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Language Barriers Affecting Healthcare Access
Your Name, RN
Washington State University College of Nursing, Campus
Course: Nursing 440 Population Health Theory
Course Faculty: Faculty name and credentials
Due Date
LANGUAGE BARRIERS AFFECTING HEALTHCARE ACCESS
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Language Barriers Affecting Healthcare Access
The Latino population has grown extensively over the last two decades, and by the year
2060, the United States Census estimates that one in three Americans will identify themselves
as Latino (Jacquez et al., 2016). Such a dramatic population increase will bring more Spanish
speakers into this country, and in the last 30 years, they were the largest group of migrants
(Squires, 2017). Healthcare access for this population can be affected as some migrants have
limited English proficiency (LEP). Individuals with LEP “cannot speak, read, write or
understand the English language at a level that permits effective interaction with HCPs (health
care providers)” (Ali & Watson, 2017, p. e1153). According to Shamsi et al. (2020), language
barriers are linked to unequal treatment and access to healthcare services for this population
and thus, unequal health outcomes. The purpose of this paper is to explore the effects of
language barriers on healthcare access in the Hispanic population, an upstream intervention to
counteract this problem, nursing implications, and personal reflection.
Population Health Concepts
The Director-General of the World Health Organization once stated that healthcare
should not be a privilege, but a fundamental right for everyone (UN News, 2019). That right to
healthcare access can be hampered if a patient who has LEP avoids going to the doctor because
of the psychological stress caused by language barriers. According to Andreae et al. (2016), 48
million people in the U.S. do not speak English as their primary language, and about 21 million
do not consider they speak English well. In a systematic review of 14 studies chronicling
language barriers and healthcare, Shamsi et al. (2020) revealed that in general, patients who do
not speak the country’s primary language have poorer health outcomes and higher occurrences
of adverse events compared to patients who speak the primary language. Some of the studies
indicated that due to communication difficulties, physicians can misdiagnose these patients or
prescribe the wrong medications (Shamsi et al., 2020). Other studies showed that 37% of
physicians thought patients hid pertinent health information due to their inability to
LANGUAGE BARRIERS AFFECTING HEALTHCARE ACCESS
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communicate effectively. Another 30-49% of patients had trouble understanding instructions or
their medical diagnoses, and 34-41% had difficulty reading the prescription labels and
comprehending medication dosing (Shamsi et al., 2020). Thus, adverse health outcomes can
result from these problems encountered with language barriers.
Hispanics with LEP may be discouraged from seeking necessary healthcare because of
discrimination concerns. Participants in a study by Jacquez et al. (2016) stated they were
apprehensive in seeking services because they felt the providers assumed that they are less
knowledgeable than their non-Hispanic counterparts and asked them offensive questions. In the
video Becoming American (Rios & Rodriguez, 2008), Dr. Steven Larson commented that
Hispanics face the stigma of being dirty, arriving late for appointments, and carrying infectious
diseases; and the longer they live in the U.S., the more discrimination they suffer through. The
main subject from the video has never been to a doctor in the 25 years since he has been in the
U.S. Avoiding care can deteriorate health, leading to hypertension, heart disease, and obesity. In
Washington state, the top three chronic diseases affecting Hispanics are hyperlipidemia (36%),
high blood pressure (30%), and obesity (27%) (Washington State Department of Health, 2015).
A study by Ali & Watson (2017) stated that patients with LEP are less likely to be offered services
like blood pressure and cholesterol screenings. Lack of services can lead to noncompliance with
treatment, nonadherence with follow-up appointments, and worsening of chronic diseases.
Discussion
An Upstream Intervention
Population health interventions can be made at the individual, community, and
organization levels in order to increase healthcare access to the affected population (Savage &
Groves, 2020). An individual-focused intervention begins at the clinic by staff members
recognizing that a patient has LEP and asking the preferred language the patient would like to
be spoken to. According to Squires (2017), staff must make use of the organization’s interpreter
LANGUAGE BARRIERS AFFECTING HEALTHCARE ACCESS
services if available, whether it is in-person, via telephone, or video. Any crucial information,
such as medication management, should always be in the patient’s preferred language.
At the community level, healthcare facilities that cater to Spanish-speaking patients
should document the use of medical interpreter services (Squires, 2017). This documentation
can inform organizations of interpreter demand to implement changes at the systemic level.
