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Try out PMC Labs and tell us what you think. Learn More. In-depth interviews in English or Spanish were conducted and documented by extensive notes.

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We used a grounded theory approach to find emerging themes, which were coded using a continuous iterative process. Six primary themes emerged: the physician-patient relationship, language, physician sex and age, time constraints, sensitive health issues, and culture and birthplace.

Such qualities as compassion, caring, human interest, and kindness were important to many Latinas, who did not feel safe sharing information if these qualities were absent. Language barriers caused problems with physician-patient interaction, which were complicated by the presence of a translator. Physicians being male or younger could make disclosure difficult, especially around issues of sexuality and genital examination.

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Birthplace foreign born vs US born played a role in how the women perceived barriers to disclosure. The treatment a patient receives can be greatly affected by what the patient chooses to disclose to his or her physician. Even though many studies have explored impediments to communication between patients and physicians, Latina women were not well represented in such studies.

Certainly, Latinas are represented in some studies of disclosure focusing on specific areas, such as intimate partner violence, 12 but a search of the literature found no studies of general considerations related to disclosure in health encounters.

A better understanding of barriers to disclosure in Latinas could improve their health care outcomes. To this end, we chose to use the approach of Sankar and Jones 1 but to broaden it to investigate more general considerations affecting disclosure. The goal of this qualitative study, therefore, was to clarify which conditions reinforce nondisclosure of health information in clinical encounters between Latina patients and their physicians.

Participants in this study were Hispanic women older than 18 years living in the vicinity of Sunset Park, Brooklyn. Women aged over 18 years were chosen instead of women aged under 18 years and men because it was thought that their reasons for nondisclosure might be different, and the resources to carry out the study were not adequate for participants with widely divergent experiences. After approval by the Lutheran Medical Center Institutional Review Board, participants were recruited through announcements in a variety of educational classes at a neighborhood support center that offered case management but did not provide medical care.

The interviewers obtained informed consent before conducting the interviews, reading the consent form to women who were illiterate. In-depth one-on-one interviews were conducted using a semistructured interview guide with many open-ended questions deed to encourage interviewees to fully describe their concerns. The guide was based on that of Sankar and Jones, 1 and the overall structure of this guide was maintained. The guide first elicited demographic information, then general notions about medical confidentiality and disclosure, then more personal experiences with disclosing sensitive medical information in actual health care encounters, and finally additional demographic information.

The guide included additional issues that might be Hispanic women turn me on to some Latinas, such as the use of interpreters.

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The availability of English and Spanish versions of the guide allowed communication in the language with which interviewees were most comfortable. The interviews took place in a private room at the Family Support Center and lasted from 30 minutes to 1 hour. Our research team consisted of 1 female Ecuadorian physician not involved with our health care system J. The variety of perspectives of our team helped ensure a depth of understanding critical to study de and validity of. A physician J. Interviewers were asked to take extensive Hispanic women turn me on and to enclose verbatim translations in quotation marks.

Interviews were not recorded, transcribed, and translated because of lack of finances, but the notes were translated and transcribed by the interviewers. The author most experienced in qualitative research K.

As the interviews progressed, emerging themes were codified into a coherent list, first individually and then as a group at team meetings. Definitions and instances of themes were clarified in the group meetings to make sure all authors defined the themes similarly. To enhance reliability, several authors coded each interview manually, discussed themes found in the interviews in detail, and used group consensus to make sure all perspectives on the themes were represented in the written.

Of the 28 women interviewed in this study, 26 discussed the physician-patient relationship. Above all, women said disclosure depended on developing a trusting relationship with their physician based on mutual respect, and their willingness to disclose health information decreased if they did not sense that their physician was compassionate.

Without compassion, trust, and respect on the part of the physician, interviewees said they would not share information, and the level of confidence in their health care clinicians plummeted. Communication problems, such as being interrupted, could disrupt this trust.

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I was so embarrassed and angry. One interviewee recounted that she and her sister had adjacent appointments with the same physician. The sister had private insurance, and the physician treated her politely.

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When the time came for the physician to see the interviewee, his attitude shifted as soon as he found out her insurance status. The only major difference between her and her sister, and thus the only reason she could find for the abrupt change in his manner, was that she was covered by Medicare.

