The “Battle” of Managing Language Barriers in Health Care

Abstract

Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging. Reports of parent perspectives on navigating language discordance in health care are limited. We analyzed portions of 48 interviews focused on language barriers from 2 qualitative interview studies of the pediatric health care experiences of LEP Latina mothers in 2 urban US cities. We found mothers experienced frustration with health care and reported suboptimal accommodation for language barriers. Six themes emerged relevant to health care across settings: the “battle” of managing language barriers, preference for bilingual providers, negative bias toward interpreted encounters, “getting by” with limited language skills, fear of being a burden, and stigma and discrimination experienced by LEP families. Parents’ insights highlight reasons why effective language accommodation in health care remains challenging. Partnering with families to address the management of language barriers is needed to improve health care quality and safety for LEP patients and families.

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

“…The need to improve language services in healthcare settings is well-established, but the issue is difficult to resolve given the perceived costs and impracticalities of using professional interpreters throughout the course of care; furthermore, there are generally few resources available to physicians to address language barriers in the absence of more favorable alternatives. [46][47][48][49] Poor communication between patients and healthcare providers for other reasons may deleteriously affect health outcomes in ways that are difficult to measure. Prior studies have found that Black, Asian, and Hispanic cancer patients are more likely to have lower quality communication as measured by access to clear information on treatment pros and cons and prognosis; time devoted to patient-centered communication and relationship-building between patients and healthcare providers; responsiveness to patient requests; patients' willingness to ask questions related to their care and condition; and knowledge about who to go to for desired…”

Satisfaction With Communication in Primary Care for Spanish-Speaking and English-Speaking Parents

“…10 Qualitative studies have demonstrated room for improvement in satisfaction with communication; Spanish-speaking mothers have described lack of language services and effective communication as factors influencing their experience of care 11 and many expressed frustration. 12 Ratings of communication with healthcare providers were low among Spanish-speaking parents in one large state study, 13 and a national study found similar dissatisfaction amongst non-English speaking parents, although specific languages were not examined, nor was the impact of use of interpreters. 14 …”

“Getting by” in a Swiss Tertiary Hospital: the Inconspicuous Complexity of Decision-making Around Patients’ Limited Language Proficiency

“…Patients were recruited from two main patient populations, 16 of Turkish 2 and 16 of Albanian 3 origin, identified by their names on the clinic schedule and approached in the waiting area of two USB outpatient clinics. After introducing herself as a PhD student/Medical anthropologist (KW), patients were informed about the study and asked whether they agreed to participate if they had a follow-up appointment.…”

“…Physicians underuse medical interpreters despite readily available interpreting services. [1][2][3] They make decisions after weighing the benefits of accurate communication against competing demands such as Btime constraints, alliances of care, therapeutic objectives and organizational-level considerations.^3 , 4 Although physicians often resort to professional interpreters for interactions that are complex or involve Bhigh-stakes,^1 , 3 sometimes they find it easier to Bget by^without one. Patients' perspectives on interpreter use are rarely assessed.…”

“…Usually, advocates emphasize the need to address language barriers to avoid possible negative implications for quality of care and patient safety. 1,[3][4][5]10 Access to health care as a human right as defined by the United Nations and World Health Organization is inextricably linked to appropriate language services. 11 Together with the recent statement by the Swiss National Advisory Commission on Biomedical Ethics 1 (NEK), they provide a valuable political instrument on a macro-level, although nonbinding.…”