Transcript Title

Hablamos Juntos –
We Speak Together
Research conducted for
WIRTHLIN
WORLDWIDE
Proj #7666
October/November 2001
Table of Contents
Methodology
3
Quality Backdrop
5
Issue Context
11
Language Barrier Issues: Spanish Speaking Patient Perspective
21
Language Barrier Issues: Provider Perspective
28
Solutions
38
Appendix:
47
Spanish Speaking Patients: Care Overview and Respondent Profile
48
Provider Environment
56
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Methodology - Providers

During the months of October and November, 15 minute telephone interviews were
conducted with health care professionals who practice in metro areas where Latinos
comprise over 5% of the general population and have experienced growth over 75%
between 1990 and 2000. Providers were divided into four segments:
 Doctors (n=300)
– Primary Care Physicians n=95
– Specialists n=65
– Emergency Room Physicians n=99
– Physicians Practicing in Clinics n=41
 Nurses (n=301)
– Must be at least a Registered Nurse
 Executives (n=200)
– Titles include: Chief Executive Officer, Chief Financial Officer, Chief of
Medical Staff, Vice President, Director of Hospital Unit, Medical Director,
Directors of Nursing
 Pharmacists (n=201)
– Must work in a retail environment

All providers indicated that their patient base was at least 5% Spanish-speaking
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Methodology – Spanish Speaking Public

During the months of October and November, 500 interviews were
conducted with adults whose primary language is Spanish

Interviews were conducted in the same metro areas as the provider portion
of the study; those with high percentage Hispanic population growth

Respondents completed the interview in Spanish

In order to qualify, respondents needed to indicate difficulty with
communicating with a doctor in English

All respondents had visited a doctor or other health care provider for
themselves or a family member within the past year
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Quality Backdrop
More than Half of Providers Say
Health Care Quality Doesn’t Earn the Highest Mark
- Provider Data -
Very Good
/ Excellent
44%
38%
Good
Not Good
18%
PQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe,
effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…
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Among Providers, Executives and Physicians
Have Highest Perceptions of Quality
- Provider Data By Segment -
Negative
Neutral
16% 2% 14%
36%
20% 2% 18%
15% 2% 14%
39%
30%
19% 2% 17%
Poor
Fair
Providers
46%
Good
Positive
Physicians
34%
Nurses
32%
Executives
Pharmacists
14% 48%
9% 40%
41%
25%
14%
55%
9% 34%
Very Good
Excellent
PQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe,
effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…
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Providers Have More Favorable Perceptions of Quality
Than Spanish Speaking Public
- Provider Data / Spanish Speaking Public Data -
Providers
Spanish Speaking Public
Very Good
/ Excellent
44%
38%
Good
Not Good
18%
Very Good
/ Excellent
27%
43%
Good
Not Good
30%
PQ2/HQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is
safe, effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…
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Among Spanish Speaking Public, No Quality Difference
Perceived on National vs. Local Level
- Spanish Speaking Public Data -
Rating of Quality in United States
Very Good
/ Excellent
Very Good
/ Excellent
27%
Good
Not Good
Rating of Quality at Community Level
43%
30%
28%
44%
Good
Not Good
27%
HQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe,
effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…
HQ9: Please think about the health care options in your community that are able to communicate with you in Spanish. How would you judge
the overall quality of the care they provide? Would you judge it to be:
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Quality Backdrop: Summary Overview

Quality grade is mediocre overall

Health care providers have higher perceptions of quality than their Spanish
speaking patients

