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