Walking the talk: understanding how language barriers affect the delivery of rehabilitation services

Individuals who lack proficiency in the dominant language of their region experience difficulty accessing healthcare and exhibit poorer health outcomes. Utilization of professional interpreters can improve health services and outcomes for this population. Most existing studies focus on medical settings, with very little research about language barriers in rehabilitation services such as occupational and physical therapy. The purpose of this study was to explore experiences of English-speaking rehabilitation clinicians working with limited English proficient (LEP) patients, as well as LEP patients receiving rehabilitation services.

A qualitative study was conducted involving four focus groups with seven Spanish-speaking patients and 13 primarily English-speaking occupational and physical therapy clinicians. Transcripts and field notes were analyzed using directed content analysis.

Time and resource constraints, session demands, environmental factors, previous experiences, and patient characteristics influenced clinicians' decisions about whether to use professional interpretation, rely on untrained interpreters, or go without interpretation. Clinicians discussed both challenges and joys of working across language barriers. Patients reported minimal experiences with, and expectations of professional interpretation in rehabilitation, instead describing clinicians' attempts to "get by" with limited non-English language skills.

Findings highlight unique considerations for language access in rehabilitation compared with other settings. These findings inform structural, process, and outcomes recommendations and changes in practice guidelines to improve language access in rehabilitation services.Implications for RehabilitationRehabilitation encounters present unique challenges for language interpretation services that require creative technological, procedural, and structural solutions.Technological solutions include flexible and mobile telecommunication devices, such as headsets, which allow real-time interpreting without interfering with treatment processes.Procedural solutions include establishing a systematic mechanism for recording patients' language needs, creating a standard and seamless protocol for clinicians to obtain language supports, and hiring trained interpreters who are familiar with rehabilitation jargon.Structural solutions include budgeting for interpreter services, sponsoring trainings for staff and clinicians, and adjusting clinicians' workload and expectations to allow greater time and flexibility to meet patients' language needs.