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Professional interpreter use improves care in patients with limited English proficiency (LEP) but inequalities in outcomes remain. We explore the experience of US Latinos with LEP and diabetes in language discordant care.

We conducted in-depth interviews of 20 low-income Latino patients with diabetes and LEP. We interviewed participants in Spanish, digitally recorded and transcribed interviews, and read transcripts to identify themes and interpret meanings using interpretive phenomenology as theoretical framework.

While patients preferred, and experienced greater trust in, language concordant clinical encounters, they did not believe that language discordance affected outcomes because they felt that these depended largely on their compliance with physicians’ recommendations. Patients also downplayed structural barriers to care and outcomes. Self-blame was paradoxically encouraged by physicians’ praise vis-à-vis favorable outcomes.

Limitations include small and convenience sample and limited generalizability. However, findings illustrate communicational dynamics between patients and clinicians with important implications for health care practice and policy. They support the perception that trust develops best within language concordant care, which underscores the importance of recruiting clinicians with diverse language skills. They highlight the importance of sensitizing clinicians to the social determinants of health, which may be overlooked when treating patients with conditions requiring substantial self-management, like diabetes. Language barriers in health care must be understood in the broader context of structural inequalities in health care. The necessary emphasis on self-management may (inadvertently) strengthen the hegemonic view that places responsibility for diabetes outcomes on patients’ ability to self-manage their condition to the neglect of social/political determinants of diabetes.

Studies have quantitatively examined the effects of language discordant care on diabetes outcomes, yet few have done so qualitatively. To our knowledge, no study has attempted to understand the experience of language discordance from the perspective of LEP patients with diabetes and how this experience may explain observed differences in outcomes.

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.

This chapter provides both an introduction to the volume and a brief review of literature on women, gender, and health and health-care services as well as racial/ethnic minorities in the same areas.

The chapter argues for the importance of greater examination of women, issues of gender, and racial and ethnic minorities in health and health-care services.

The chapter reviews the issues of women and racial and ethnic minorities and previews this book.