Public Health and the Linguistic Barrier for the Spanish-Speaking Population in the United States

By Student Guest Blogger:
David Leander
Class of 2010, Weinberg College of Arts & Sciences
Materials Science, Economics, and Spanish; Global Health Studies and Classical Studies

During my 45-minute drive from Evanston to the Plaza Family Medical Clinic in Pilsen, I became aware of the change of scenery that materialized seamlessly–realizing the familiar microcosm that morphed within a few blocks.  The Chicagoland streets transformed into the calles I remembered from my study abroad experience in Mexico City.  Street vendors, Latino supermercados, and of course, the language lined the streets.  In the clinic, I waited in the hallway to the examination rooms before approaching a patient–in hand with a 15-page survey, subject compensation, IRB forms.  As an unfamiliar face to subjects both as a member of the clinic and as a native Spanish-speaker, my entrance to the examination room was a strange intrusion on both fronts.  Initially awkward, I explained my research project to the patients.  I gained their trust and our conversation about pharmacies and the language barrier began.

The Latino population is predicted to become the largest minority group in the United States.  As a consequence, in terms of a public health perspective, the problem of language concordance presents itself as a serious concern.  In particular, several studies document that pharmacies in the United States lack the capability to provide Spanish-speakers with translated materials.  Related, medication errors represent significant costs that affect the healthcare industry–many of which occur in outpatient situations.  Thus, it is imperative that pharmacies focus on providing customers language appropriate materials.

My study, in conjunction with the Feinberg School of Medicine’s Health Literacy and Learning Program, investigated this issue from the perspective of the customers themselves.  I was linked with ACCESS Community Network, which is a large community healthcare provider in Chicago–specifically, I recruited subjects at the Plaza Medical Center on Cermak in Chicago’s Pilsen community.  While patients waited to see their primary healthcare provider, I would survey them regarding their behavior with prescription medicines when the language barrier is present.  All subjects were 18-70 years old, taking at least 1 prescription medicine, and a Spanish-speaker.  I conducted all surveys (15-20 minutes with 33 questions) exclusively in Spanish.  Overall, I spoke with 35 subjects.

The principal results of my study concurred with previous studies that indicated that pharmacies lacked translation capabilities.  48% of subjects did not receive full translation services (information pamphlet, prescription label, and advice from pharmacist) and 20% did not receive any translation services.  Moreover, I found a discord between patient needs and preferences.  As rationally economic consumers, subjects reported that price (and proxies of price such as location and convenience) dominated their decision in choosing  a pharmacy.  On the other hand, in terms of patient needs, subjects reported that they thought that pharmacies could improve services by offering bilingual services.  Thus, this difference represents a challenge for pharmacies and their customers.  Furthermore, delving into subjects’ behavior, I found that a significant percentage (43%) used translators (children, spouses, or non-pharmacy employees).  None of these translators however are suitable for providing safe and efficient delivery of pharmaceutical medicines.  As well, of those subjects that received translations, it was reported that these translations may not be fully digestable for patient use.  Demographically, the subjects I surveyed had a range of years of education of 0 to 18 years, with a median of 7 years.  Therefore, another issue involved is that of providing comprehensible, target-appropriate materials to deliver safe information.

David Leander at Undergraduate Symposium

I presented this information at the 2010 Undergraduate Research Symposium.  In terms of how this has affected my future career, I just started full-time work at Epic two weeks ago.  Epic is a healthcare software company in Verona, WI and I hope to help find ways to diminish the language barrier in healthcare delivery.  Beyond this scope, I am interested in a future in the medical and/or healthcare field.  This experience gave me the once in a lifetime opportunity to develop, execute, and analyze my own research topic as an undergraduate in the public health sphere.  This project would not have been possible without the support of the Mabie family, to whom I am deeply thankful–their generous support provided me everything I needed to carry out this project.  As well, I would like to thank the ACCESS staff who assisted me in this project.  Lastly, I would like to thank the amazing faculty that guided me through this experience: Stacy Bailey, director of the Health Literacy and Learning Program, aided me in developing a survey battery and connecting with the ACCESS clinic; Professor Beth Barden was essential to helping me develop my research proposal and application; and Profesora Elisa Baena served as my advisor for my Spanish 399 Independent Study, which I took as a capstone project for my senior year as a Spanish major.

A particularly memorable experience that I had outside of the research perspective was when I saw one woman who I interviewed a month later in the waiting room.  She asked me how my project was going and she actually told the people around her in the room about my study.  Incredulously, they looked at me, a South Korean native, and wondered who would ask them questions.  ”Él” (him), she would say, pointing at me, to which I would respond: “Si, hablo español.  ¿Ud. puede hablar conmigo mientras está esperando para el doctor?”  (Yes, I speak Spanish.  Would you be able to speak with me while you wait for the doctor?).  Because of this action, a referral of sorts, I was socially validated and was extremely successful that day recruiting patients.  This experience was not only important training as a research experience, but also in understanding the social aspect of healthcare.  With language especially, trust and competency are essential.

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