Limited English proficiency is common and has major adverse impacts on health and health care. Even when interpreters are used, patients are often unaware of key aspects of their treatment plan, are reluctant to ask for more information, and are dissatisfied with care. Lay health advisors and other navigator-type interventions appear to be promising approaches to help overcome barriers to care. We hypothesize that combining the most potent features of interpreters and navigators will improve the outcomes of non-English speaking patients.
Our specific aims are A) To determine the informational needs of Spanish-speaking inner city patients with hypertension or kidney disease; B) To train interpreters to act as advocates for patients with hypertension or kidney disease; and C) To perform a randomized controlled trial to test the utility of using interpreters as advocates. We will first determine the informational needs of Spanish-speaking inner city patients with hypertension or kidney disease and then use this information to train interpreters to act as advocates. Next, we will conduct a randomized controlled trial involving 150 patients who receive help from a standard interpreter when they see their primary care physician and 150 patients who receive help from an interpreteradvocate. In addition to translating conversations (standard interpretation), interpreter-advocates will encourage patients and providers to discuss treatment details that have not been addressed as well as patients' goals and concerns. Primary outcomes wilt focus on patient and physician satisfaction and informational exchange while secondary outcomes will examine blood pressure control. The proposed project will test a novel intervention to help patients with limited English proficiency. Future work will involve learning how to make the intervention more potent, determining the impact of intervention on hypertension management and other clinical outcomes, extending the intervention for use with other medical conditions, and determining the cost-effectiveness of interpreter-advocates.
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