Everyday in the US, thousands among the 22+ million people with limited-English proficiency (LEP) have a medical visit. Federal law requires that LEP patients receive free language assistance services (e.g., interpreting) to prevent unequal care due to language barriers. However, poor language assistance for LEP patients is correlated with poor medical access, utilization, and outcomes. Because most medical providers do not speak all the foreign languages of their patients, interpreting is the most frequent type of language assistance. Today, the quality of medical interpreting is not assured, regulated, or otherwise monitored by any recognized authority. The interpreter could vary from a trained professional to the patient's own young child. Consequently, the probability of safe, quality care is uncertain for LEP patients during an interpreted-medical visit. Borrowing from an airline industry approach and social learning theory, this Phase I project will examine the effects of a prototype brief safety video to help LEP patients prevent and address common errors and dangers during interpreted-medical visits. Latino LEP patients are the focus of this Phase I due to the high and rapidly increasing representation in the US population. The video content will build on lessons from our prior projects to train and assess interpreting and cultural competency in healthcare, findings from the published literature, and from practice standards proposed by State and National interpreting associations. A small, randomized control study will be used to examine the differential effects of the video on patient knowledge and behaviors for a safer interpreted-medical visit. Two groups of 20 LEP Latinos with Type II diabetes will be randomized to a control or an intervention mock medical visit. One family medicine physician and one professional interpreter with prior experience in language access training will be trained to perform a standardized Type II diabetes follow-up visit with LEP participants. Mock visits will be designed to expose LEP participants to common interpreting challenges that lead to errors and unsafe care during interpreted-medical visits. Primary dependent variables will be patient actions to Planned and Unplanned Intepreting Challenges in the mock visit. Visits will be digitally video recorded with consent. Measurements will include systematic observations of the video content and a post-visit patient interview. Systematic documentation throughout development and pilot testing will assess factors related to video quality, feasibility of project implementation, and participant preferences. The degree of success in this project will determine a subsequent Phase I for significant refinements to the video approach or a Phase II project to rigorously examine the video in applied settings for commercialization. This work will assist healthcare organizations to improve patient safety, quality of care, and medical outcomes for LEP patients.
Substantial research in health disparities indicates that medical errors and unsafe care are higher among limited-English proficient people (now more than 22 million in the US). Despite federal, state and professional mandates requiring healthcare organizations to offer LEP patient language assistance and interpreting, the unmonitored and informal nature of current medical interpreting continues to lead to uncertain and unsafe patient care. This 6-month project will develop and pilot a prototype 4- to 5-minute patient safety video to help LEP patients identify, prevent, and address interpreting challenges so as to communicate accurately with their provider and ensure safe care.
