LEP patients perceived inferior care and described concrete harms when interpretation was inadequate or absent

Description #

Patients perceived their care as inferior when interpretation was inadequate, and recounted concrete harms attributed to absent interpretation — a misanswered depression screen, a man fainting after a cardiac stress test because he could not express feeling unwell, and medication/appointment miscommunications. These are patient-reported quality and safety harms linking language access to outcomes.

"Poor outcomes due to inadequate or absent interpretation included medical errors and misunderstandings ranging in severity… Another man had no interpreter present during a cardiac stress test. Unable to express that he felt unwell after the test, he fainted in the waiting room." (Brooks, 2016, p. 32)

"Many patients shared that they felt their care was inferior when there was not adequate interpretation." (Brooks, 2016, p. 32)

Methods Context #

What? #ⓘ

The observable: patient-reported perceptions of care quality and narrated adverse events/medical errors attributed to inadequate or absent interpretation.

"Results: LEP patients face significant challenges when accessing health care services due to inadequate or insufficient access to professional interpreters… Many participants felt they had received poorer quality care." (Brooks, 2016, p. 30)

How? #ⓘ

Four semi-structured Spanish-language focus groups; representative participant narratives of poor outcomes were identified through immersion/crystallization thematic coding by multiple investigators.

"One investigator (KB) read and analyzed the transcripts to identify themes and develop a thematic codebook." (Brooks, 2016, p. 31)

Who? #ⓘ

22 LEP Spanish-speaking adults in Providence County, Rhode Island; reports are patient perceptions and recollections, not chart-abstracted adverse-event data.

"The major strength of our study was that we sought the perspectives of LEP patients interacting with the healthcare system." (Brooks, 2016, p. 32)

Other Notes #

Patient-perceived quality and recalled harms (epistemic/mechanism), not adjudicated adverse-event rates — see the qualifying caveat on the qualitative, single-population design.

Caveats #

• Findings are single-site patient perceptions from Spanish-speaking focus groups; providers were not interviewed and outcomes were not measured The evidence is the perceptions of 22 Spanish-speaking LEP patients in a single county (Providence, Rhode Island), elicited in focus groups. Providers were not interviewed about why they did or did not use professional interpreters, and no clinical outcomes were measured — so claims of inferior care and provider overestimation of comprehension reflect one side of the encounter and may not generalize to other languages, regions, or to chart-adjudicated outcomes. The authors note saturation was reached but the optimal qualitative sample size is unknown.