Spanish speaking public identifies clear room for improvement

No clear distinction on quality levels between national and local health care
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Issue Context
• Importance of Patient-Provider Communication
• Issue Priority
• Expectations of Responsibility
• How Well System Currently Operates
When it Comes to Quality, Providers Say
Patient-Provider Communications is the Top Issue
- Provider Data, % Very Important –
Patient-provider
Communications
94%
The cost of health
care is manageable
72%
69%
Access to specialists
Access to the most current
research and best practices
Liability issues are limited
64%
52%
PQ3: When working to provide your patients with the highest quality care possible, how important are each of the following?
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7 in 10 Providers See Addressing
Barrier Issue as an Important Priority
- Provider Data -
Level of Priority
10%
58%
Top priority
One of a number of
important priorities
68%
Top/Important
Priority
Moderately important priority
30%
2%
Not an important priority
PQ5: Among all the issues currently facing the health care delivery system, how much of a priority should helping primarily Spanish-speaking
health care consumers better use and benefit from the health care system be? Do you think it should be…
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Among Providers, Doctors and Pharmacists Show the
Least Urgency in Addressing Language Issue
- Provider Data -
% Top/Important
Priority
Executives
10%
Nurses
11%
Doctors
Pharmacists
69%
65%
8%
52%
11%
46%
Top Priority
79%
76%
60%
57%
One of a large number of priorities
PQ5: Among all the issues currently facing the health care delivery system, how much of a priority should helping primarily Spanish-speaking
health care consumers better use and benefit from the health care system be? Do you think it should be…
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No Consensus on Where Responsibility
for Accommodation Falls
- Provider Data -
Providers
40%
Provider’s
Responsibility
Patient’s
Responsibility
60%
- Spanish Speaking Public Data -
Spanish Speaking Public
Provider’s
Responsibility
48%
49%
Patient’s
Responsibility
PQ12A/HQ4: Understanding that your opinion might fall somewhere in the middle, which of the following comes closest to representing how
you feel: 1) It’s primarily the patient’s responsibility to be able to function in an English-speaking environment. 2) It’s primarily
the provider’s responsibility to assure the patient clearly understands them so they can be served most effectively.
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Different Expectations and Sense of Responsibility
Exist Across Provider Segments
- Provider Data by Segment -
Provider’s
Responsibility
Patient’s
Responsibility
25%
Hospital Executives
75%
28%
Nurses
72%
Pharmacists
50%
50%
45%
Physicians
PQ12A:
54%
Understanding that your opinion might fall somewhere in the middle, which of the following comes closest to representing how
you feel: 1) It’s primarily the patient’s responsibility to be able to function in an English-speaking environment. 2) It’s primarily
the provider’s responsibility to assure the patient clearly understands them so they can be served most effectively.
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Providers Give Mixed Reviews on System’s Current
Handling of Issue – Most Give Mediocre Grade
- Provider Data -
System’s Level of Accommodation for Spanish Speaking Public
Accommodates
very well
9%
Accommodates
moderately well
44%
Accommodates not
very well
Accommodates not
well at all
40%
6%
PQ6: Overall, how well do you feel the health care system is set up to accommodate this group?
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Nurses View System As Most Accommodating,
Physicians See Room for Improvement
- Provider Data By Respondent Type -
Providers
54% 9%
40%
45%
5%
48% 4%
43% 5%
Not Well At All
35%
44%
38%
Not Very Well
Physicians
Nurses
Executives
Pharmacists
39%
47%
42%
7% 46%
12% 59%
10% 52%
49%
8% 57%
Moderately Well
Very Well
PQ6: Overall, how well do you feel the health care system is set up to accommodate this group?
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Despite the More Critical Evaluation of Providers, Spanish
Speaking Consumers Say System Accommodates Them Well
- Provider Data / Spanish Speaking Public Data -
Providers
Very well
Spanish-Speaking Public
9%
Moderately
well
44%
Not very
well
Not well at
all
40%
6%
31%
Very well
Moderately
well
41%
Not very
well
Not well at
all
17%
7%
PQ6, HQ3: Overall, how well do you feel the health care system is set up to accommodate this group?
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Issue Context: Summary Overview

Physician-patient communication – the issue most compromised when a
language barrier exists – is strongly seen as a driving force behind patient
outcomes

The clear majority of providers see improving the ability of Spanishspeaking patients to benefit from the health care system as an important
priority

Hospital executives are particularly interested in improvements in this area,
and - when compared with doctors on the front line - more often accept
responsibility for accommodating the language barrier. Doctors more often
feel that it’s the patient’s responsibility to function within the existing
system