Policies can be transformed to mandate the incorporation of bilingual staff or interpreters in all
medical facilities that cater to Hispanic patients. These facilities may need to look at their
finances and allocate funds to provide interpreting resources or train existing potential staff to
become certified interpreters.
Although costs may increase, medically trained interpreters and bilingual nurses have
proved to be extremely useful when providing care to LEP patients. A pain clinic in Bronx, New
York, modified their services to hire only native Spanish or certified Spanish speakers for their
front desk and encouraged existing staff to become certified interpreters for a salary increase
(Andreae et al., 2017). After the clinic implemented the change, they saw a rise in appointment
adherence amongst their Spanish-speaking patients and enhanced communication and rapport
between physicians and patients (Andreae et al., 2017). Squires (2017) also pointed out that
utilizing interpreter services can decrease patient hospital stays by three days and decrease
hospital readmissions by 15-25%. These statistics show that enforcing interpreter services can
affect patient outcomes and avoid adverse events.
Implications in Nursing Practice
Patients going into a medical facility for an appointment or procedure are already
anxious, and if they have LEP, it adds to their psychological stress (Meuter et al., 2015). If
qualified interpreters are not available, patients may depend on their relatives who are not
medically trained for translation services, thus provoking miscommunication and adverse
patient outcomes (Meuter et al., 2015). To provide appropriate and effective care to patients,
nurses and medical staff must acknowledge language barriers and implement effective
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communication techniques in order to overcome these problems. Available interpreting services
should be used if LEP patients prefer to be spoken to in their native language, and the nurse
should speak directly to the patient and not the interpreter when using these services to give the
patient a sense of inclusion (Squires, 2017). Nurses who are already bilingual can take the next
step and become medically certified interpreters, and nurses who only speak English can
familiarize themselves with the Spanish language or go as far as become certified interpreters.
Even if the nurse is only able to speak simple conversational Spanish, it can help build a rapport
with the patient and put their mind at ease while they wait for the interpreter. Since nurses are
spokespeople and advocates for their patients, they should take it upon themselves to hone their
language skills to effectively provide care for their LEP patients.
Reflection
In the city of Yakima, Washington, where I reside, 46.4% of the total population is
Hispanic, and 37.1% of that population speak a language other than English (United States
Census Bureau, n.d.). I work in a gastroenterology clinic in which a third of the patients prefer to
be spoken to in Spanish. Sometimes the doctors and nurses will talk to the patients in English if
the patients are somewhat proficient to save time. This is not the best communication tactic
since vital information can be missed. After researching this topic, I have a better understanding
of what Hispanic patients who speak limited English must feel like when they come to the clinic.
A past goal I had set for myself was to learn some Spanish phrases to communicate simple, but
important, pronouncements and instructions to the patients, such as calling time-out before the
start of a procedure and instructing them on how to position themselves. I intend to learn more
conversational Spanish to enhance my interactions with LEP patients, and this assignment has
fortified that intent. I have noticed recent changes occurring at the clinic and hospital levels with
an increase in bilingual personnel hired to staff the front desk and answer phones. I hope to see
more of these changes occurring in healthcare facilities across the nation to provide health
equity and access to the projected influx of Hispanic immigrants coming into this country.
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References
Ali, P. A., & Watson, W. (2017). Language barriers and their impact on provision of care to
patients with limited English proficiency: Nurses’ perspectives. Journal of Clinical
Nursing, 27, e1152-e1160. https://doi:10.1111/jocn.14204
Andreae, M. H., White, R. S., Chen, K. Y., Nair, S., Hall, C., & Shaparin, N. (2017). The effect of
initiatives to overcome language barriers and improve attendance: A cross-sectional
analysis of adherence in an inner city chronic pain clinic. Pain Medicine, 18, 265-274.
https://doi:10.1093/pm/pnw161
Jacquez, F., Vaughn, L., Zhen-Duan, J., Graham, C. (2016). Health care use and barriers to care
among Latino immigrants in new migration area. Journal of Health Care for the Poor
and Underserved, 27(4), 1761-1778. https://doi.org/10.1353/hpu.2016.0161
Meuter, R. F. I., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective
communication when patients or clinicians use a second language. BioMed Central
Health Services Research, 15(371), 1-5. https://doi:10.1186/s12913-015-1024-8
Rios, P. G., & Rodriguez, M. T. (Directors). (2008). Becoming American: Part of the series:
Unnatural causes [Video]. California Newsreel.
https://wsu.kanopy.com/video/becoming-american
Savage, C., & Groves, S. (2020). Optimizing population health. In C. L. Savage
(Ed.), Public/community health and nursing practice (2nd ed., pp. 23-54). F. A. Davis
Company
Shamsi, H. A., Almatairi, A. G., Mashrafi, S. A., & Kalbani, T. A. (2020). Implications of
language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), 4450. DOI: 10.5001/omj.2020.40
Squires, A. (2017). Evidence-based approaches to breaking down language barriers.
