“Lost in Translation”: How Clinicians Make Sense of Structural Barriers to Diabetes Care among US Latinos with Limited English Proficiency
Health and Health Care Concerns Among Women and Racial and Ethnic Minorities
ISBN: 978-1-78743-150-8, eISBN: 978-1-78743-149-2
Publication date: 10 August 2017
Abstract
We explored how clinicians assisting low-income US Latino patients with diabetes and limited English proficiency (LEP) made sense of language-discordant care in the context of the social determination of health.
We interviewed 14 physicians in an urban teaching hospital, recorded and transcribed the interviews, and read transcripts to identify themes and interpret meanings. We used a mixed qualitative approach and drew from the Marxian tradition that illuminates how the dynamic of the clinical encounter tends to reproduce the social order by excluding its critical appraisal.
Participants believed that language barriers undermine the quality of the clinical encounter and diabetes outcomes, were eager to serve disadvantaged patients, and were well schooled in the social determination of health and its role in diabetes inequalities. However, they appeared unable to conceptualize macro-level changes that may achieve greater health equity.
The structure of medical discourse appears to limit the ability of individual clinicians to conceptualize and engage in social change on behalf patients. Recent debates in primary care indicate that this limitation is currently being challenged. Health services for persons with diabetes and limited English proficiency in the United States and elsewhere require significant improvements in interpreter services. At a broader level, clinicians should consider stepping beyond the limited, traditional role of medical/behavioral advisor to engage in political action toward greater social equity, which would result in better health.
Research in the various dimensions of language discordance is largely quantitative thus the need for qualitative studies to inform practice and policy.
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Acknowledgements
Acknowledgments
The authors thank the patients, medical personnel, and staff who kindly volunteered their time and expertise to our project. The first author also thanks her students whose questions and concerns are a continuing source of inspiration. Funding was provided by 3R01DK090272-02S1 and K24DK102057 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Citation
Chaufan, C., “Miki” Hong, M.-K. and Fernandez, A. (2017), "“Lost in Translation”: How Clinicians Make Sense of Structural Barriers to Diabetes Care among US Latinos with Limited English Proficiency", Health and Health Care Concerns Among Women and Racial and Ethnic Minorities (Research in the Sociology of Health Care, Vol. 35), Emerald Publishing Limited, Leeds, pp. 127-143. https://doi.org/10.1108/S0275-495920170000035007
Publisher
:Emerald Publishing Limited
Copyright © 2017 Emerald Publishing Limited