Providers see significant opportunities to improve the system’s ability to
accommodate its Spanish-speaking patients (only 9% say currently doing
this very well – nearly half say it doesn’t do this well)
From a patient perspective, however, there is not a clear cry for
improvements. They often feel that the current system accommodates them
well
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Language Barrier Issues: Spanish
Speaking Patient Perspective
• Incidence of Accommodation
• Areas Most Impacted
• Coping Strategies
Most Spanish Speakers Are Faced with Provider Alternatives Where
The Majority Are Unable to Speak/Translate Spanish
- Spanish Speaking Public Data -
Proportion of local health care professionals who speak Spanish or
have someone on their staff who can
6%
All
18%
Most
12%
Half
52%
Some
36% half or more
64% some or less
12%
None
HQ8: Overall, when you visit health care professionals and pharmacists in your community, how many do you find are able to speak Spanish
themselves or have someone on staff that can help with translation or interpretation?
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Clear Majority of Spanish Speaking Public Say Achieving
Positive Outcomes Compromised by Language Barrier
- Spanish Speaking Public Data -
31%: Language has no impact
on care outcomes
68%: Positive outcomes are made more
difficult when providers neither speak
Spanish nor offer translators
HQ12: Now, please think about a time when you were with a doctor, nurse, pharmacist or other health care provider who only spoke English
and there was no translator available. Please tell me for each of the areas, was it …
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Areas Where Language Barrier Has Most Negative
Impact: Patient View
-Spanish Speaking Public Data –
- % more difficult when with English-speaking only provider -
Total % More Difficult
Ability to fully explain symptoms/ask questions
37%
80%
43%
Ability to follow-through with filling prescriptions
33%
38%
71%
Trusting doctor understands your medical needs
32%
38%
70%
Care provided resulted in positive outcomes
31%
37%
68%
Ability to understand doctor’s recommendations
30%
37%
67%
Seeing doctors as often as needed
32%
32%
Following up with recommended appointments
Easily scheduling appointments
Taking medications according to instructions
35%
26%
31%
25%
A little more difficult
62%
61%
30%
25%
64%
51%
Much more difficult
HQ12: Now, please think about a time when you were with a doctor, nurse, pharmacist or other health care provider who only spoke English
and there was no translator available. Please tell me for each of the areas, was it …
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One in Five Have Gone Without Care When Needed Due
to Language Obstacles
- Spanish Speaking Latino Data -
19% Have not sought care when
needed due to language barrier
HQ11: In the course of the past year, how many times were you sick, but decided not to visit a doctor because the doctor didn’t speak
Spanish or have an interpreter?
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Bringing Along a Translator Tops List of Strategies for
Spanish-Speaking Patients
- Spanish Speaking Public Data -
Go, but bring along someone
to help with translations
46%
Go alone anyway and try to
make it work
33%
Not go, but find a different
doctors office that could
communicate in Spanish
15%
4%
Never faced with this situation
Not go, instead care for
yourself at home
1%
HQ10: When faced with the possibility of visiting a doctor’s office where no one speaks Spanish and no interpreter is provided, what do you
usually do?
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Language Barrier Issues - Spanish Speaking Patient
Perspective: Summary Overview

Despite the feeling that they’re “accommodated,” the vast majority of
Spanish-speaking patients are faced with provider alternatives in their
community that generally do not speak Spanish or offer translators

The clear majority of Spanish-speaking patients (68%) feel that the language
barrier makes positive outcomes from their care experience more difficult to
achieve

Problems with communication have resulted in one in five Spanishspeaking patients not pursuing care when it was needed

Nearly half of patients routinely bring along someone to help with
translations during doctor visits in an attempt to function within the system
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Language Barrier Issues:
Provider Perspective
• Incidence of Accommodation
• Areas Most Impacted
• How It Is Handled
• Barriers
Majority of Provider Environments Include Spanish
Speaking Staff
- Provider Data -
Have Someone on Staff to Help
No
20%
Providers’ Own Skills
Fluent
7%
Speak /
understand
some
Spanish
Yes
79%
Don’t
understand
the language
at all
59%
34%
PQ16: Do you have someone on your full time staff, including yourself, that can help with interpretations for Spanish-speaking patients?
PQ17: How would you describe your own Spanish skills?
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Where Providers Say System Fall Short
- Provider Data / Open End Response Categories -
40% - Barriers to
Communication
with Patients
37% - Lack of
Interpreters
“I think that because the patient cannot communicate with the provider
they do not get the quality of care that they deserve.”
“It's still hard to find interpreters at the time of service.”
“There aren't always Spanish speaking persons available on hand.”
26% Problems
Treating Patients
“If you cannot communicate with the patient you cannot adequately
prescribe. Most Hispanics have not had a wellness screening approach
to medicine, they only had a crisis approach -- they only continue to
come in when they are sick.”
24% - Lack of
Bilingual Staff
“Primarily we don't have physicians that speak Spanish. We have support
staff, but not the primary physicians.”
13% Lack of
Spanish Materials
12% - Financial
Concerns
“I think sometimes as long as you have communication pamphlets or
audio visuals that explain things to patients and if you're bilingual it
makes the communication more effective.”
“Access to medication due to financial difficulties.”
PQ7: In what specific ways, areas, or process does the health care system not accommodate this group? Where exactly does it fall short?
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Areas Where Language Barrier Most Compromises
Outcomes
- Provider Data 
50% or more feel
significantly
compromises
outcomes