Of the 28 women interviewed, 23 expressed difficulty disclosing information to their physician because of language. Interviewees said that language problems sometimes caused nurses and physicians to react negatively, making patient disclosure less likely. He had a really Hispanic women turn me on accent, and he got upset because of that. Translators were associated with major difficulties in disclosing medical information. Interviewees believed that their confidentiality was not protected when a translator was present and were often uncomfortable with any third person in the room.

That situation is really embarrassing. He went directly to check me. It was the most uncomfortable situation. Language issues and time constraints occasionally worked together to prevent disclosure. Sometimes patients pretended to understand the physician because finding a translator could take a long time. A few women even believed that patients used lack of time so that they would not have to disclose embarrassing or sensitive health information during the health encounter.

Differences in sex and age also created barriers to disclosure. Sex difference was a more common theme than age difference. Of the 28 women interviewed, 15 stressed that having a female physician made them more comfortable, especially for gynecological matters.

These women stated that not only was it easier to discuss genital problems and feminine and reproductive issues with a woman doctor, but also it was much more likely that they would be compliant with her health advice and not miss their appointments. I feel embarrassed. Sensitive issues came up on their own as reasons not to disclose health information. Sex, sexual orientation, sexually transmitted diseases STDsgenital issues and examinations, domestic abuse, abortions, information that adolescents feared physicians would disclose to their parents, and drug use were issues that women believed patients had difficulty discussing with the medical community.

Of the 28 women interviewed for this study, 24 believed that these sensitive topics were difficult to share with health care professionals under most circumstances. All 24 women who talked about sensitive issues mentioned difficulties discussing sex and STDs, and some believed that the Latino culture made it difficult to discuss sexual issues comfortably with physicians. This avoidance of sexual issues was present even in women who were interviewed in Spanish and had Spanish-speaking physicians.

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It is worse when the physician is a male. They believed that most adults were knowledgeable about sex. They particularly wished to avoid exposing children to the topic. Several women mentioned that Hispanic women turn me on common strategy was to tell the doctor about a friend who had a problem related to sexuality when actually the patient herself had the problem. Amplifying the effect of cultural background, some women did not want to disclose STDs in the medical setting because of the judgments they believed doctors and nurses would have.

A doctor may judge you or look down on you if you tell them about that. Interviewees also believed that patients who were dealing with domestic abuse would find it a difficult subject to bring up with health professionals, tending to either avoid such questions or lie. Confirming this finding, the 1 interviewee who had been a victim of domestic abuse said that she waited 3 years before she told her physician about the abuse.

Culture affected aspects of all of the above themes, with birthplace sometimes modifying these effects. Regarding the physician-patient relationship, for instance, many women placed a high value on a caring social interaction whether they were born inside or outside the United States.

Likewise, slightly more than one-third of these 2 groups strongly expressed that being listened to and heard by their physicians was important. Many women from both groups stated that their cultural background made it difficult for them to discuss sexual issues with their physicians. Regarding physician sex, many foreign-born Latinas strongly preferred female physicians, with 14 interviewees expressing this preference spontaneously, whereas only 1 US-born interviewee expressed this preference, and 2 preferred male physicians.

Birthplace also was related to the anxiety around genital examinations and nondisclosure of genital problems to avoid examination, with 6 foreign-born women but only 1 US-born woman expressing this concern.

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One woman born in the United States stated that she preferred a male physician because female physicians might assume that they knew how to conduct a genital Hispanic women turn me on in the best way, whereas male physicians, lacking such assumptions, might be more careful and respectful. Many foreign-born women, on the other hand, reported feeling far less embarrassed being examined by a woman. Suggested by the tenor of the interviews but difficult to quantify, women who grew up in the United States differed from those born outside the United States in their emphases on aspects of the patient-physician relationship and communication.

They should ask how long he has been in practice and did he ever have a lawsuit. Full disclosure of health issues between Latina patients and physicians is more likely to occur in the context of a warm, trusting, compassionate relationship in which the patient feels respected and truly heard. As our study found, language barriers could create stress that worked against disclosure on both sides of the patient-physician relationship. The presence of translators sometimes added barriers to the trust and connection needed to disclose issues about which women felt embarrassed, afraid, or vulnerable.

