Navigating Language Barriers in Health Care for Older Hispanic Immigrants: A Qualitative Exploration

Background and Purpose: Older Hispanic immigrants are a rapidly growing population who live longer than U.S.-born older adults but reach later life with more significant functional limitations and complex health care needs. Evidence suggests that language barriers in health care–associated with adverse health outcomes and decreased satisfaction among patients with limited English proficiency–may be particularly salient for this population. Given recent evidence that the availability of Spanish-language health services in the U.S. is declining, finding additional strategies to mitigate language barriers and improve service delivery among this underserved population is critical. This study qualitatively explores how older Hispanic immigrants and their providers navigate language barriers in health care settings.

Methods: We conducted semi-structured, in-depth interviews with 172 older Hispanic immigrants. We recruited participants who resided in Florida (n=78) or Massachusetts (n=94) via community-serving organizations. Interviews were conducted in Spanish, virtually and in person, between September 2020 and May 2022. To reflect the population’s diversity, we included participants from the six Latin American countries with the largest populations in the U.S.: Cuba, the Dominican Republic, El Salvador, Mexico, Puerto Rico, and Venezuela. Guided by grounded theory principles, we first developed codes inductively until the team agreed on the coding scheme. Then, we conducted two rounds of coding using index, analytic, and attribute codes. Lastly, we collapsed emergent codes into themes.

Results: We identified three themes from the data. 1) Speaking Spanish was not sufficient for effective communication. Participants and their providers communicated most effectively within the context of a positive relationship marked by responsiveness to patient needs and a sense of genuine caring. 2) Speaking Spanish was not necessary for effective communication. The provider’s tone and body language, regardless of the language they spoke, helped minimize language barriers’ adverse effects. 3) Speaking English was not necessary for effective communication. Participants used many different communication techniques, including written signs, fostering relationships with bilingual staff members, and enlisting Spanish-speaking bystanders’ help.

Conclusions and Implications: While language concordance was helpful, it was neither sufficient nor necessary for effective communication among older Hispanic immigrants. Participants used creative strategies to convey their needs, and providers used many strategies to convey their care for participants. Developing a strong patient-provider relationship appears critical to overcoming language barriers. Results support developing specific competencies for working with older Hispanic immigrants rather than relying exclusively on language skills. Competencies to enhance the patient-provider relationship can communication more effective regardless of the provider’s language abilities.