Improving Patient-Provider Communication: Evolution of a Tool to Assess Physical Therapist Students’ Spanish-Language Proficiency

ABSTRACT

Communication is at the foundation of safe and effective health care. When patients with limited English proficiency (LEP) have healthcare providers who do not speak their language, the communication barrier can lead to poor outcomes. Responding to the high number of Spanish-speaking individuals with LEP, a Doctor of Physical Therapy (DPT) program has integrated Spanish-language training in the curriculum. This paper describes their development and pilot testing of the Physical Therapy Spanish Proficiency Measure (PT-SPM). The PT-SPM was developed for English-Spanish bilingual faculty or clinicians to assess DPT students’ clinically relevant Spanish communication. The PT-SPM has 11 total items with four subscales: verbal proficiency, aural proficiency, written proficiency, and cultural competence. Twenty-three pairs of DPT students and their bilingual clinical instructors were recruited for an interrater agreement study; each used the PT-SPM to independently rate the student’s Spanish communication with Spanish-speaking patients with LEP in clinical settings. Cohen’s weighted kappa was calculated to evaluate interrater agreement between the students and clinicians on item level, using linear incremental weights. The weighted kappa coefficients ranged from 0.35 (fair agreement) to 0.80 (substantial agreement). All weighted kappa coefficients were statistically significant. Two items had fair agreement; four items had moderate agreement, and five items had substantial agreement. These results support that the PT-SPM may have value as an assessment tool for DPT students in clinical settings. Educators in other health professions may consider adapting the PT-SPM. This paper contributes to the broader interprofessional dialogue about how to assess and improve patient-provider communication.

Acknowledgments

The authors express their gratitude to the individuals who provided input during the development of the PT-SPM, the physical therapists and students who participated in this pilot study, and graduate assistant Berenice Peralta Matus for her assistance with manuscript preparation.