Patient-Provider Communication and Health Disparities: An Experiment Exploring Language Proficiency and Communication Accommodation

Effective communication is critical for equitable healthcare delivery. In situations where there is language discordance between patients and providers, with one person speaking a shared language more proficiently, communication challenges may exacerbate disparities, particularly for racially or ethnically minoritized patients. Even when patients and providers are both fluent enough in English to not need interpretation, communication challenges intensify when patients are required to use their second language (L2) to interact with a native English (L1) speaking healthcare provider. Communication accommodation encompasses speech adjustments used to mitigate these barriers. Because communication accommodation strategies are not explicitly taught in healthcare training, it is unknown how healthcare providers adjust and the role a patient's English proficiency plays in guiding provider language choices. This experimental study tested how L1 physician assistant students modify their communication during intake interviews with Latine L2 avatar patients of varying English proficiency, using the mixed-reality simulation platform Mursion. Data from 41 physician assistant students in 2023-2024 were analyzed for acoustic (i.e., speech rate, pitch modulation) and lexical adjustments (i.e., word frequency, contextual diversity). Results revealed significant accommodations: students reduced their speech rate, narrowed their pitch range, and used higher-frequency vocabulary when interacting with lower-proficiency L2 avatars. The results demonstrate that communication accommodation occurs and could be a potential mechanism for the widening or narrowing of healthcare disparities in patient outcomes. Future work should consider identifying which accommodations improve patients' comprehension of medical advice and their relationships with healthcare providers.