Linguistic and cultural barriers to care
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
CONTEXT: Primarily because of immigration, Asian Americans are one of the fastest growing and most ethnically diverse minority groups in the United States. However, little is known about their perspectives on health care quality.
OBJECTIVE: To examine factors contributing to quality of care from the perspective of Chinese- and Vietnamese-American patients with limited English language skills.
DESIGN: Qualitative study using focus groups and content analysis to determine domains of quality of care.
SETTING: Four community health centers in Massachusetts.
PARTICIPANTS: A total of 122 Chinese- and Vietnamese-American patients were interviewed in focus groups by bilingual interviewers using a standardized, translated moderator guide.
MAIN OUTCOME MEASURES: Domains of quality of care mentioned by patients in verbatim transcripts.
RESULTS: In addition to dimensions of health care quality commonly expressed by Caucasian, English-speaking patients in the United States, Chinese- and Vietnamese-American patients with limited English proficiency wanted to discuss the use of non-Western medical practices with their providers, but encountered significant barriers. They viewed providers’ knowledge, inquiry, and nonjudgmental acceptance of traditional Asian medical beliefs and practices as part of quality care. Patients also considered the quality of interpreter services to be very important. They preferred using professional interpreters rather than family members, and preferred gender-concordant translators. Furthermore, they expressed the need for help in navigating health care systems and obtaining support services.
CONCLUSIONS: Cultural and linguistically appropriate health care services may lead to improved health care quality for Asian-American patients who have limited English language skills. Important aspects of quality include providers’ respect for traditional health beliefs and practices, access to professional interpreters, and assistance in obtaining social services.
- United States Bureau of the Census. Statistical Abstracts of the United States. Washington, DC: U.S. Government Printing Office; 1995:19.
- Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271:690–4. CrossRef
- Morales LS, Elliott MN, Weech-Maldonado R, Spritzer KL, Hays RD. Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0. Health Serv Res. 2001;36:595–617.
- Snyder RE, Cunningham W, Nakazono TT, Hays RD. Access to medical care reported by Asians and Pacific Islanders in a west coast physician group association. Med Care Res Rev. 2000;57:196–215.
- Meredith LS, Siu AL. Variation and quality of self-report health data: Asians and Pacific Islanders compared with other ethnic groups. Med Care. 1995;33:1120–31. CrossRef
- Taira DA, Safran DG, Seto TB, et al. Asian-American patient ratings of physician primary care performance. J Gen Intern Med. 1997;12:237–42. CrossRef
- Murray-Garcia JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300–10. CrossRef
- Frayne SM, Burns RB, Hardt EJ, Rosen AK, Moskowitz MA. The exclusion of non-English-speaking persons from research. J Gen Intern Med. 1996;11:39–43. CrossRef
- Watanabe P, Jennings J, Melendez E, et al. A Dream Deferred: Changing Demographics, Challenges and New Opportunities for Boston. Boston, Mass: Institute for Asian American Studies, University of Massachusetts Boston; 1996.
- Chung RCC, Singer MK. Predictors of psychological distress among Southeast Asian refugees. Soc Sci Med. 1993;36:631–9. CrossRef
- Mollica RF, McInnes K, Pham T, Fawzi MCS, Murphy E, Lin L. The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. J Nerv Ment Dis. 1998;186:543–53. CrossRef
- Office of Refugees and Immigrant Health. Refugees and Immigrants in Massachusetts: An Overview of Selected Communities. Boston, Mass: Bureau of Family and Community Health and Massachusetts Department of Public Health; 1997.
- Hayes TJ, Tatham CB. Focus Group Interviews: A Reader, 2nd Ed. Chicago, Ill: American Marketing Association; 1989.
- Hisrich RD, Peters MP. Focus groups: an innovative marketing research technique. In: Focus Group Interviews: A Reader. 2nd Ed. Chicago, Ill: American Marketing Association; 1989:77–90.
- Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Aff (Millwood). 1991;10:254–67. CrossRef
- Cleary PD, Edgman-Levitan S, McMullen W, Delbanco TL. The relationship between reported problems and patient summary evaluations of hospital care. QRB Qual. Rev. Bull. 1992;18:53–9.
- Edgman-Levitan S, Cleary PD. What information do consumers want and need? Health Aff (Millwood). 1996;15:42–56. CrossRef
- Consumer Assessment of Health Plans (CAHPS). Fact Sheet. AHRQ Publication No. 00-PO47, April 2000. Rockville, Md: Agency for Healthcare Research and Policy. http://www.ahrq.gov/qual/cahpfact.htm. Accessed August 7, 2002.
- Brown JA, Nederend SE, Hays RD, Short PF, Farley DO. Special issues in assessing care of Medicaid recipients. Med Care. 1999;37:MS79–88. CrossRef
- Weidmer B, Brown J, Garcia L. Translating the CAHPS 1.0 survey instruments into Spanish. Med Care. 1999;37:MS89–96. CrossRef
- Glaser B, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine; 1967.
- Strauss A, Corbin J. Grounded theory methodology, an overview. In: Handbook of Qualitative Research. Denzin N, Lincoln Y, eds. Thousand Oaks, Calif: Sage; 1994:273–85.
- Trotter RT II. Folk medicine in the Southwest: myths and medical factors. Postgrad Med. 1985;78:167–79.
- McPhee SJ. Caring for a 70-year-old Vietnamese woman. JAMA. 2002;287:495–504. CrossRef
- Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275:783–8. CrossRef
- Weech-Maldonado R, Weidmer BO, Morales LS, Hays RD. Cross-cultural adaptation of survey instruments: the CAHPS experience. In: Cynamon M, Kulka R, eds. Seventh Conference on Health Survey Research Methods, Williamsburg, Va, September 24–27, 1999. Rockville, Md: Department of Health and Human Services; 2001:75–82.
- Kuo D, Fagan MJ. Satisfaction with methods of Spanish interpretation in an ambulatory care clinic. J Gen Intern Med. 1999;14:547–50. CrossRef
- Philipp BL, Wilson C, Kastner B, Pearson C, Bauchner H. A comparison of suburban and urban daytime telephone triage calls. Pediatrics. 2000;106:231–3. CrossRef
- Ngo-Metzger Q, Massagli MP, Manocchia M, et al. Patient-centered quality measures for Asian-Americans: Research in progress. Am J Med Qual. 2000;15:167–73. CrossRef
- Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic and social characteristics: the longitudinal mortality study. Am J Public Health. 1995;85:949–56.
- Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993;88:1973–98.
- Feinstein JS. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993;71:279–322. CrossRef
- Krieger N. Is breast cancer a disease of affluence, poverty, or both? The case of African American women. Am J Public Health. 2002;92:611–3. CrossRef
- Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.
- Riddick S. Improving access for limited English-speaking consumers: a review of strategies in health care settings. JHCPU. 1998;9:S40–61.
- Putsch RW. Cross-cultural communication: the special case of interpreters in health care. JAMA. 1996;254:3344–8. CrossRef
- Rivadeneyra R, Elderkin-Thompson V, Silver RC, Waitzkin H. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000;108:470–4. CrossRef
- Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG. Language barriers in medicine in the United States. JAMA. 1995;273:724–8. CrossRef
- Youdelman M, Perkins J. Providing Language Interpretation Services in Health Care Setting: Examples from the Field. New York, NY: The Commonwealth Fund, 2002.
- Putsch RW, Joyce M. Dealing with patients from other cultures. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods, 3rd Ed. Boston: Butterworths; 1990:1050–65.
- Linguistic and cultural barriers to care
Journal of General Internal Medicine
Volume 18, Issue 1 , pp 44-52
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Asian Americans
- health care access
- language barriers
- indigent care
- community health centers
- Industry Sectors
- Author Affiliations
- 1. the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Mass
- 2. Cambridge, Mass.
- 3. the Center for Survey Research, University of Massachusetts, Boston, Mass
- 4. the Department of Sociology, University of Rhode Island, Kingston, RI