Overcoming Language Barriers towards Improved Healthcare Delivery among Hispanic Communities

Evidence-Based Practice Proposal: Overcoming Language Barriers as a Means of Contributing towards Improved Healthcare Delivery among Hispanic Communities
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Abstract
The increased diversity of American communities has equally propagated increased challenges for healthcare workers as they administer services to immigrants. This has resulted in a language barrier between these two groups that often impedes effective communication and subsequent service delivery. This is particularly the case with Hispanic immigrants whose numbers have increased significantly across the US. There is a need for healthcare workers to better understand their patients through their culture and language. This can significantly improve communication between patients and healthcare workers, and in doing so ultimately improve healthcare service delivery. For this reason, this proposal explores the challenges plaguing interactions between healthcare workers and Hispanic immigrants based on the language barrier between said groups. At the same time, it proposes solutions centered on improving the language, in this case Spanish, fluency and literacy of healthcare workers as well as their cultural competence as a means of improving healthcare service delivery and attaining increased rates of patient satisfaction. This proposal, if implemented, promises to help better understand the challenges existing between healthcare workers and Hispanic immigrants. Similarly, it outlines viable action plans that healthcare workers and facilities can implement and regularly evaluate as a means of ensuring continuous improvement from healthcare workers on matters of overcoming language barriers and developing cultural competency. In essence, this proposal seeks to help overcome the challenges surrounding healthcare service delivery to Hispanic immigrants and their communities by fostering increased participation of healthcare workers in the culture and language of said immigrants. In doing so, this proposal hopes to improve healthcare service delivery and patient satisfaction among Hispanic immigrants and their communities.
Keywords: cultural competency, language barrier, healthcare, immigrants
Evidence-Based Practice Proposal: Overcoming Language Barriers as a Means of Contributing towards Improved Healthcare Delivery among Hispanic Communities
Introduction
The modern healthcare landscape is one that is constantly changing and adapting not only to the incorporation of new technologies, but also the adoption of new best practices. As such, overcoming language barriers in the healthcare setting has become a major concern for patients, professionals, and facilities in equal measure. Seeing as communication has been established as being fundamental to efficient healthcare service delivery, overcoming language barriers, particularly in communities with significant immigrant populations, has become integral to improving the delivery of care. This proposal highlights the existent literature on the subject in addition to proposing a solution to the problem as well as implementation and dissemination plans on matters of improving care delivery in Hispanic communities by overcoming the language barriers between patients and healthcare professionals.
Problem
As far as immigrant communities in the USA are concerned, language barriers play a crucial role in influencing the quality of life they live and the services that they can comfortably access. Because of this, language barriers can be a source of stress for many immigrant families, and especially so when they need to access healthcare services (Cristancho, Garces, Peters, & Mueller, 2008). In essence, the presence of language barriers between patients and healthcare professionals limits the ability of said patients to comfortably and articulately communicate their healthcare issues without having to use translators who may make said patients feel uncomfortable. Taking into account the fact that healthcare facilities are looking to provide quality services to their patients, language barriers are a direct hindrance to the achievement of this goal.
One of the largest immigrant communities in the USA is the Hispanic community. Seeing as many of these immigrants communicate primarily in Spanish, this can pose a serious challenge for healthcare workers that are unable to speak or understand Spanish (Cristancho et al., 2008). In this regard, it becomes integral to ensure that healthcare workers in communities that are predominantly Hispanic can speak or at the very least understand Spanish in order to provide high quality healthcare services. It is essential that this issue is resolved in every way possible, seeing as such a barrier can hinder the disposition of healthcare services and in doing so endanger the lives of many immigrants that are unable to express themselves to healthcare workers (Jacobs & Diamond, 2017).
It is critical to note that this issue is a significant healthcare problem due to the numerous ways in which it affects healthcare service delivery (Cristancho et al., 2008). It not only alienates patients that are unable to speak in English, but also limits the ability of physicians and other healthcare workers that are incapable of speaking Spanish to collect valuable healthcare data from their patients. Inevitably, this compromises the quality of care provided to said patients (Jacobs & Diamond, 2017). Because of these factors, addressing the challenges posed by language barriers in the healthcare setting becomes integral to the delivery of high-quality care consistently. At the same time, it enables healthcare workers and facilities to anticipate the needs of the communities they serve and in doing so improve their service delivery.
