BARRIER TO COMMUNICATION WITH A PATIENT

Barrier to Communication with a Patient

Barrier to Communication with a Patient

Introduction

Hablamos Juntos and The Robert Wood Johnson Foundation sponsored this focus group study with physicians to better understand communication barriers to health care for minority patients. Hablamos Juntos is a project funded by the Robert Wood Johnson Foundation to improve communication between healthcare providers and their patients with limited or no English proficiency. Lake Snell Perry & Associates, a research firm in Washington, DC, conducted the six focus groups in four sites across the country May through July, 2003.

The purpose of this project is to hear directly from physicians who treat a growing number of patients who are non-English proficient (NEP) or limited English proficient (LEP). Physicians with Latino patients were particularly encouraged to participate in this study since Hispanics represent both the largest and fastest growing minority population in the United States. The focus groups explored physicians' experiences with their NEP/LEP patients, the kinds of challenges these patients pose, some of the strategies and actions they have taken to address these challenges, and their reactions to messages and information created to engage physicians on this topic. In order to hear a variety of experiences, a mix of physicians participated in this study from internists, pediatricians, OBGYNs to specialists such as surgeons, ENTs, urologists and Nephrologists(M, 2003,, 286).

The Challenge

A growing body of research on health disparities between ethnic groups shows that being a member of a minority group in the United States, in and of itself, can be a barrier to health care. And though socioeconomic status and ethnicity are only two elements in the larger picture of access to care, statistically they have shown themselves to be critically important. The inability to speak English, in particular, has been empirically associated with less care-seeking and access to care.

Language barriers create problems for both patients and providers. For patients, language and communication influence how and if NEP/LEP patients access and experience health care. Because of language barriers, these patients often encounter the following basic types of problems:

• Lack of awareness of existing services and how to access them;

• Difficulty in making appointments and accessing basic information about

the visit when they do seek care;

• Inability to communicate adequately with health care support staff, providers, and ancillary staff at all points within the healthcare delivery system;

• Low patient satisfaction in situations where language is a barrier, which may lead to reluctance to return to the health care setting.

Furthermore, research shows that even when NEP/LEP patients are able to access health care, health care quality may be diminished and health outcomes may be poorer for them than for other patients. Specifically:

• These patients receive less information about the therapeutic regimen, and understand less of the instructions related to their medication;1

• After cross-language encounters, patients are less likely to keep subsequent appointments and are more likely to make emergency room visits than are patients in same-language encounters;2

• Non-English speakers are less likely to receive preventive services;3

• Latino parents, in one study, ...