40-50% or more
significantly
compromises
outcomes






Less than 40% feel
significantly
compromises
outcomes




Fully understanding doctor’s treatment advice and medical
condition/disease
Fully explaining symptoms/problem/concerns to provider
Increased risk of complications when concurrent medications or home
remedies being used are not discovered
Incomplete or inaccurate medical history
Follow-through on doctor recommended advice
Taking medications according to instructions
Limited knowledge of services that are available or how to access care
Unable to identify cognitive or functional impairment.
Following up with recommended appointments with specialists
Overall, going to see doctors as often as they should when needed
Unable to obtain informed consent and patients are offered fewer
treatment alternatives
Unable to establish trust/confidentiality with patient due to use of a third
party to communicate
Unable to properly diagnose
Problems making appointments
PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are
most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect
mentioned.
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Areas Where Language Barrier Most Compromises
Outcomes: Provider View
- Provider Data / % Top 2 (Rating 6/7) on scale -
Fully understanding doctor’s treatment advice
and medical condition/disease
52%
Fully explaining symptoms/problem/concerns
to provider
51%
Increased risk of complications when concurrent medications
or home remedies being used are not discovered
51%
50%
Incomplete or inaccurate medical history
Follow-through on doctor recommended advice
Taking medications according to instructions
Limited knowledge of services that are available
or how to access care
43%
42%
41%
PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are
most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect
mentioned. Use a 7-point scale, where 1 means “language barrier does not compromise outcomes at all” and 7 means “language
barrier compromises outcomes significantly.”
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Areas Where Language Barrier Most Compromises
Outcomes: Provider View (Cont’d)
- Provider Data / % Top 2 (Rating 6/7) on scale -
40%
Unable to identify cognitive or functional impairment
Following up with recommended appointments
with specialists
Overall, going to see doctors as often as they
should when needed
Unable to obtain informed consent and patients
are offered fewer treatment alternatives
Unable to establish trust/confidentiality with patient
due to use of a third party to communicate
Unable to properly diagnose
Problems making appointments
36%
31%
30%
29%
28%
26%
PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are
most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect
mentioned. Use a 7-point scale, where 1 means “language barrier does not compromise outcomes at all” and 7 means “language
barrier compromises outcomes significantly.”
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Providers Approach the Language Barrier With A Range
of Strategies
- Provider Data / Open End Response Categories -
56% Spanish
Speaking Staff
“We get one of the staff members who is Spanish speaking to translate.”
“I grab a Spanish-speaking employee and ask for help.”
39% Provide
Interpreter/Translator
“We usually try to find someone who can interpret for us, and we usually
have someone who can do that.”
“We usually try to find someone to translate. We have Spanish
translators over the phone and also books to help. “
22% Patient Provides
Interpreter
“Well, if somebody's on staff that can speak Spanish we grab them. If
not then we have a family member or friend translate. If we can't do
that then we use pictures, but boy is it difficult.”
20% Telephone
Language Service
“We have dedicated translators, and we also use the AT&T language
line to back it up.”
16% Provide
Written/Visual Help
“We can use a lot of pictures and diagrams. We can print stuff both in
Spanish in English using the computer.”
11% Call for
Translator/Interpreter
“If we have a Spanish speaking patient we assign them to a Spanish
speaking specialist and we call in a person to translate. “
PQ10: Different (hospitals/clinics/offices) handle getting around the language barrier in different ways. If a patient that speaks only Spanish
comes into your practice or hospital, what usually happens?
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Current Translation Approach Relies Heavily on Informal
Methods
- Provider Data -
Staff such as doctors,
nurses, clerks help
with translations
51%
Patients bring family/
friends to translate
dolor
hinchazón
pierna
29%
15%
Retain external group
to provide interpreting
services on-site or
remotely
4%
Foreign language training for
health professionals offered
PQ10A-A: There are a number of ways interpretive services can happen in health care organizations. I’m going to describe four models.
Please tell me which best describes how your organization currently operates.
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According to Providers, Cost Dominates List of Barriers
to Doing More
- Provider Data -
53%
Cost issues
13%
Not an institutional priority/lack of focus
No language skills on staff
6%
Lack of training/knowledge about how to accommodate
6%
No resources/ideas for dealing with the problem
6%
Not enough time
6%
Patient responsibility
5%
Not enough doctor/nurse/staff
3%
Prejudice/cultural issues
3%
PQ14: Please think for a moment about why more steps aren’t taken to better accommodate the primarily Spanish speaking patient. What
do you feel is the main barrier preventing organizations from doing more in this area?
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Language Barrier Issues - Provider Perspective:
Summary Overview

In these high-need communities, the majority of provider organizations have
someone on staff that is able to speak Spanish to serve as an interpreter.