Nursing 2017, 47(9), 34-40. https://doi: 10.1097/01.NURSE.0000522002.60278.ca
LANGUAGE BARRIERS AFFECTING HEALTHCARE ACCESS
UN News. (April 7, 2019). ‘Health is a right, not a privilege’ says WHO chief on world health
day. https://news.un.org/en/story/2019/04/1036221
United States Census Bureau. (n.d.). Quickfacts, Yakima city, Washington.
https://www.census.gov/quickfacts/fact/table/yakimacitywashington/SEX255219
Washington State Department of Health. (2015). Hispanic chronic disease profile.
https://www.doh.wa.gov/Portals/1/Documents/Pubs/345-334-Hispanic.pdf
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Running head is no longer needed in APA 7th ed, only page numbers
Use this format with these headings for you paper. This is a formal paper. Use third person
narrative. You may use first person in your reflection if necessary. Please use rubric to ensure
you are covering each area that is expected. You must use APA 7th ed.
[Title of the Paper in about 12 Words. Please indicate the topic chosen on the Title Page.
Select from appropriate list in the assignment instructions]
Student’s Full Name and credentials
College of Nursing, Washington State University Campus
NURS 440: Population Health Theory
Instructor Name and Credentials
Due date
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[ABBREVIATED TITLE-50 CHARACTERS MAX PLUS SPACES]
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[Title of the Paper in about 12 Words This should be the same as the title of your paper]
[Per APA, do not use Introduction as a heading name.]
[Start adding text here. Retain tab delineated indents for paragraphs. Describe the
healthcare problem in your selected topic and provide evidence from credible sources to
substantiate the problem. Provide a clear purpose statement that includes what you are trying to
achieve in the case study paper. This is typically the last sentence in the introduction section. For
example, “The purpose of this mini-paper is to ……” ]
from APA Manual 7th ed. Crediting Sources you may use this online resource for APA
formatting and style related topics including a sample APA paper formatting and in-text
citations and reference guidelines.
https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_style_introduction.html
[Demonstrate understanding of epidemiology and the social ecological model somewhere in your
paper (i.e., two or more levels [e.g., intrapersonal, interpersonal, community, organizational,
policy]).]
Population Health Concepts [Retain as a first level heading]
[Retain tab delineated indents for paragraphs and add text. Please choose one of the case
study topics. Make logical, insightful, and compelling connections between the healthcare
problem in the case and relevant population health theories/concepts and support with
information from scholarly sources*. To Integrate multiple sources of knowledge with the case
study information.]
[ABBREVIATED TITLE-50 CHARACTERS MAX PLUS SPACES]
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Discussion [Retain as a first level heading]
An Upstream Intervention [Retain as a second level heading]
[Retain tab delineated indents for paragraphs and add text. Describe how you would go
about advocating for an upstream solution as a potential intervention to address the healthcare
problem and support with information from scholarly sources*. The discussion on an upstream
intervention should include a specific example on how you might help to promote changes.]
Implications in Nursing Practice [Retain as a second level heading]
[Retain tab delineated indents for paragraphs and add text. Tie your discussion on an
upstream intervention to implications in nursing practice from a population health perspective.
Please refresh yourself on Nursing implications and be sure that that is what you are putting in
this section]
[ABBREVIATED TITLE-50 CHARACTERS MAX PLUS SPACES]
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Reflection [Retain as a first level heading]
[Retain tab delineated indents for paragraphs and add text. To describe your reflection on
how this learning activity might inform your own nursing practice. This section is different from
the Implications in Nursing Practice section in that this is a personal reflection.]
[ABBREVIATED TITLE-50 CHARACTERS MAX PLUS SPACES]
References [Retain as a centered heading]
[APA References
o This includes different reference guidelines when there are one, two, three to
seven, or more than seven authors.]
[Another online resource for APA formatting and style related topics including a sample APA
paper formatting and in-text citations and reference guidelines.]
https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_style_introduction.html
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