Language plays a central role in the provision of healthcare services seeing as it is the avenue through which patients express their concerns and healthcare professionals provide information to patients. In this sense, a language barrier is essentially a barrier to healthcare service delivery, and is one that should be resolved in the shortest time and most effective manner possible (Patel & Rushefsky, 2015). This is the core reason why language barriers between patients and healthcare professionals in Hispanic communities must be addressed and appropriate solutions effectively implemented.
Purpose Statement
This project, therefore, hopes to demonstrate the significance of having healthcare workers understand the language, and by extension culture, of Hispanic communities across the USA. It equally hopes to demonstrate the significance of ensuring that healthcare workers are culturally conversant and competent with the communities they serve, in this case the Hispanic communities.
Question
For Hispanic communities in the USA, does equipping healthcare professionals with Spanish speaking competence versus simply improving their cultural competence result in improved healthcare service delivery for patients over a period of 2 years?
P – Hispanic communities in the USA
I – Equipping healthcare professionals with Spanish speaking competence
C – Promoting cultural competence
O – Improved healthcare service delivery for patients
T – 2 years
Literature Review
Literature Analysis
Ahmed et al., (2017). The authors indicate that immigration to any country presents challenges to any healthcare system. The healthcare sector is among the affected sectors. The article indicates that a communication gap develops between physicians and the immigrant patients. On the one hand, the article demonstrates that physicians are concerned about the fidelity of their conversations with the immigrant patients. On the other hand, the immigrant patients are concerned about the inability of the physicians to understand their culture because of the language barrier. While the article does not provide mortality and morbidity rates because of the language barrier, it indicates that it has adverse effects on the quality of care.
Ali & Watson, (2018). The article demonstrates that language barrier remains a major hindrance towards access to healthcare for immigrant patients. Using data collected from 59 nurses, the research demonstrates that language barrier has adverse effects on the ability of nurses to communicate with their patients. While interpreters are critical in reducing language barrier, they raise the issues of privacy, confidentiality and patient comfort.
Singleton & Krause, (2009). Despite the cultural and linguistic barriers, nursing literature offers minimal assistance in integrating linguistic considerations to nursing efforts. Given that nurses are in a better position to ensure the interconnectedness between patient culture and language, there is a need to focus on how they can work towards addressing the problem of language barrier. Cultural beliefs determine how individuals interpret healthcare messages. Hence, knowing about the language of patients is critical in determining how they interpret healthcare information in a particular situation.
Flores, (2014). Flores demonstrates that the language barrier has adverse effects on access to care, the use of health services, patient-physician communication and the quality of care. The inability of physicians to communicate effectively with the Hispanics due to language barriers increases the length of hospital stay and makes patients more vulnerable to overdoses. According to the author, 61.9 million Americans reside in a non-English primary-language household and 25.1 million have limited English proficiency. Addressing the issue of language barrier would require an increase in the number of bilingual clinicians. Students in medical schools should receive foreign language instruction to enable them to deal with patients who do not understand English well.
Fernández & Pérez-Stable, (2015). The authors maintain that the number of Spanish-speaking Limited English Proficiency (LEP) is in the U.S. is high. About 16 million individuals in the U.S. speak Spanish at home and they have LEP. Close to 9 million Hispanics do not speak English at all or speak it “not well.” Such a large number of Hispanics who are unable to speak English makes it challenging for them to access healthcare services. A majority of the Spanish speakers have basic language skills hence they are unable to communicate well when dealing with complex communication required by routine clinical care.
Andreae et al., (2017). The research examines the adverse effects of poor adherence with scheduled appointments. The authors examined various causes for missed appointments. The study identified language as a barrier to access to healthcare services among the Hispanics. The first generation of Hispanic immigrants to the U.S. is vulnerable to discouraging experiences when they visit healthcare facilities. The inability of many of the Hispanics to communicate well makes them feel that the physicians are discriminating them. Where patients feel discriminated, there are more likely to fail to attend scheduled appointments. The results of the study demonstrate that making phone calls in the preferred language of the patients increases the probability of adhering to scheduled appointments.