The area most compromised by the language barrier is the obvious one:
problems with adequate communication. Providers are not confident that
they fully understand the patient’s situation, nor are they confident that the
patient is able to understand their explanations and instructions pertaining
to treatment.


At provider organizations, staff in all positions - from nurse to janitor – are
relied on for help with interpretation and translation as a “band-aid”
measure. This is currently the main way these provider organizations are
handling the issue.
Providers see cost issues as the major impediment to effectively solving the
problem.
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Solutions
Most Effective Steps to Help: Patient’s View
- Spanish Speaking Public Data / Open End Response Categories -
49%
Bilingual
Providers/Staff
45%
Interpreters
15%
Patients Should
Learn English /
Language Education
12%
Doctors Should
Speak Spanish
“Employ people that speak Spanish. Always have someone who can
communicate with the patients that speak Spanish.”
“Have more bilingual people to help them when someone needs
medicine or is going to communicate with the doctor.”
“They must have an interpreter for those who come and can't speak
English. So everything will go all right.”
“They should have interpreters if the doctor doesn't speak Spanish and
the person doesn't speak English.”
” The responsibility is the patients’. Yes, you should put more interest in
learning English, the language is English here and we should
communicate.”
“Learn the language of the doctor in order to be able to express oneself
better in the language of the doctor.”
“The doctor could be bilingual so that we Hispanics could communicate
with other Americans.”
“I feel a little uncomfortable. Have a doctor that speaks Spanish.”
HQ13: Obviously, it creates a problem for both doctor and patient when there is a language barrier. What do you think offices should provide
to patients such as yourself who are comfortable speaking only Spanish? What should they do to make it easier?
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What Would Be Helpful?: Patient’s View
- Spanish Speaking Public Data / % Top 2 (4/5 Rating) on scale -
Trained interpreters to tell the
doctor everything you say
88%
Doctor’s office staff that can explain
in Spanish appointments/exams
86%
Standard care instructions
translated into Spanish
80%
Training doctors to look at/talk to
you when using an interpreter
78%
Hand-held electronic devices
available to translate a conversation
Doctors to better understand
home remedies and folk healers
66%
34%
HQ14: There are a number of steps that could be taken to help Spanish-speaking patients and English-speaking doctors better
communicate. Tell me how helpful each of the following would be to you. Use a 1 to 5 scale where 1 means not at all helpful and 5
means significantly helpful.
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Interpreters: A Patient’s Perspective
- Spanish Speaking Public Data -
Not
Important
At All
Importance of Talking Directly to Provider
Very
Important
99%
1%
92%
Very Important
Somewhat important
7% 1%
Not very important
Not at all important
Concerns About Using an Interpreter
No
Concerns
35%
Have
Concerns
65%
•
•
•
•
•
•
•
•
•
•
•
Interpreters wouldn’t explain things to patient clearly
Interpreter would omit info/not tell everything
Patients wouldn’t tell the whole truth
Privacy
Embarrassment
Interpreters would use terms that are new or unfamiliar
Interpreter doesn’t understand patient
Doctor will look at/talk to interpreter, not patient
No Interpreter Available
No Trust/Confidence in Interpreter/Doctor communication
Patient wouldn’t talk about personal things when translator present
HQ15: How important do you feel it is that you talk directly to a doctor or nurse when getting care, rather than through an interpreter?
HQ16: Some people have concerns about using an interpreter during a doctor visit, others don’t. What specific concerns, if any, do you
