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Top Language, Care Access Barriers for Spanish-Speaking Patients

The study found language barriers also served as care access barriers, especially during the patient registration process.

Patients with limited to no English language proficiency face all the same care access barriers their English-speaking counterparts do, but they must also contend with the added layer of language barriers, according to a study in Academic Pediatrics.

Specifically, individuals with limited or no English language proficiency face challenges interacting with front office staff, medical personnel, and organization representatives over the phone, the study found. This comes on top of existing care access barriers patients often face regardless of language preference, like poor facility navigability or lack of convenient appointments.

The study in question looked at care access experience for pediatric patients with family caregivers, like a parent or legal guardian, who does not speak English. Previous studies have indicated considerable care access disparities between children from Latinx families whose caregivers do not speak English and children whose caregivers do speak English.

Children from Spanish-speaking families face delays in care, are less likely to have a usual source of care, and are less likely to receive referrals to necessary specialty care or testing, the researchers reported.

And this could largely be because of stymied healthcare interactions.

“Caregivers’ education levels and functional/health literacy may further compound the challenges that Spanish-speaking families face,” the research team explained. “Patient perspectives on obstacles are important to understand to guide the design of interventions aimed at addressing them.”

Through a qualitative analysis of 28 Spanish-speaking families at an academic medical center, the researchers found that individuals with limited English language proficiency face additional obstacles to healthcare access. These obstacles come on top of those already experienced by the general patient population, the team found.

The qualitative interviews yielded two categories of healthcare access challenges. Foremost, challenges associated with language preference and proficiency underscored the unique barriers immigrant or Spanish-speaking families may face in academic medical centers.

Study participants noted barriers during the patient registration process and when contacting the healthcare facility over the phone. Additionally, overreliance on medical interpreters and lack of bilingual medical personnel got in the way of positive healthcare experiences for Spanish-speaking families.

Spanish-speaking families also reported long appointment wait times.

These issues come on top of the healthcare access barriers often cited by patients regardless of language preference and proficiency. Common barriers included poor medical center navigability, distance to services, limited convenient appointment slots, poor care coordination, and inability to take time off school or work.

Study respondents also reported issues with healthcare affordability, access to insurance, and immigrant status as barriers not related to language preference or proficiency.

Spanish-speaking caregivers reported taking matters into their own hands. One couple told researchers they proactively request a medical interpreter before their appointment begins, rather than wait for the healthcare organization to appoint one.

Others said consistent engagement with the healthcare center allowed them to build confidence and health literacy, which helped in the long run.

Nevertheless, some efforts are falling through the cracks. Some caregivers told researchers they often feign understanding, nodding their heads despite not understanding a provider’s notes or instructions.

Others said they use the patient or another family member to interpret. Most healthcare experts caution against this, lest that family interpreter have limited health literacy themselves or not give patients and parents the full diagnosis to lessen disappointment.

There are some things healthcare organizations are doing well right now to assist Spanish-speaking families through the healthcare encounter. Caregivers said interpreters and bilingual staff helped them better engage during the care encounter. Care instructions written in Spanish, like after-visit notes, were also helpful, respondents said.

Patient portals and other digital engagement and communication tools could add to these strategies, the analysis showed. Sixty-five percent of respondents had a computer or a tablet, 87 percent had access to internet, and 87 percent had a smartphone. Some respondents did acknowledge that communication technology would only be useful if it was offered in Spanish.

Future studies may look at the experiences of Spanish-speaking families in primary care and the language barriers they do—or do not—encounter. They may also look at the experiences of families that speak another language besides Spanish or English.

These findings are important considering the current healthcare disparities affecting Latinx and Spanish-speaking populations, the researchers argued. Data has confirmed that the novel coronavirus has affected Hispanic populations more than White people.

Ensuring access to high-quality and meaningful healthcare is one key strategy in closing those care disparities in the long run.

“Crossing communication divides between Spanish-speaking caregivers and academic medical centers may require innovative strategies that combine personnel and technology, and that evolve to meet the changing needs of children and their caregivers,” the researcher concluded.

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