Barriers in Healthcare for Latinx Patients with Limited English Proficiency—a Narrative Review

Abstract

Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts ( n = 429). We classified study titles ( n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients’ immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07995-3.

Access challenges for patients with limited English proficiency: a secret-shopper study of in-person and telehealth behavioral health services in California safety-net clinics

“…Our findings are consistent with multiple studies demonstrating access barriers faced by patients with LEP that may contribute to underutilization of care and negative health outcomes. 4 , 6 , 38 Further, our finding that 38% of clinics listed in online provider directories could not be reached by any of our callers or were not taking new patients provides further evidence of the existence of “ghost networks” (ie, providers who are listed by payers as in-network options but are nonexistent or unavailable) in behavioral health. 39…”

“… 3–5 Compared with English-proficient patients, patients with LEP receive fewer health care services, have greater unmet mental health needs, and receive poorer quality care. 6 , 7 The challenges start well before patients with LEP interact with the health care system: patients with LEP with a mental health condition are less likely to perceive a need for treatment or seek specialty behavioral health treatment. 8 Recent studies have identified factors contributing to inequities in access and outcomes for Spanish-speaking patients, including lack of language services, perceived discrimination, and mistrust and privacy concerns.…”

“… 8 Recent studies have identified factors contributing to inequities in access and outcomes for Spanish-speaking patients, including lack of language services, perceived discrimination, and mistrust and privacy concerns. 6 , 9 , 10 Disparities are exacerbated when patients with LEP lack access to language-concordant clinicians or qualified interpreters. 11 …”

Racial disparities in cancer care, an eyeopener for developing better global cancer management strategies

“…124 Studies have also revealed that minority groups, such as African Americans, Asian Americans, and Hispanics/Latinos seek hospice care less frequently. 125 Cultural variations in the impact of the disease or its mitigation and palliative care among different sections of patients and their families are also often variable in the western world as compared to close-knit societal frameworks as seen in South Asia, Southeast Asia, and the far East. Buddhism's predominant faith in "natural fate" urges sufferers to face pain as they await death.…”

The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes

“…The population demographics continue to evolve, and many ethnic groups are growing rapidly. Presently, the Latinx population constitutes the largest racial and ethnic minority group in the United States (3), comprising approximately 18.9% in 2020 and is projected to constitute 28% of the country by 2060 (4). Importantly, as much as 70% of this population speaks a language other than 1 Division of Internal Medicine, University of Toronto, Toronto, Ontario, Canada; 2 Office of Clinical Research, Baptist Health South Florida, Miami, Florida, USA; 3 English at home, and 28.4% are not fluent in English (5)(6)(7)(8).…”