The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics.

Field C.A., Caetano R.
Alcoholism: Clinical and Experimental Research: 2010, 34(2), p. 262–271.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Field at craig.field@austin.utexas.edu. You could also try this alternative source.

At a US emergency department, a brief conversation about the pros and cons of their risky drinking and offers of support for any efforts to reduce harm led to extra reductions in the drinking of Hispanic patients which were greatest when they were matched to a Hispanic and Spanish-speaking counsellor.

Summary Background Evaluating the effectiveness of treatments such as brief alcohol interventions among Hispanics is essential to effectively addressing their treatment needs. Clinicians of the same ethnicity as the client may be more likely to understand the culture-specific values, norms, and attitudes and, therefore, the intervention may be more effective. Thus, in cases in which Hispanic patients were provided an intervention by a Hispanic clinician, improved drinking outcomes were expected.

Methods Patients were recruited from an urban Level 1 Trauma centre following screening for an alcohol-related injury or alcohol problems. 537 Hispanics were randomly assigned to brief intervention or treatment as usual. Hierarchical linear modelling was used to determine the effects of ethnic match on drinking outcomes, including volume per week, maximum amount, and frequency of five or more drinks per occasion. Analyses controlled for level of acculturation and immigration status.

Results For Hispanics who received brief motivational intervention, an ethnic match between patient and provider resulted in a significant reduction in drinking outcomes at the 12-month follow-up. In addition, there was a tendency for ethnic match to be most beneficial to foreign-born Hispanics and less acculturated Hispanics.

Conclusions As hypothesised, an ethnic match between patient and provider significantly enhanced the effectiveness of brief intervention among Hispanics. Ethnic concordance between patient and provider may have impacted the effectiveness of the intervention through several mechanisms including cultural scripts, According to the featured study, "Cultural scripts are patterns of social interaction that are a core characteristic of a particular cultural group. More than being indicative of personal values, cultural scripts are values and beliefs that characterise a particular culture or ethnic group. As a result, the potential impact of attending to these cultural scripts and cultural norms likely extends beyond empathy, which is a core component of interventions based on motivational interviewing. In contrast to interventions based on motivational interviewing, in the treatment as usual condition there was no opportunity to convey appreciation and understanding of cultural scripts through the use of reflections, communication of empathy or examination of personal values." ethnic-specific perceptions pertaining to substance abuse, and ethnic-specific preferred channels of communication.

For other reports on this trial see these Findings entries: Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting; The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?.

Last revised 20 January 2011

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