have about having an interpreter help doctors and patients communicate?
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Most Effective Steps to Help: Provider’s View
- Provider Data / Open End Response Categories -
38%
Use Interpreters
33%
Bilingual Staff
32%
Employee Education
(Spanish Classes)
32%
Materials in Spanish
12%
Patient Education
“Using professional translators -- people who understand every nuance
of the language.”
“The use of interpreters and less reliance on a person who works in the
hospital like a clerk, or cleaning staff because of confidentiality -- so we
bring in trained professional interpreters.”
“I think if you are in a location that has a high volume of Spanish
speaking patients you should have at least one employee who speaks
Spanish.”
“Training in medical Spanish is critical.”
“We have initiated classes for more people to speak and understand
Spanish.”
“We had a lot of written information in Spanish for ailments and disease
prevention.”
“They need to learn the language.”
“Language classes in schools or churches.”
PQ13: Next, we’d like to better understand some of the steps that providers can take to address the language barrier presented in the care of
those who speak primarily Spanish. What are the most effective steps you have taken or know of that can help this group better use
and benefit from the health care system?
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What Would Be Helpful?: Provider’s View
- Provider Data / % Top 2 (6/7 Rating) on scale -
69%
Spanish language standard care instructions
61%
Materials/tapes for Spanish speaking patients
56%
Funding to develop medical interpreter capacity
Help distinguish good interpreters from poor ones
50%
Identify language banks or technology
50%
47%
Funding for computer-aided interpretation equipment
45%
Accessible services to non English-speaking patients
Instruction on using interpreters successfully
Help with assessing your language competencies
Background on subpopulation differences/behavior
PQ15A:
39%
35%
32%
Next, I’m going to read a number of things that could be provided to you to help this communication. Please tell me which of the
following would be significantly helpful to you on a 1 to 7 scale where 1 means not at all helpful and 7 means significantly helpful in
communicating with Spanish-speaking patients.
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What Would Be Helpful?: Provider’s View
- Provider Data by Segment -
Physicians
Nurses
Hosp. Admin.
Pharmacists
Spanish language standard care instructions
65%
74%
67%
69%
Materials/tapes for Spanish speaking patients
50%
75%
62%
57%
Funding to develop medical interpreter capacity
48%
62%
70%
48%
Help distinguish good interpreters from poor ones
43%
60%
47%
48%
Identify language banks or technology
38%
57%
47%
59%
Funding for computer-aided interpretation equipment
28%
54%
52%
60%
Accessible services to non English-speaking patients
32%
52%
52%
48%
Instruction on using interpreters successfully
31%
49%
31%
43%
Help with assessing your language competencies
28%
39%
31%
44%
Background on subpopulation differences/behavior
26%
41%
34%
25%
PQ15A:
Next, I’m going to read a number of things that could be provided to you to help this communication. Please tell me which of the
following would be significantly helpful to you on a 1 to 7 scale where 1 means not at all helpful and 7 means significantly helpful in
communicating with Spanish-speaking patients.
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Interpretive Service Approaches: Current vs. Ideal
- Provider Data -
Currently Operate
Best Option
Use employees
41%
51%
19%
29%
15%
15%
24%
4%
PQ10A-A: There are a number of ways interpretive services can happen in health care organizations. I’m going to describe four models.
Please tell me which best describes how your organization currently operates.
PQ10A-B: Which you feel is the best solution to the language barrier.
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Solutions: Summary Overview

