racial concordant care and other covariates (not shown). The findings were robust to both models.

Table 2.

ORs of Immigrant Patient Satisfaction With Care Received in Past 12 Months.

Variables	Very satisfied with care received in past 12 months
Variables	OR	95% CI	p
Patient-centered communication^a
Listening	2.04	[1.79, 2.32]	<.001
Time spent	2.69	[2.35, 3.07]	<.001
Explaining	1.84	[1.61, 2.1]	<.001
Respect	1.31	[1.15, 1.5]	<.001
Participatory decision making	1.14	[1.01, 1.3]	.04
Racially concordant care
Patient–provider race concordance	1.12	[0.98, 1.28]	.10
Explanatory variables
Sex (Ref. = male)
Female	1.23	[1.12, 1.37]	<.001
Age group (Ref. = 18-34 years old)
35-54 Years old	1.02	[0.76, 1.08]	.69
55-65 Years old	1.33	[1.18, 1.8]	<.001
Race/ethnicity (Ref. = NH White)
NH Black	0.89	[0.72, 1.09]	.27
Hispanic	1.76	[1.48, 2.09]	<.001
NH Asian	0.91	[0.77, 1.08]	.29
Marital status (Ref. = not married)
Married	1.12	[1.02, 1.29]	.06
Education (Ref. = ≥college degree)
No high school	0.92	[0.77, 1.09]	.47
High school degree	1.10	[0.85, 1.24]	.36
Some college, no degree	1.06	[0.86, 1.26]	.55
Employment status (Ref. = not employed)
Employed	1.03	[0.89, 1.13]	.71
Limited English proficiency (Ref. = no)
Yes	1.29	[1.08, 1.47]	<.001
Insurance type (Ref = private]
Public	1.07	[0.91, 1.26]	.95
Uninsured	1.10	[0.93, 1.32]	.58
Health status (Ref. = fair/poor)
Very good	1.77	[1.47, 2.16]	<.001
Good	1.27	[1.12, 1.45]	.01
Years of U.S. residency
Less than 5 years	0.82	[0.66, 1.01]	.06
5-9 Years	0.83	[0.71, 0.97]	.05
10-14 Years	0.89	[0.76, 1.04]	.21
Family poverty level (Ref. = <100%; FPL)
100% to 199% FPL	0.85	[0.78, 1.05]	.06
200% to 399% FPL	0.77	[0.71, 1.01]	.01
400% FPL or more	0.75	[0.68, 1.01]	.01
U.S. region (Ref. = Northeast)
Midwest	1.22	[0.99, 1.42]	.04
South	1.08	[0.92, 1.26]	.62
West	1.00	[0.88, 1.15]	.78
Survey year (Ref. = 2007)
2008	0.98	[0.8, 1.2]	.63
2009	1.01	[0.8, 1.26]	.97
2010	0.91	[0.72, 1.13]	.35
2011	0.91	[0.72, 1.14]	.29
2012	1.01	[0.79, 1.3]	.84
2013	1.19	[0.9, 1.58]	.39
2014	1.20	[0.95, 1.52]	.31
2015	1.03	[0.81, 1.3]	.67
2016	1.26	[0.98, 1.62]	.14

Note. OR = odds ratio; CI = confidence interval; NH = non-Hispanic; FPL = federal poverty level; LEP = limited English proficiency.

p < .05. **p < .01. ***p < .001.

The assessments of patient-centered communication are based on responses of “always” or “usually” relative to “sometimes” or “never” when being asked how often have your providers: (a) listened carefully to you, (b) explained things so you understood, (c) spent enough time with you, (d) showed respect for what you had to say, and (e) involved patients when making medical decisions.

Table 3 compares the odds ratios of care satisfaction in the past 12 months among immigrants stratified by race/ethnic groups. We find that after controlling for patient-centered communication and other covariates, racially concordant care is not a statistically significant predictor of patient satisfaction for any racial/ethnic group. In addition, immigrants from any racial/ethnic group are more likely to be very satisfied with their care received if providers always listened when patients spoke, always spent enough time with patients, and providers always explained things well to patients (i.e., they received high marks on communication). Hispanic and non-Hispanic Asian immigrants were the only two groups that are more likely to be very satisfied when providers always showed respect (odds ratio [OR] = 1.21, p < .05; OR = 1.59, p < .001); non-Hispanic White immigrants were the only immigrant group that’s more likely to be very satisfied with care if providers always involved them in making medical decisions (OR = 1.54, p < .05).

Table 3.

Comparison of ORs of Immigrant Patients by Race/Ethnic Groups.

Variables^a	Very satisfied with care received in past 12 months
	NH White (n = 1,254)		NH Black (n = 1,198)		Hispanic (n = 7,912)		NH Asian (n = 3,189)
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Patient-centered communication ^b
Listening	2.8***	[1.92, 4.31]	1.8***	[1.18, 2.74]	1.74***	[1.51, 2]	2.37***	[2.15, 3.17]
Time spent	4.11***	[2.7, 6.28]	3.42***	[2.36, 4.94]	2.29***	[1.99, 2.64]	2.71***	[1.43, 3.41]
Explaining	1.63*	[1.04, 2.55	2.15***	[1.42, 3.26]	2***	[1.73, 2.31]	1.84***	[1.27, 2.37]
Respect	1.13	[0.73, 1.74]	1.08	[0.72, 1.64]	1.21*	[1.01, 1.45]	1.59***	[0.94, 1.98]
Participatory decision making	1.54*	[1.03, 2.29]	1.28	[0.86, 1.91]	1.1	[0.96, 1.27]	1.07	[0.96, 1.35]
Racially concordant care
Patient–provider race concordance	1.15	[0.82, 1.61]	0.67	[0.39, 1.14]	1.15	[0.97, 1.36]	1.21	[0.9, 1.51]

Note. OR = odds ratio; CI = confidence interval; NH = non-Hispanic.