Steinberg et al., (2016). The article demonstrates that offering safe and high-quality care to children with limited English proficiency (LEP) remains a challenge. Minority populations like the Latinos and the Hispanics have problems when accessing healthcare services due to their inability to communicate well the care providers. The situation is worse for children from LEP families. Their parents report poor communication with healthcare professionals which often leads to dissatisfaction. The author advocates the need to have interpreters to facilitate communication between the patients and the providers. The problem is that some families tend to distrust the interpreters. Healthcare professionals need to ensure that LEP parents develop trust with their interpreters.
Meuter et al., (2015). The authors maintain that miscommunication in healthcare can be harmful to patients. With the rising number of migrant patients and foreign-trained healthcare workers limits communication between providers and their clients to the use of a second language. Language-discordant conversations are of interest because they present a degree of risk. While the article does not provide statistical information to demonstrate the gravity of the matter, it indicates that failure to communicate accurately may cause a patient to fail to comply with instructions or fail to choose a life-saving treatment.
Squires, (2017). The author indicates that increasing immigration into the U.S. has caused a challenge since healthcare professionals have to deal with a diverse population. According to the author, the largest group of immigrants in the last 30 years speaks Spanish. Despite the increasing Hispanic population, only 5% of the nurses in the U.S. identified as Hispanic or Latino. As a result, patients in this group are more likely than any other group to encounter a language barrier. While some Hispanics have tried to learn English, others have lost English skills as they age. Age-related neurologic events cause some older adult Hispanics to lose those skills hence the need for an interpreter. While using family members to interpret is cost-effective for healthcare facilities, it increases the risk of medical errors. These interpreters often lack basic medical knowledge which makes it possible to make mistakes while describing complex medical terms.
Dobbins, (2015). In this article, Dobbins seeks to go beyond the issue of language while trying to establish healthcare issues that exist in the Hispanic population. She writes that research indicates that the Hispanic population reports a lower healthcare satisfaction rate. She continues to say that policies and guidelines have mainly focused on enhancing cultural competency of the healthcare professionals. However, Dobbins believes that focus should shift from the language issues often highlighted, to the healthcare providers. She reveals that language can indeed be a major problem but can never be considered as the only issue. Apparently, there are other challenging problems that impact healthcare. Dobbins indicates that a problem like the shortage of nurses is one that goes beyond the issue of language. In her recommendations, she notes that basic nursing education programs need to be improved.
Moissac & Bowen, (2018). Even though directed at Francophones, this article does offer some insight on the topic of language barrier and its impact on the quality of care. Minority groups all over the world experience problems that emanate from their cultural or ethnic backgrounds. In this article, multiple method study involving online and paper-based surveys with patients and interpreters were used. As per the results, language barrier was said to lead to poorer patient assessment, misdiagnosis and/or delayed treatment, incomplete understanding of the patient condition and prescribed treatment, and impaired confidence in services received. The authors thus sought to communicate that the risks of language barriers need attention.
Bowen, (2015). Bowen takes a direct approach as she seeks to provide an understanding of how language barrier continues to be a problem in healthcare provision. Her aim is to offer evidence that sheds light on the negative impact of language barrier on access to healthcare, patient satisfaction and experience, and disparities in healthcare provision between English proficient patients and others. She reveals that patients facing language barrier issues are also highly likely to face an increased risk of medication errors and complications, and adverse events. Bowen then reveals that there is low awareness of the risks or issues associated with language barrier because of research publication issues. Harmonization of the research resources can indeed be of great help if the issues associated with language barrier are to be considered and acted upon.
Chaufan et al., (2013). In this article, Chaufan and her colleagues start by offering the reader an overview of the situation regarding diabetes and how language barrier affects its care. Latinos, they say, are disproportionately affected by diabetes mainly because at least 21 million of them are not proficient in English. This study delves deeper into the issue of interpreters and their effectiveness in helping solve the issue of language barrier and its eventual effect on diabetes patients especially Latino patients with limited English proficiency or LEP. This study was conducted in San Francisco General Hospital General Medical Clinic and mainly used interviews and observation methods in data collection. The researchers concluded that the recruitment of more Spanish speaking physicians is central to the success of doctor-patient communication and concomitant success of diabetes care among LEP Latinos.