Patients most often call for bilingual medical staff as the solution that would work best
for them and also for interpreters. Providing standard materials in Spanish also is a
valued resource

There is only moderate interest among Spanish-speaking patients in technology-based
solutions

Despite the call for interpreters, patients have strong opinions about the importance of
communicating directly with their providers. Most have concerns about using a
translator. Concerns are primarily focused on the clarity/accuracy of both sides of the
communication exchange and issues pertaining to privacy

Providers also envision solutions focusing on staff’s language abilities and use of
translators. Many – one-third – mention language training for staff in Spanish
(including medical Spanish) as something that would be valued

When specific solutions are posed, providers are most responsive to those that answer
needs immediately – providing of specific materials in Spanish for patient reference.
The focus is on helping the provider help the patient

Although providers exhibit slightly more openness to technology-based solutions, they
clearly do not view it as the first line of defense
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Appendix
Spanish Speaking Patients
• Care Overview: Usage Patterns
• Care Locations: Where and Why
• Reasons for Not Seeking Care
• Respondent Profile
Many Spanish Speaking Patients Rarely Visit Doctor
- Spanish Speaking Public Data -
HQ5:
41%
29%
30%
I rarely visit a doctor, only
when it’s absolutely
necessary
I visit doctors when
I’m sick, and try to
go before the
problem gets too
bad
I visit doctors fairly
regularly, including
when I’m sick and for
routine check-ups and
other preventative
care
Please think about your experience visiting doctors, hospitals, clinics, or pharmacists in your community. Which best describes you
personally…
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Care Location: Where and Why?
- Spanish Speaking Public Data -
Where Consumers Go for Healthcare
37%
Doctor’s Office
Why They Go There
33%
Recommendation
34%
23%
Insurance covered it
36%
Hospital-based clinic
32%
12%
5%
Lower cost
4%
Good providers
4%
Referral
4%
Spanish Advertisement
3%
6%
3%
For Yourself
They speak Spanish/have
interpreter
16%
Clinic
Hospital ER
13%
Close to home
For Your Child/Children
HQ6: Most often, what type of place to do you go to for your health care? For your children? ( Reduced Base n=393)
HQ7: Please think about the health care facility you go to most often. How did you choose this location?
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Reasons for Not Seeking Health Care
in the Past 12 Months
- Spanish Speaking Public Data -
Reasons for Not Visiting A Health Care Provider in the Past Year
No one got sick
76%
Too expensive/cost
money
Not sure where to go
10%
2%
Treat illness at home
1%
Language barrier
1%
Reduced Base (n=222) Asked of those who did not qualify for survey because they haven’t visited a doctor or health care
provider in the past year
QE: What is the main reason you have not visited a doctor in the past year?
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Respondent Profile: Spanish-Speaking Consumers
- Spanish Speaking Public Data -
Someone in immediate family suffers from chronic illness (% Yes)
28%
Number of years lived in the U.S.
9.9 Yrs.
Average Age
36.5 Yrs.
Country of origin:
Colombia
2%
Mexico
Cuba
3%
Puerto Rico
El Salvador
3%
Guatemala
2%
76%
Nicaragua
1%
7%
Peru
1%
Dominican Rep.
2%
Venezuela
1%
Honduras
1%
USA
1%
Gender:
Male
Female
34%
66%
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Spanish Speaking Patients: Level of Exposure to Health
Care System
- Spanish Speaking Public Data by Level of Exposure -
High Exposure
(n=138)
Low Exposure
(n=360)
More than Half Speak Spanish
38%
34%
Less than Half Speak Spanish
62%
65%
Excellent/Very Good
30%
28%
Good
39%
46%
Fair/Poor
29%
26%
Go alone and try to make it work
38%
32%
Go, bring along someone to translate
43%
48%
Not go, find a different doctor’s office
that could communicate in Spanish
17%
15%
Didn’t pursue care due to language
23%
17%
Incidence of Accommodation:
Overall Care --Quality in Community:
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Areas Where Language Barrier Has Most Negative
Impact: Patient View by Exposure Level
-Spanish Speaking Public Data by Exposure Level–
- % more difficult when with English-speaking only provider -
High Exposure
(n=111)
Low Exposure
(n=281)
Ability to fully explain symptoms/ask questions
85%
79%
Ability to follow-through with filling prescriptions
68%
72%
Trusting doctor understands your medical needs
73%
69%
Care provided results in positive outcomes
72%
66%
Ability to understand doctor’s recommendations
75%
64%
Seeing doctors as often as needed
66%
63%
Following up with recommended appointments
66%
60%
Easily scheduling appointments
66%
58%
Taking medications according to instructions
47%
52%
HQ12: Now, please think about a time when you were with a doctor, nurse, pharmacist or other health care provider who only spoke English
and there was no translator available. Please tell me for each of the areas, was it …
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Spanish Speaking Patients: Level of Exposure to Health
Care System
-Spanish Speaking Public Data by Exposure Level -
High Exposure
(n=138)
Low Exposure
(n=360)
Importance of talking directly to doctor/nurse when
getting care (% Very Important)
93%
91%
Have concerns with interpreters
71%
63%
Interpreter wouldn’t explain things to patient
clearly/understandably
34%
31%
Interpreter would omit info/Not tell everything
33%
29%
Patients wouldn’t tell the whole truth
7%
6%
Trained interpreters to tell the doctor everything you say