The logistic estimation adjusts for the following variables: gender, age, race/ethnicity, marital status, employment status, education attainment, insurance coverage, self-reported health status, LEP, years lived in the U.S., family poverty level, U.S. region, and survey year. ^bThe assessments of patient-centered communication are based on responses of “always” or “usually” relative to “sometimes” or “never” when being asked how often have your providers: (a) explained things so you understood, (b) listened carefully to you, (c) spent enough time with you, (d) showed respect for what you had to say, and (e) involved patients when making medical decisions.

p < .05. **p < .01. ***p < .001.

Discussion

To our knowledge, this is the first study using nationally representative survey data to examine the effect of patient-centered communication and racially concordant care on the global satisfaction of care received in the past 12 months among immigrants. We found that immigrants generally respond positively to patient-centered communication, even if there is no racial concordance with their USC. This finding supports previous calls for increasing usage of patient-centered communication to improve care experience and delivery (Anhang Price et al., 2014; Street et al., 2008). Providers who are skilled in informing, showing respect, and supporting patient involvement could overcome perceived issues of being racially discordant with their patients and establish a connection with the patient that contributes to greater patient satisfaction (Street et al., 2008). Therefore, medical providers should focus on patient-centered communication to address cultural barriers by building trust with immigrant patients and improving patient satisfaction.

Our study finds that while all immigrant racial/ethnic groups preferred providers who listened, spent enough time, and explained things well, a subset of immigrants also preferred providers who showed respect or practiced participatory decision making. This finding emphasizes the importance of providing culturally competent care to immigrant populations, as it is key to not only achieving better clinical outcomes (Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003) but also important to gaining higher levels of patient trust (Street et al., 2008). Coming from vastly different sending countries and with unique backgrounds, immigrants may exhibit different beliefs and expectations that can affect their perceptions of being satisfied with health care (Villani & Mortensen, 2014; Xu & Borders, 2008). For example, Villani and Mortensen (2014) found that because of differences in cultural expectations, Spanish-speaking Hispanic patients reported they were less likely to be satisfied with the amount of time providers spent with them than English-speaking Hispanic patients. Therefore, to achieve higher level of patient satisfaction with immigrant patients, medical providers should adjust their communication strategy based on the race/ethnicity of immigrant patients in order to achieve higher patient satisfaction.

We also find that having racially concordant providers did not increase the likelihood of immigrant patients being very satisfied with medical care. One possible explanation is that immigrants may exhibit different socioeconomic and sociodemographic characteristics compared with their U.S.-born counterparts. For example, Djamba (1999) found that compared with U.S.-born Blacks, Black African immigrants were more educated, less likely to be on welfare, more likely to be married, and more employable (Djamba, 1999). In addition, immigrants may exhibit language barriers (Portes & Schauffler, 1994) and different cultural values (Phinney et al., 2000). Therefore, compared with U.S. natives, immigrants may not have the same strengthened relationships with their providers due to race concordance because their status as immigrants is more important their identity as a racial/ethnic minority. Another explanation, which was noted in Saha et al.’s (2003) study, suggested that the possibility of increased awareness of racial and ethnic disparities and of potential provider bias against minority patients has made medical providers more sensitive in their interactions with minority patients, which includes immigrants. Hence, the effect of having racial concordant providers on care satisfaction is weakened.

Limitations

There were several limitations in our study. First, the MEPS survey asked respondents about the global satisfaction of medical care received in the past 12 months instead of how satisfied they felt with providers from their USC. Therefore, the global satisfaction may be weaker when representing how patients feel about their providers from usual sources of care. Second, we do not include the nonimmigrant group in our analysis, which may be difficult to fully interpret the findings in relation to the nonimmigrant research literature. Last, by grouping immigrants into large racial/ethnicity groups, we ignore sociodemographic differences within racial/ethnicity groups. As a result, we may lose individual effects from small racial/ethnicity subgroups. Future research should include the care satisfaction of providers from the patient’s USC and also include detailed racial/ethnic subgroups. Also, future research should assess how patient-centered communication may influence immigrants’ health care use, including preventive screening, medication adherence, and chronic disease management.

Despite these limitations, we provided further evidence that the strategy to improve immigrant patients’ care satisfaction through better care experience is viable. Our results suggest that having racially concordant providers does not increase the likelihood of immigrant patients being satisfied with care. Instead, pursuing a patient-centered communication strategy may lead to increases in care satisfaction among immigrant patients. This suggests that patient-centered communication is key to reducing disparities in care satisfaction among the foreign-born immigrant population. Potential policies to encourage patient-centeredness practices may include providing additional resources and trainings in patient-centered communication to providers who serve in immigrant communities and requiring all providers who serve immigrant communities to comply with providing patient-centered communication.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jun Chu

Notes

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