Artiga et al., (2015). In the U.S., Hispanics account for the largest population of LEP individuals and as indicated in the summaries before, these individuals are susceptible to poor healthcare. Language barrier continues to be a major issue for LEP individuals. However, Artiga and her colleagues note that the Affordable Care Act (ACA) may have helped to increase healthcare coverage to all communities. However, access and utilization of care are still major issues for LEP individuals. The data collected and analyzed in this article is for English and Spanish-speaking Hispanic adults with insurance. Between these two groups, the study revealed that Spanish-speaking insured Hispanic adults face challenges with their health plans compared to their English-speaking counterparts. Additionally, the study reveals that Spanish-speaking Hispanic adults also face major issues when it comes to meeting the financial demands of healthcare.
Castellanos, (2016). In this study, Castellanos seeks to examine the primacy methods of communication used by LEP Latinos. The two main methods are children as interpreters and the use of physician language concordance. For children, the study reveals that the use of children often leads to misdiagnosis and lower patient satisfaction. There is also the potential for miscommunication, especially when dealing with children. However, Physician language concordance are said to lead to higher patient satisfaction and improved health outcomes. The researchers thus seem to indicate that physician language concordance is the better option when it comes to dealing with LEP Latinos and healthcare issues.
For an effective evidence analysis of the research see Appendix 1.
Applicable Theory
The psycholinguistic approach studies the psychological and neurobiological factors that facilitate the acquisition and use of language. The theory covers the cognitive processes involved in the generation of a meaningful sentence out of vocabulary structures and the processes that enable the understanding of utterances and words (Meuter et al., 2015). The theory advocates that the use of unfamiliar language terms makes it impossible for listeners to understand the intention of the speaker.
The psycholinguistic theory is critical in addressing language barriers between healthcare professionals and Hispanics. The theory indicates the way in which speakers can focus the attention of their audience to key elements of their message by applying both semantic and syntactic features (Meuter et al., 2015). Speakers should package their message appropriately such that the listeners can understand the communication being passed around. Even for listeners who do not understand a language well, packaging the message well will assist them to interpret the message more accurately.
In this case, the language barrier between healthcare professionals and Hispanics occur because of the inability of the professionals to package their message well. Given some of the healthcare professionals do not speak Spanish well, it becomes difficult for them to communicate effectively with their Hispanic clients. The inability of the Hispanics to understand a message frustrates their efforts to receive high-quality care. Using the psycholinguistic theory, healthcare workers learn about the semantic and syntactic elements they need to apply as they communicate with Hispanic clients who have a limited understanding of the English language. Packaging the message well will make it possible for Hispanics to access more healthcare services.
Proposed Solution
As far as healthcare facilities and the delivery of care are concerned, language barriers serve as a serious impediment. This is because language barriers between the staff and the patients makes it difficult for the patients to articulately describe their conditions to physicians. Similarly, this makes it challenging for both patients and physicians to communicate effectively with each other. In response to this significant barrier to healthcare service delivery, increasing multilingual fluency and cultural competence among healthcare professionals working in multiethnic communities is quintessential to overcoming said barrier (Ahmed, Lee, Shommu, Rumana, & Turin, 2017). In this way, communication between healthcare professionals and patients can be significantly improved, effectively improving service delivery as well.
Implementation Plan
Obtaining Approval
In order to effectively implement the proposed solution, it is necessary to get approval from the organization’s leadership as well as fellow staff. The most effective way to get this approval is by making a presentation to the hospital board alongside the various leaders at the facility on the need for multilingual fluency and cultural competency among its workforce. This presentation will detail the benefits of this approach, how training will be facilitated, as well as the costs that this implementation will incur in both the short-term and in recurring expenditure. When this is compared with the loss of revenue incurred due to language barriers, it will be possible to demonstrate the value of this solution and its pressing need to the facility.
