Faculty Bibliography

Racial and ethnic minorities in the U.S. experience higher incidence of and greater morbidity from chronic disease. Limited English proficiency (LEP) is a known contributor to these health disparities. The Culturally and Linguistically Appropriate Services (CLAS) standards of the U.S. Department of Health and Human Services promote health equity through the incorporation of professional interpreter services. While such services have been shown to improve quality of care, limited data exist on patient perspectives regarding these services. Better understanding patient experiences with telephone interpreter services (TIS), an increasingly used modality for professional interpretation, could elucidate ways of improving care for this population. This study explored Spanish-speaking patient experiences with TIS at an urban community clinic. Qualitative data collected via focus groups was analyzed using content analysis and grounded theory methods. Our findings suggest that TIS are generally well accepted by Spanish-speaking LEP patients. Limited relationship development with providers and physician attitudes toward TIS were among reported barriers to the use of these services.

Background: Racial and ethnic minorities in the US, a large and growing population, experience higher incidence of and greater morbidity from chronic disease. Limited English proficiency (LEP) is a known contributor to these health disparities. The Culturally & Linguistically Appropriate Services standards promote health equality through the incorporation of interpreter services (IS). IS have shown improved quality of care, but limited data exist on patient perspectives of IS; particularly telephone interpreter services (TIS), an increasingly used form of IS. Better understanding patient experiences with TIS could elucidate ways of enhancing patient-centered care for this patient population; potentially improving health outcomes. Methods: Participants were recruited via flyers, telephone, and face-to-face encounters. They completed a semi-structured questionnaire and participated in a 1-hour, audio-recorded focus group. The focus group facilitator completed field notes after each group. Audio recordings were transcribed then analyzed by content analysis approach and grounded theory. Results: Thirteen individuals participated in 4 focus groups (Group1 n = 4; Group 2 n = 3; Group 3 n = 3; Group 4 n = 3). Participants were female (n=13), ages 33-73 years (mean 55), from Mexico (n=7), Ecuador (n=2), Dominican Republic (n=3), and Columbia (n=1), and had resided in the US for an average of 22 years (range 1-38). 70% reported poor self-rated English language ability (20% fair, 10% not reported). Ten thematic codes in 3 major domains (general attitudes, facilitators, barriers) were identified. Participants reported gratitude for TIS, perceiving TIS increased access to healthcare, and preference for TIS to family members as interpreters. Barriers to the use of TIS were concerns of confidentiality, lack of interpersonal development with physicians, and preference for language-congruent providers. Facilitators to the use of TIS were positive physician attitude toward TIS, physician framing of TIS as a tool in providing quality care, and assurance of accurate communication. Conclusions: Telephone interpreter services (TIS) are generally accepted by Spanish-speaking, LEP patients, and perceived as increasing access to care and assuring accuracy of medical communication. Participants seemed to balance accessing healthcare with concerns of confidentiality when using TIS. Overall, participants fell into two groups; one prioritized access to healthcare, timely and accurate, and the other prioritized relationship building with medical providers. The later was limited in TIS based encounters. Positive physician attitudes toward TIS facilitated their use. This highlights a need for healthcare provider awareness of the impact their attitudes have on patient experiences and acceptance of TIS, and for provider training on relationship building with use of TIS. Lastly, information gathered about patient preferences for language congruent providers speaks to a need for continuing workforce diversification efforts