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Background: Hispanics with limited English proficiency face communication challenges that affect medication use and outcomes. Pharmacists are poised to help patients' use medications safely and effectively; however, scant research has explored factors that may impact pharmacists' communication with Spanish-speaking patients (SSPs).Objective: Guided by social cognitive theory (SCT), the purpose of this study was to examine the relationships between pharmacy environmental factors, pharmacists' cognition, and pharmacists' communication with SSPs.Methods: A cross-sectional survey used a vignette to quantify the amount of information pharmacists would provide to an SSP. Pharmacy environmental factors (language-assistance resources, Spanish-speaking staff, and number of SSPs) and pharmacists' cognition (self-efficacy beliefs and cultural sensitivity) that may influence communication also were assessed. The relationships between environmental factors, cognition, and pharmacists' communication with SSPs, including indirect relationships, were examined using composite indicator structural equation (CISE) modeling.Results: Of the 183 respondents, most were white (91%) and male (63%) with a mean age of 47 years (SD = 12.77). The CISE modeling revealed that the number of SSPs served by the pharmacy and the pharmacist's self-efficacy in communicating with SSPs were significantly directly associated with pharmacist's provision of information to SSPs. Two environmental factors (presence of interpreter services and Spanish-speaking staff) operated indirectly through self-efficacy to significantly impact the provision of information.Conclusions: Study findings identify both environmental factors and cognition that could contribute to pharmacists' communication behavior with SSPs. Thus, future interventions to improve pharmacists' communication with SSPs may include training pharmacists to integrate interpretative services and Spanish-speaking staff into service delivery and strengthening pharmacists' self-efficacy beliefs. [ABSTRACT FROM AUTHOR]

Background: Hispanics are the largest growing population in the United States, and their use of prescription medications can be influenced by the education and counseling they receive from pharmacists. However, little is known about pharmacists' communication with patients who speak Spanish or factors that can influence such communication.Objectives: The objective of the study was to develop and validate an instrument to measure pharmacists' self-efficacy in communicating with Spanish-speaking patients.Methods: An initial pool of 15 items developed from previous research and suggestions from communication experts and practicing pharmacists was subjected to cognitive interviewing. Nine retained items were administered to 1022 licensed pharmacists by mail survey. Summary statistics and exploratory factor analysis (EFA) were conducted. Retained factors were determined by the examination of eigenvalues and scree test results. Cronbach's alpha coefficients were calculated to assess internal consistency.Results: A total of 540 community pharmacists completed the survey. Item means ranged from 2.93±1.47 to 1.58±0.88 based on a 5-point scale (1: not at all confident to 5: extremely confident). EFA resulted in a 2-factor solution, accounting for 71% of the variance. The 2 factors consisted of health and drug information (alpha=0.92) and opening the encounter (alpha=0.75). The alpha for the overall scale was 0.88.Conclusions: The results provide evidence to support the reliability and validity of an instrument to measure pharmacists' self-efficacy beliefs about communicating with Spanish-speaking patients in community practice. Practitioners and researchers may use this instrument to inform pharmacy education, pharmacy practice improvement, and research efforts around communicating with Spanish-speaking clients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Across adult healthcare, discussions of alternatives, risks and benefits vary in inclusiveness or are even absent. We examine these discussions and their associated factors in pediatric visits. METHODS: Coders noted speaker and recipient for alternatives, risks and benefits from 98 videotaped visits. Outcomes included discussion of alternatives, risks or benefits (yes/no) and involvement of parent or child in discussions (active or passive). Bivariate techniques were used to relate visit factors to outcomes. RESULTS: Most visits included discussion of alternatives (58% of visits), risks (54%) and benefits (69%). Longer visits were more likely to include risk discussions. For alternatives, active parent/child involvement was more likely with college graduate parents; for risks active involvement was more likely with female and more experienced physicians. Parents and children raised risks more frequently than benefits, often focusing on disadvantages such as taste or frequency/duration of therapy. CONCLUSION: Most pediatric visits include alternatives, risks and benefits but parent/child involvement in raising these topics is limited. PRACTICE IMPLICATIONS: When parents or children initiate these discussions, they often mention risks salient to adherence. Future work could explore whether longer visits or interventions targeted for specific participants could foster such discussions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The physician-caregiver relationship affects patients' health outcomes, but measures of this important relationship are lacking. We develop and validate the physician-caregiver relationship scales (PCRS), incorporating three relationship domains (liking, understanding, dominance). METHODS: Videotapes of 100 children's visits were coded for verbal and nonverbal communication. Roter interaction analysis system utterance categories (personal remarks, laughter, agreements, approvals, concerns, reassurances, back channels and empathy) and summary measures (physician proportion of total talk and of number of questions) along with nonverbal measures (touch initiations, upright postures and leaning toward a participant) were used as indicators. Model fit was evaluated with confirmatory factor analysis (CFA). Validity was evaluated by associations of the PCRS with visit characteristics and global affect ratings. RESULTS: PCRS domains incorporating verbal and nonverbal indicators demonstrated good model fit (RMSEA<0.05; SRMR<0.12; TLI and CFI>0.95). Construct and predictive validity were demonstrated with PCRS domains relating to visit characteristics and affect ratings as predicted. CONCLUSIONS: CFA supported the multi-dimensional PCRS with three domains-liking, understanding and dominance. Such measures are valuable tools for investigations of physician-caregiver relationships. PRACTICE IMPLICATIONS: Models suggest specific indicators of the physician-caregiver relationship and inform interventions to improve these relationships. [ABSTRACT FROM AUTHOR]