Current Problem
As far as this facility is concerned, healthcare professionals are not required to be multilingual and have basic awareness of cultural competency. There are no existing policies, either state-wide or internal that ensure healthcare professionals can remain culturally competent with the communities that they serve. In this way, it becomes extremely difficult to regulate how well facilities and their staff can administer services to the ethnically and culturally diverse communities that they serve. Consequently, there is a need to institute policy changes that require healthcare staff to receive training in an additional language as well as on cultural competency as a means of ensuring they communicate better with their patients. This shift will work well to ensure that healthcare professionals in the facility can better serve their communities in spite of their diversity.
Proposed Solution
In communities where immigrants make up a core part of the demographic, it is imperative to acknowledge the fact that said immigrants will inevitably impact the culture of the community. These impacts spill over into the healthcare sector and can significantly impact the quality of healthcare services that immigrants and their communities receive when they seek healthcare. As such, there is a need to educate the healthcare staff working in the facility on the culture and customs of said immigrants. This is a significant step towards ensuring healthcare workers can better understand the patients that they serve based on a better understanding of the culture, customs, and social dictates of said immigrant patients. In this regard, educational training on cultural competency based on the community in question works well to ensure this goal is realized.
At the same time, language forms the basis upon which quality care is delivered to patients. It is almost impossible to provide quality care when healthcare professionals and patients cannot understand each other due to language barriers (Ali & Watson, 2018). While it is important for immigrants to learn the local language, their inability to communicate effectively in said language should not negatively influence the quality of care that they receive. To address this issue, providing language classes to healthcare workers to better serve their immigrant populations is imperative (Ali & Watson, 2018). Notably, most of this training will hinge on having healthcare workers capable of asking basic probing questions and being able to recognize particular signs and symptoms in the language of their immigrants. In these ways, it becomes possible to guarantee that at the very minimum patients and physicians can understand each other in a healthcare setting.
Rationale for Proposed Solution
Taking into consideration the work of Bowen, it is clear that language barriers between patients and healthcare workers significantly affect communication and by extension the quality of care delivered (2015). In order to address this problem, Chaufan, Chesla, Fielding and Fernandez posit that having physicians as being capable of understanding the language of their immigrants, in this case Spanish, is instrumental to improved patient-physician communication (2013). At the same time, it is vital to note that there are significant non-language barriers that hinder effective care delivery. Dobbins (2015) shows that effective care delivery hinges not only on effective communication, but also on cultural competency from physicians. By better understanding the culture of the immigrant communities they serve, physicians can improve the quality of care provided and patients can enjoy higher rates of satisfaction (Dobbins, 2015).
Implementation Logistics
In order to ensure success in the implementation of these recommendations, they need to be carefully and successfully integrated into the organizational culture of the facility and become a natural part of the workflow. One of the core ways in which this can be achieved is by ensuring that language training is offered regularly to the staff in a conducive and effective manner. This can happen in two main forms. First, face-to-face language and cultural competency training should be provided to staff members on a rotational basis by a certified expert on the language and culture of the immigrant community in question. For efficiency, staff will undertake said training on a rotational basis to ensure that service delivery is not crippled by regularly scheduled training of staff members.
Secondly, it is also vital that staff members are provided with virtual training facilities that will allow them to learn at their own time, whether at work or outside of work. This will ensure continual learning from the staff about the language and cultural practices of the immigrant community that they serve. At the same time, it is equally important to stress the need for said training to be offered to all staff at the facilities. The hospital board will be tasked with ensuring an effective plan of implementation is developed in good time. The organizational leadership will then be tasked with ensuring that the training is conducted and attended, and that staff can access said training at any time. This will guarantee an effective plan that can be effectively implemented and carefully monitored for success.
Resources
In order to be success, all staff members at the facility should be trained on cultural competency and language with respect to the immigrant community the facility serves. Aside from the face-to-face training staff members receive, virtual training that can be accessed remotely should also be provided to the staff members to facilitate continuous learning (Moissac & Bowen, 2018). This training can be facilitated through a dedicated website established to help staff learn continually at their convenience. Where necessary, physicians can be provided with handouts and posters that contain basic questions and terms that may be in...