142nd APHA Annual Meeting and Exposition

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298093
Lost in translation: Physicians' perspective on how language barriers affect diabetes outcomes among Latino patients with limited English proficiency

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014

Claudia Chaufan, MD, PhD , Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA
Hegla Fielding, R.N. MA , Institute for Health & Aging, University of California San Francisco, San Francisco, CA
Catherine Chesla, RN, PhD, FAAN , Family Health Care Nursing, University of California San Francisco
Alicia Fernandez, MD , Division of General Internal Medicine, University of California San Francisco, San Francisco, CA

Language barriers are one major cause of ineffective diabetes care and poor outcomes among US minority populations. Because at least 21 million of US Latino patients, the largest and fastest growing minority population in the US, have limited English proficiency (LEP) and are disproportionately affected by diabetes, Latinos are at high risk of experiencing poor diabetes outcomes as a result of language barriers.  Use of professional interpreters can substantially improve the quality of care, yet may not be sufficient to eliminate disparities in diabetes outcomes for LEP patients.  Moreover, clinicians must decide when the use of interpreters is appropriate and even necessary.  Therefore, research comparing the clinical effectiveness in communication modalities (bilingual primary care provider vs. interpreter-mediated care) is needed.  Prior research from our team exploring the experience of patients across language divide suggests that patient self blame may obscure language and other structural barriers to diabetes care among low-income, LEP Latino patients. In this study, we examine the experience of language discordant care from the perspective of physicians providing care to these patients.  Using interpretive phenomenology as a theoretical framework, we interviewed a convenience sample of 15 clinicians (about one third of them bilingual and two thirds of them needing interpreter services) at a major, urban public hospital in northern California that counts with award-winning interpreter services.  We analyzed key themes pertaining to how language barriers influence clinical recommendations and providers’ clinical decision making in risk factor control (e.g. clinical inertia). We present preliminary results of our investigation.

Learning Areas:

Chronic disease management and prevention
Other professions or practice related to public health
Social and behavioral sciences

Learning Objectives:
Discuss language barriers as one key contributor of poor health outcomes and health disparities among US minority populations. Identify barriers and facilitators of effective communication in language discordant care Understand physicians’ experience and decision-making process concerning interpreter use in language discordant care Evaluate the contribution of language barriers to equity in health care

Keyword(s): Health Disparities/Inequities, Latinos

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the second author in this study and was involved in the data collection, analysis and reporting of the results. I am the collaborator of the principal investigator, Dr. Claudia Chaufan, and a registered nurse at the institution where the study was conducted.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.