Methods: While observational studies have consistently shown the benefits of language concordance, intervention studies involving language concordance have been less common. We will describe the theoretical justification and conceptual design of a language concordant health coaching intervention for nurses caring for limited English proficiency Latinx patients with T2D.
Results: The teaching of medical Spanish has been predicated on the discourse model of the medical interview. As such, medical Spanish curriculum has emphasized the development of discourse features such as question formation, history taking, formal commands, and medical terminology. We argue that this discourse model does not address the linguistic needs of providers caring for patients with T2D. Instead, we propose a course in medical Spanish predicated on the discourse model of the motivational interview. This approach emphasizes discourse features such as relationship building, goal setting, and health coaching. Our course design introduced students to key information in diabetes management, the principles of motivational interviewing, and discourse features in Spanish that facilitate chronic care counseling. Major elements of the Spanish language curriculum include forms of address (tú vs. usted), use of metaphors and popular sayings to facilitate understanding of diabetes concepts, variable question formation strategies, discourse markers that promote reflective listening, and affirmation techniques in Spanish. The development of motivational interviewing skills in Spanish is supported by a variety of learning activities including didactic lectures and demonstrations, role plays, voice board simulations, and standardized patient interactions. The course was delivered to students in a graduate nursing program and to practicing nurses as a CNE offering. Students came to the course with different language backgrounds. Some learned Spanish as a second language in a formal academic setting while others were heritage learners of the language. Our results show that the novel curriculum was successful in all groups of learners.
Conclusion: While observational studies have consistently shown the efficacy of language concordance, language concordant interventions for limited English proficiency Latinx have not yet been tested. This paper outlines the theoretical justification and conceptual design of a language concordant intervention for nurses caring for Spanish-speaking patients with diabetes. The intervention is effective in multiple educational formats and for multiple learner profiles.