For week 3, we’ll focus on how, in order to promote access to care, we must advocate for policies that reduce language and cultural barriers.
Language barriers between patients and providers can pose challenges to providing high-quality, compassionate, patient-centered care. Patients with Limited English Proficiency (LEP) face barriers in accessing health care, may experience lower-quality care, and suffer worse health outcomes. These language barriers can overlap with other social determinants of health, exacerbating disparities in health care access and health outcomes.
Patients with limited English proficiency may have limited financial resources, a lack of formal education, vulnerability due to insecure immigration status, and mental health issues such as anxiety and stress. These disparities are further exacerbated in racial and ethnic minorities. Language barriers make it even more difficult for patients to advocate for themselves, ask questions, and navigate already complicated health care systems.
Often, and even though in some cases it is a requirement of receiving federal funding, providers do not provide medically-certified translation services because of both the cost and the increased time that is needed for patient visits with translation services. Even when interpreters are available, some clinicians choose not to use them or fail to use them effectively.
Other patients may decline translation services, opting instead to have a family member or a friend translate on their behalf, which can lead to situations where minor children are translating for their parents or an abuser is translating on behalf of the person they are abusing. And, even with the best intentions, a family member or friend can end up injecting their own feelings about the patient’s health, losing the patient’s voice altogether.
When communication barriers persist, patients are less satisfied, may not understand how to use medication, and are less comfortable maintaining a care regimen. Critically, providers may not fully understand a patient’s needs, impacting their ability to properly diagnose, which can increase patient morbidity or mortality.
Patients with limited English proficiency might be seen by some as outsiders, making it dangerously easy to devalue and depersonalize them — and to make damaging assumptions about things such as their intelligence, religion, culture, or attitudes towards health.
Cultural differences
Language is not the only barrier faced in providing care to patients. Cultural differences can also cause misunderstandings between patients and providers. Realizing how culture can influence a person’s perceptions of health can make a difference in understanding a person’s medical needs and how to communicate with them.
Cultural competence in health care addresses the disparities that people of racially and culturally diverse backgrounds often experience. It can ensure all patients get the care they need to live healthier lives.
Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. This practice requires systems that can personalize health care according to cultural and linguistic differences.
It also requires understanding the potential impact that cultural differences can have on healthcare delivery, such as: how patients perceive symptoms and health conditions; when and how patients seek care; patients’ expectations of care; patients’ preferences regarding procedures or treatments; patients’ willingness to follow recommendations or treatment plans; and who patients believe should participate in making healthcare decisions.
Overall, the message is clear: providers must address language and cultural barriers in order to ensure high-quality, compassionate, patient-centered care.
Some steps in the right direction might include:
- investing in high-quality interpreter services and automating the process to reduce the barriers to use;
- training staff to use these services efficiently and effectively;
- creating a culture of equity in which excellent care is expected for all patients;
- and making it clear that good communication with patients is part of good clinical practice.
References:
- https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-language-barriers-exacerbate-health-inequity/2021-02
- https://journalofethics.ama-assn.org/article/language-based-inequity-health-care-who-poor-historian/2017-03
- https://publichealth.tulane.edu/blog/cultural-competence-in-health-care/