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Survey shows language barriers cause many Spanish-speaking Latinos to skip care

Research identifies need to develop cost-effective models for translation services

December 12, 2001, Washington, DC - One-fifth of Spanish-speaking Latinos living in communities with fast-growing Latino populations report not seeking medical treatment due to language barriers, according to a new survey released by the Robert Wood Johnson Foundation (RWJF). The survey found both patients and providers agree that language barriers significantly compromise health care quality.

"We think language barriers are a significant contributor to the racial and ethnic disparities that exist in treatment and outcomes," said Risa Lavizzo-Mourey, MD, MBA, senior vice president and director of RWJF's health care group. "Our nation will only get more racially and ethnically diverse in the coming years. We need to start trying to solve this
problem now."

The survey, conducted by Wirthlin Worldwide, was designed to assess the impact of language barriers on accessing and delivering care quality in communities that have seen fast growth in their Latino populations. According to the U.S. Census Bureau, the nation's Latino population grew 57.9 percent from 1990 to 2000--from 22.3 million to 35.3 million. Now about 12.5 percent of the total U.S. population, Latinos are projected to comprise 25 percent of the total population by the year 2050.

Patients who experience language barriers are a growing population. The Census reports that 28 million Latinos in the U.S. over the age of five speak Spanish at home and estimates that 14 million Latinos speak English less than "very well."

"Many of these high-growth areas historically have not had large, well-established Latino populations," said Lavizzo-Mourey. "The health care systems in states such as North Carolina, Arkansas, Georgia, Tennessee and Alabama are now faced with infrastructure challenges in addressing the health care needs of this surging population."

Both patients and providers feel that language barriers present immense obstacles to achieving positive health outcomes, the survey found. According to patients, language barriers make it much harder to fully explain symptoms/ask questions and to follow through with filling prescriptions. Language barriers also make them less likely to trust that their physician understands their medical needs.

Ninety-four percent of providers say communication is a top priority in delivering quality care, and they cite language barriers as a major challenge to delivering that care. Seventy-three percent of providers say the aspect of care most compromised by language barriers is a patient's understanding of treatment advice and of their disease; 72 percent say that barriers can increase the risk of complications when the provider is unaware of other treatments being used; and 71 percent say barriers make it harder for patients to explain their symptoms and concerns.

The research found that when translation help is offered, it is often makeshift. Fifty-one percent of the providers surveyed say that when they need interpretive services, they often enlist help from staff who speak Spanish, including clerical and maintenance staff. Another 29 percent say they rely on patients to bring in family members or friends who can translate for them.

Patients say makeshift translation practices, like using family members or untrained staff, often leave them feeling embarrassed, that their privacy has been compromised and that the translators have omitted information. They also say these concerns cause them not to talk about personal issues when interpreters are present.

"Medical translation is complicated and subtle," said Yolanda Partida, MSW, DPA, program director of Hablamos Juntos: Improving Patient-Provider Communications for Latinos, a new, $18.5-million national initiative of the Robert Wood Johnson Foundation. "The fact that nearly two-thirds of the patients in this survey have concerns about using interpreters indicates that these makeshift approaches are not working."

Hablamos Juntos-We Speak Together-is aimed at developing and validating effective and affordable models using trained translation services to help providers overcome language barriers. "The solutions to these problems are not clear," Partida said. "We are at an early stage in our understanding of how best to provide and pay for interpretation services."

Hablamos Juntos, housed at the Tomás Rivera Policy Institute, Claremont Graduate University, Claremont, CA, will provide grants of up to $1 million to as many as 10 health care provider organizations in communities or catchment areas with new and fast-growing Latino populations. To be eligible for the program, applicants must serve a community, city, county or catchment area that has a minimum Latino population of 10,000 in 2000 and has experienced at least a 50 percent growth in Latino population from 1990 to 2000.

The program is open to provider organizations such as physician groups, community health centers, hospitals, state Medicaid agencies, health plans/managed care plans, local health authorities or health profession organizations, or a consortium of these organizations.

"Hablamos Juntos is a starting point," said Lavizzo-Mourey. "We chose to focus on Spanish because of the size and growth of the Spanish-speaking population in the U.S. But we hope that what we learn through this program will help patients and providers who encounter barriers from other languages."

For more information on the Hablamos Juntos program, visit the initiative's website at www.hablamosjuntos.org.

Methodology
Wirthlin Worldwide is a global marketing and opinion research and consulting firm headquartered in McLean, Virginia.

During the months of October and November, Wirthlin Worldwide conducted telephone surveys among health care providers and Spanish-speaking Latino adults. Interviews were conducted across geographic areas in the United States where Latinos comprise over five percent of the general population and have experienced growth over 75 percent between 1990 and 2000.

Interviews were conducted with 1,001 health care providers (comprised of physicians, nurses, hospital executives and pharmacists) who indicated that at least five percent of their patient base was primarily Spanish speaking. In addition, interviews were conducted in Spanish with 500 Spanish Speaking Latino adults.

the Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to basic health care at reasonable cost; to improve care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse -- tobacco, alcohol, and illicit drugs.

A webcast and transcript of this press conference can be found on kaisernetwork.org at http://www.kaisernetwork.org/healthcast/rwj/12dec01.