87%
88%
Doctor’s office staff that can explain in Spanish
appointments/exams
85%
87%
Standard care instructions translated into Spanish
78%
81%
Top 3 Concerns:
Top 3 Steps to Better Communication:
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The Provider Environment
• The Provider’s Changing World
• Respondent Profile
• Outcomes by Provider Segment
Providers Indicate Increasing Numbers of Spanish Speaking
Patients; A Group That Presents Them With a Challenge
- Provider Data -
Increased
Stayed the
Same
Decreased
37%
39%
Significantly more of
a challenge
35%
Slightly more of
a challenge
22% 22%
No more challenge than
English-speaking pat
1% 1%
Slightly
76%
54%
11%
Significantly
PQ8: You indicated earlier that a proportion of your patient base speaks primarily Spanish. Compared to three years ago, do you think that
the frequency with which your organization is personally treating these health care consumers has…
PQ9: In your personal practice or work environment, how big of a challenge does dealing with primarily Spanish-speaking consumers
present relative to the challenge of your English-speaking clientele?
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Respondent Profile: Providers
- Provider Data -
Physicians
Nurses
Hosp. Admin.
Pharmacists
19
23
22
16
5-10%
53%
33%
39%
44%
10% or more
47%
67%
61%
56%
Community Hospital
74%
64%
65%
—
Government Hospital
2%
4%
8%
—
37%
32%
18%
—
Practice Setting: Office-based
65%
29%
—
—
Average number of customers served in a week
N/A
N/A
N/A
981
Average number of years in the field
Patient base with English difficulty:
Primary Hospital Type:
For Profit
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Areas Where Language Barrier Most Compromises
Outcomes: Provider View
- Provider Data by Segment -% Top 2 (Rating 6/7) on scalePhysicians
Nurses
Hosp. Admin.
Pharmacists
Fully understanding doctor’s treatment advice and medical
condition/disease
43%
57%
56%
54%
Fully explaining symptoms/problem/concerns to provider
44%
53%
54%
53%
Increased risk of complications when concurrent medications or home
remedies being used are not discovered
39%
53%
52%
66%
Incomplete or inaccurate medical history
44%
55%
52%
N/A
Follow-through on doctor recommended advice
36%
46%
45%
47%
Taking medications according to instructions
32%
48%
44%
47%
Limited knowledge of services that are available or how to access
care
36%
43%
41%
47%
Unable to identify cognitive or functional impairment
39%
38%
44%
N/A
Following up with recommended appointments with specialists
32%
39%
40%
34%
Overall, going to see doctors as often as they should when needed
24%
36%
33%
32%
25%
35%
30%
N/A
23%
35%
31%
N/A
Unable to diagnosis properly
23%
32%
29%
N/A
Problems making appointments
18%
32%
31%
N/A
Unable to obtain informed consent and patients are offered fewer
treatment alternatives
Unable to establish trust/confidentiality with patient due to use of a
third party to communicate
PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are
most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect
mentioned. Use a 7-point scale, where 1 means “language barrier does not compromise outcomes at all” and 7 means “language
barrier compromises outcomes significantly.”
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Providers: Regional Differences
-Provider Data by Region -
Northeast
(n=30)
Midwest
(n=109)
South
(n=486)
West
(n=377)
Excellent/VG
77%
88%
83%
80%
Good
37%
39%
39%
36%
Fair/Poor
23%
12%
17%
20%
Communications -- % Very Important
93%
94%
94%
94%
Barrier Issue -- % Top/Very Important Priority
70%
68%
64%
73%
Provider’s Responsibility
57%
61%
57%
64%
Patient’s Responsibility
43%
39%
42%
36%
% Accommodate Very/Moderately Well
57%
58%
50%
55%
% Accommodate Not Very Well/Not Well At All
43%
42%
49%
45%
70%
85%
80%
69%
Overall Care – Quality
Responsibility:
Level of Accommodation:
Hispanic Patient Base Increased in Past 3 Years
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Providers: Regional Differences
-Provider Data by Region Northeast
(n=30)
Midwest
(n=109)
South
(n=486)
West
(n=377)
57%
74%
77%
86%
1. Fully understand doctor’s treatment advice and medical
condition/disease
60%
53%
54%
48%
2. Fully explaining symptoms/problems/ concerns to provider
53%
57%
52%
46%
3. Increased risk of complications when concurrent medications or
home remedies being used are not discovered
43%
49%
54%
49%
4. Incomplete or inaccurate medical history
47%
50%
51%
49%
5. Follow through on doctor recommended advice
43%
43%
45%
39%
Workforce Model
53%
47%
47%
56%
Patient-Based Model
47%
23%
35%
22%
Contract Service Model
—
25%
13%
15%
Language Training Model
—
4%
3%
5%
57%
50%
51%
58%
Have someone on staff to help
with interpretations -- % Yes
Top 5 Impacts of Language Barrier (Top 2 Box %):
Current Translation Model:
Cost Issues as Barrier
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What Would Be Helpful: Provider’s View of Solutions by
Region
-Provider Data by Region Northeast
(n=30)
Midwest
(n=109)
South
(n=486)
West
(n=377)
Spanish language standard care instructions
60%
70%
69%
70%
Materials/tapes for Spanish speaking patients
53%
63%
63%
59%
Funding to develop medical interpreter capacity
60%
56%
56%
56%
Help distinguish good interpreters from poor ones
60%
53%
49%
49%
Identify language banks or technology
43%
50%
56%
42%
Funding for computer-aided interpretation equipment
43%
50%
51%
40%
Accessible services to non English-speaking patients
37%
45%
48%
43%
Instruction on using interpreters successfully
47%
37%
41%
35%
Help with assessing your language competencies
13%
38%
38%
33%
Background on subpopulation differences/behavior
43%
31%
32%
31%
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