Recorded presentation

Mondi Mason, PhD, MPH, Health Behavior and Health Education, University of North Carolina, 323-B Rosenau Hall, CB# 7440, School of Public Health, Chapel Hill, NC 27599-7440, (919) 966-0246, masonm@email.unc.edu

Health care settings have structural and contextual barriers that can cause differences in care received by limited English proficient (LEP) patients. Therefore, health care organizations have adopted formal strategies to meet the needs of LEP patients and to comply with Title VI of the Civil Rights Act of 1964. Examples of strategies include: writing a language access policy, hiring bilingual employees and interpreters, and contracting with telephonic interpreter services. However, the efficacy of these strategies in the clinic environment is not clear. It is often assumed that if a strategy is adopted it will automatically be diffused within an organization. As the findings of this study indicate, this is not always the case. This study revealed that despite the organization’s efforts, structural and contextual barriers affect how strategies are operationalized within the clinic environment. Through direct observation and semi-structured interviews with administrators, providers, nursing and support staff, and Spanish speaking patients, and using the Diffusion of Innovations as a framework, this study explored how strategies to enhance language access were implemented in five community health centers (CHC). Key areas examined include: perceptions of language access by patients and CHC employees, formal and informal strategies utilized to provide language access, outcomes from implementing these strategies, and recommendations for improving strategies. Despite efforts to implement formal strategies to enhance language access, language barriers continue to occur between LEP patients and CHC employees that affect patient care. The findings include: patient care based on inaccurate or incomplete information and delays in care due to inefficiencies in the clinic environment. Other issues also emerged such as: discrimination and prejudicial attitudes toward patients, alienation among staff, and mixed messages from the administration about the use of formal language access strategies. Additionally, health care professionals are implementing informal strategies such as using family members as interpreters, or making do with gestures to overcome language barriers in an environment rife with time constraints. These structural and contextual barriers create gaps in language access and thus reduce the efficiency of the clinical practice. These findings have implications for the design and creation of more culturally competent health care organizations for the efficacious delivery of health care to LEP patients.

Learning Objectives:

• Identify formal strategies to reduce language barriers in clinic environments.
• Recognize structural and contextual barriers that inhibit the implementation of formal language access strategies.
• Describe concrete examples for creating a more culturally competent clinic environment.

Keywords: Access to Health Care, Public Health Administration

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation