How Cultural, Language Barriers Impact Positive Patient Experience

Cultural and language barriers keep patients and providers from building strong relationships, posing considerable obstacles to a positive patient experience, according to research published in the Journal of Medical Internet Research.

In a changing healthcare landscape that emphasizes value, healthcare professionals are working to pinpoint the factors that constitute a positive experience for patients. These insights are especially important for community health centers (CHCs) that are transitioning to patient-centered medical home (PCMH) status.

Researchers from a safety net clinic in Northern California sought to understand how it could revamp its programs to meet patient needs during its PCMH transition. Through qualitative interviews of 19 patients speaking one of three languages – English, Spanish, and Mien – the researchers identified key trends that both build up and detract from the patient experience.

Patients across all language proficiencies valued positive interactions with their providers. Confidence in one’s doctor, good staff- and provider-patient relationships, and active listening skills are all essential for rapport-building.

But when it came to care barriers, there were some issues Spanish- and Mien-speaking patients had to handle that English-speakers did not.

The CHC experience was generally difficult to navigate and clunkier for patients who did not report English language proficiency, the researchers found.

“For the Spanish-speaking and Mien-speaking patients, speaking a language other than English added another layer of complexity and difficulty regarding basic interaction with doctors and staff, as well as interaction with residents specifically,” the team reported. “Patients described a general concern as to whether doctors and patients fully understood each other when having to work through an interpreter.”

Additionally, patient-provider communication was strained when patients and doctors did not speak the same language. Patient trust fell by the wayside, and providers struggled to elicit patient activation.

The two patient populations did recognize efforts from providers who did not speak the same language. Providers who emphasized tone, used non-verbal cues, or attempted to speak the patient’s language were viewed favorably by Mien- and Spanish-speaking patients.

Both Mien- and Spanish-speaking patients said that interpreters made the care encounter easier to navigate, and Spanish-speakers specifically stated that in-person interpreters were preferable.

But interpreters were not always ideal, the patient respondents added. Utilizing an interpreter often felt impersonal and made the care encounter take longer.

There were some CHC characteristics that all patients – even English-speaking patients – believed detracted from the patient experience.

All 19 patients reported that providers who did not know patient health histories, asked repetitive questions, or ordered duplicate tests, were viewed less favorably. Additionally, poor communication or care coordination detracted from the patient experience, the interview population said.

Patients also stated that receiving most of their care from a resident physician diminished the patient experience. Patients said they felt as though they were not being treated by “real” doctors, and did not always understand why their doctors were leaving the practice so consistently. Resident physicians took away from patient-provider relationships.

These gripes point to more organizational problems, rather than barriers caused by cultural differences. Ultimately, it is those cultural barriers that have a greater impact, particularly in the CHC setting, the researchers suggested.

“CHC encompasses the various skills, cultural understandings, and attitudes that allow a patient to satisfactorily navigate the health care system and patient-provider interactions,” the researchers said. “Through the lens of CHC, lacking such competencies creates and perpetuates inequities within a health care setting.”

These cultural barriers also prevent true patient activation and engagement, two of the fundamental goals in a PCMH model.

“Not speaking English also hindered self-efficacy related to engaging with the registration staff to understand the delay being experienced by the patient’s mother,” the team concluded. “This touches on another component of CHC—having ‘an enterprising disposition and a proactive stance toward health’ and one’s care.”