Provider Patient Communication Through Professional Interpreters

Improving Provider-Patient Communication Among LEP Patients Abstract Elderly Hispanic patients experience numerous challenges when seeking for healthcare services since they are only eloquent in their native language and are classified as Limited English Proficient (LEP) patients. Language barriers contribute to poor provider-patient communication and necessitate the integration of third parties in the care delivery process. This paper whether the use of professional interpreters improves patient-provider communication and results in better health outcomes.

Through a study that was carried out a sample of 40 elderly Hispanic diabetic patients at a Wellness Center in Los Angeles, using a professional interpreter improves provider-patient communication. The use of professional interpreters and language concordance is associated with improved provider-patient interactions, enhanced interpersonal care, and better medication adherence within three months. Keywords: elderly Hispanics, patients, medication adherence, bilingual interpreters, treatment, patient-provider communication, healthcare providers. Overview Provider-patient communication is an important factor in enhancing patient outcomes in the modern healthcare environment.

Elderly Hispanic immigrants and Mexican Americans are among patient populations facing relatively high rates of diabetes. Sentell & Braun (2012) contend that the prevalence of rates of diabetes among Hispanic communities for diagnosed and undiagnosed patients is approximately 18.3%. These populations are pre-disposed to diabetic disorders due to several factors including limited knowledge, lack of access to resources, and cardiometabolic mechanisms (Detz et al., 2014). Since most of these patients are Limited English Proficiency (LEP) patients, they experience tremendous communication challenges as they seek for healthcare services for their diabetic conditions.

Communication between healthcare providers and LEP patients is significantly affected by language barriers even as family members are used as ad-hoc interpreters. This project sought to examine whether the use of bilingual interpreters help to improve adherence to treatment procedures and provider-patient communication among diabetic LEP patients. This project is significant to help determine the effectiveness of linguistic intervention in the administration of healthcare services.

Purpose Statement The purpose of this project was to examine whether the use of bilingual interpreters help to enhance medication compliance among LEP diabetic patients within a 3-month period. The project was conducted on the premise that the use of family members as ad hoc interpreters has proven ineffective in enhancing medication compliance among LEP diabetic patients. In this case, the project sought to determine whether using bilingual interpreters and language concordance would help improve treatment adherence among LEP diabetic patients.

The research also sought to establish whether using bilingual interpreters and language concordance reduce glycosylated hemoglobin A1c >9%. The project also sought to determine whether using bilingual interpreters would improve communication between providers and patients by an average of >10 points.

Therefore, the research question for this project is, “In Spanish speaking diabetic individuals (50-75 years old), would the use of a bilingual interpreter call during provider visits compared to utilizing family members as interpreters, improve medication adherence over a 3month period?” Data The project was conducted in an outpatient and community senior center that caters for elderly Hispanic patients suffering from diabetes.

In this regard, the researcher identified a Wellness Center in Los Angeles that provides primary care services to diverse diabetic patient populations, particularly elderly Hispanic patients who are not proficient in the English language. Population As shown in the previous segments, the target population for this project was elderly Hispanic patients aged between 50 and 75 years suffering from diabetic disorders. Generally, the Hispanic population is one of the fastest growing groups of people in the United States, particularly among America’s elderly population.

As the population continues to grow, they are faced with numerous challenges including health problems including diabetes. Elderly Hispanic immigrants and Mexican Americans are among patient populations facing relatively high rates of diabetes with prevalence rates that are estimated at 18.3%. One of the challenges faced by diabetic elderly Hispanic patients aged 50-75 years as they seek for healthcare services is communication problems since most of them are only eloquent in their native language.

Therefore, this patient population is disadvantaged due to language barriers that often necessitate the use of an interpreter in the healthcare delivery process. Sample To help complete the project and achieve its purpose, an appropriate representative sample was identified and included in the study. The researcher identified a sample of forty (40) elderly Hispanic patients with diabetes. These patients are currently suffering from diabetes and use family members as ad hoc interpreters to help overcome the language barriers they face in provider-patient communication.

Diabetic elderly Hispanic patients at the Wellness Center in Los Angeles were eligible for the project if they were between 50-75 years at the commencement of the project, were LEP patients, were continuously enrolled at the center, and used family members as ad hoc interpreters. The individuals were randomly selected and involved in the project voluntarily through signing an informed consent form to confirm participation. To determine generalizability of the research’s findings, the researcher utilized descriptive statistics for comparison of the overall department attributes as shown in Appendix 1.

Instrumentation The development or design of the data collection process for this study involved the use of a decision tree. Using the decision tree, the researcher started with defining the phenomenon of interest and research question, identifying the phenomena to be evaluated in order to answer the research question, and examining the availability of instruments to measure the phenomena (Bastos et al., 2014). Data Collection The data collection process commenced with seeking for approval from IRB chair and committee.