Women perceived time constraints to interfere with disclosure primarily because physicians did not hear them out, appeared uninterested in what they were saying, or were in a hurry. With respect to sex, many women stated that they were more willing to fully disclose their health issues to a female physician. Willingness to disclose was related to a lesser extent to age concordance. Sexual issues emerged as the most sensitive topic, with many interviewees, both foreign born and US born, stating that they were often not comfortable discussing these issues and, furthermore, would not mention genital problems to avoid examination.

Interviewees indicated that Latino culture, with its emphasis on relationships, was related to their wanting a warm caring connection with their physician. Many foreign-born women believed that a female physician made it easier for them to disclose sexual and gynecological issues, whereas some US-born women did not express this preference so strongly. Cape and McCulloch 15 found that one-half of patients in general practice believed the doctor to not be interested in emotional issues and thus did not disclose them.

An expression of interest in the form of a question was a predictor of disclosure. Beach et al 16 found that almost double the of patients including Latinos reported satisfaction with care when they were treated with dignity. In our study, we did not address the topic of dignity with our participants directly.

Differences between the way some foreign-born and US-born women preferred to be treated within the patient-physician relationship, however, suggest that the concept of dignity may not be uniform within Latina women. For many foreign-born women, dignity seemed to be related primarily to being heard and cared for. Other studies also emphasized the problems caused by the time constraints found in the present study. The importance of sex concordance to disclosure found in our study has been borne out in other studies as well.

Disclosure of psychosocial information increases in both African American and white women, for instance, when paired with Hispanic women turn me on physicians. Regarding culture, similar to the present study, Rodriguez et al found that women born outside the United States, most of whom were Latina, were less likely to disclose intimate partner abuse than US-born white or African American women. Elderkin-Thompson et al 19 reported that cultural metaphors not compatible with biomedical concepts or not congruent with clinical expectations were associated with lack of communication between physician and patient.

The literature related to trust is particularly illuminating with respect to the differences we found between US- and foreign-born Latinas. Sheppard et al 21 conducted focus groups with mostly low-income African American women to explore experiences that influenced trust in health professionals and lay health workers.

Our study, however, carries these findings further in confirming that, for Latinas, a caring and compassionate relationship is central for disclosure of important health information. Time constraints, the presence of translators, sex and age differences, and lack of awareness of what constitutes sensitive issues for Latinas can all affect this relationship and thus disclosure. The limitations of the present study were as follows.

The diversity of the sample was probably lacking in the area of sexual orientation, as none of the interviewees disclosed that they were bisexual or lesbian. The range of ages, nationalities, and other demographic characteristics was sufficient, however, to enable study findings to be of value. These findings, for instance, could be used to inform the de of surveys, which could yield knowledge with wider generalizability. The interviews were not recorded and transcribed verbatim, limiting the selection of illustrative quotations and making less information available to researchers who did not conduct interviews.

Offsetting this limitation, notes taken were rich with detail, and the interviewers were integral to data analysis and were thus able to confirm or correct interpretations. Our findings uncovered possible important relationships that should be confirmed in other settings. These factors could be addressed in several ways. Making sure that staff are trained in simple techniques for building rapport, such as appropriate eye contact and active listening, for instance, could help them better communicate empathy and compassion and establish trusting relationships.

Reinforcing this point, many interviewees specifically requested that their clinicians hear what they said in these interviews and obtain additional training Hispanic women turn me on communication. When translators are used, even those who are appropriate and well trained, physician awareness of the difficulty some Latinas experience disclosing sensitive information could be helpful.

Under these circumstances, and when discussing any sensitive issue, particularly if related to sex, skilled communication that builds empathy and creates trust will assist Latinas to fully disclose important health information. Tong for sharing her expertise in cultural issues with respect to the interview guide, and Ronald J.

Conflicts of interest: none reported. National Center for Biotechnology InformationU. Journal List Ann Fam Med v. Ann Fam Med. Author information Article notes Copyright and information Disclaimer.

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