Bilingual Perspectives of Functional Dyspepsia Management in People from Underserved Areas

Introduction: Disorders of gut-brain interaction (DGBIs), like functional dyspepsia (FD), are prevalent and challenging conditions. In other gastrointestinal (GI) disorders, individuals from underserved areas (UAs) have difficulty accessing care. Little is known about UA FD patient perspectives of their care, especially in those with limited English proficiency (LEP). We aimed to characterize patients' experiences with FD management with the goal of informing future studies targeting DGBI management in potentially vulnerable communities residing in UAs.

Methods: Participants meeting FD criteria were identified in two community health centers affiliated with a large academic medical center in the northeastern United States. Semi-structured interviews were conducted in English and Spanish. Transcripts were reviewed by a bilingual panel of investigators using the constant comparative method of iterative data acquisition. Psychosocial stressors and GI symptom severity were assessed.

Results: A total of 26 participants were interviewed (12 English-speaking, 14 Spanish-speaking). Broadly, GI symptoms were mild and there was mild-to-moderate psychological distress present. Adverse social determinants of health were highly prevalent. Despite mild symptom severity on objective scales, FD severely impacted quality-of-life and interfered with physical, psychological, and social wellbeing, including avoidance of certain foods and professional/social situations. Study subjects (particularly those of LEP status) reported difficulty in receiving care. Thematic saturation was achieved.

Conclusion: Even when symptoms were mild, interviewees from UAs reported significant FD-related impairment, along with psychological distress. Education interventions targeting FD-related care in UAs should be designed to improve shared decision-making in FD, sensitive to the burden of social determinants of health.