This was followed by participants’ recruitment, planning for project execution, and preparing the project setting. The next step in the data collection process entailed collecting demographic data from the sample. The researcher then administered a pre-test prior to the commencement of the 3-month project. The pre-test generated data relating to the status of provider-patient communication in the center, medication adherence, and impact of using family members as ad hoc interpreters on lessening language barriers.

The project was then executed for three months before demographic characteristics were analyzed and a post-test administered four weeks after the study. The researcher then examined pre-test and post-test scores, synthesized data, and created a final report of the study’s findings. Variables The dependent variable for this study is provider-patient communication while the independent variables are language-concordance and professional interpreters. Provider-patient communication is the dependent variable since the intervention being implemented is expected to have impacts on this variable.

On the other hand, professional/bilingual interpreters and language-concordance are the independent variables that will also act as the interventions. The study measures the impact with which professional interpreters and language-concordance affects provider-patient communication in terms of reduced language barriers. In this case, the independent variables will be deemed effective in enhancing provider-patient communication if the reduce the language barriers facing LEP patients when seeking for healthcare services. Project Design The research design used in conducting this study is a pre-test/post-test design to help answer the research question.

As previously indicated, the intervention utilized in the study is using professional interpreters and language-concordance as measures for improving provider-patient communication among LEP patients. Using this research design, the researcher administered a pre-test prior to the beginning of the 3-month period and a post-test four weeks after the project was completed. Results Statistical techniques were utilized to analyze pre-test and post-test scores obtained from the study sample. As shown in Table 1, majority of the study’s participants were females while the average age was 65 (SD = 15.45).

While more than 50% of the participants were married, at least 65% of them obtained some college education. 80% of these participants were born in Mexico while more than half of them had had diabetes for at least 5 years. Based on these statistics, the researcher found that gender is a nominal variable since more than half of the study’s participants i.e. 60% were females. On the other hand, age is an ordinal variable while marital status is a nominal variable since the average age of participants was 65 (SD = 15.45).

The researcher conducted descriptive analyses through chi square or t test statistics to examine the link between language discordance/concordance and the level of health education obtained by patients in relation to interpersonal care and diabetes self-management. Table 2 demonstrates the link between having language discordance and the extent of health education obtained by the patient. In comparison to language-concordant patients, language-discordant patients stated that they obtained less health education for diabetes self-management and medication adherence. However, this impact was lessened through having a professional or bilingual interpreter.

The use of a professional or bilingual interpreter during patient call visits implied that provider-patient language discordance or language barriers were no longer linked to less health education. Table 3 shows that there was a strong link between language concordance/discordance and interpersonal care practices adopted by the LEP patients in relation to medication adherence and diabetes self-management. In this regard, language-concordant patients had better interpersonal care in comparison to language-discordant patients.

The use of a professional or bilingual interpreter rather than family members as ad hoc interpreters did not significantly mitigate this effect. However, professional or bilingual interpreters helped to improve the quality of interpersonal care for these patients. Table 4 shows the association between having a professional interpreter and glycemic control (A1c >9%) among LEP patients. As evident in the table, language-discordant patients have poor glycemic control than language-concordant patients.

The use of a professional interpreter was found to have significant effects on enhancing LEP patients’ glycemic control (A1c>9%). This implies that the use of a professional or bilingual interpreter improved patients’ glycemic control in both unadjusted and adjusted models. Table 5 shows the association between using a professional/bilingual interpreter and provider-patient communication levels. After conducting a paired sample t test of pre-test and post-test scores obtained from the participants, the researcher found significant improvements in provider-patient interactions after the intervention.

In this case, using a professional/bilingual interpreter had substantive effects on provider-patient communication. Discussion Conclusions One of the key findings of this study is that using a professional or bilingual interpreter significantly improves provider-patient communication in the interactions between LEP patients and their providers. The impact was evident in the fact that paired-samples t-test comparing patient-provider communication scores before and after 3 months following the use of language-concordance and professional interpreters showed an average improvement of > 10 points.

This finding was consistent with existing literature that shows professional interpreters help to improve provider-patient communication among Limited English Proficiency (LEP) patients (Fernandez et al., 2011; Jacobs et al, 2006). Secondly, the study also found that the use of a professional interpreter is associated with improved glycemic control (A1c>9%) among diabetic LEP patients. The improvement in glycemic control is attributable to better interpersonal care and engagement in effective diabetes self-management practices.

This suggests that patients enhanced the medication adherence following the use of a professional interpreter in their interactions with healthcare providers. The improvements in interpersonal care and medication adherence is attributable to the fact that using a professional interpreter enhances health education for these patients (Detz et al., 2014; Ngo-Metzger et al., 2007). This implies that using a professional interpreter lessens language barriers between providers and their patients resulting in better communication and enhanced medication adherence/interpersonal care.

Limitations Despite providing significant insights regarding the association between using professional interpreters and provider-patient communication, there were.