Language Concordance and Interpreter Use in Primary Care: Perspectives from Spanish-preferring Patients

Healthcare provided by bilingual providers or with assistance from qualified interpreters is intended to improve patient-provider communication. Despite federal laws requiring healthcare facilities to provide access to appropriate interpretation language assistance services for patients not proficient in English, many Spanish-preferring patients receive primary care from providers not fluent in Spanish or who regularly use formal interpreters. Partnering with two urban SafetyNet providers in Southern California, we conducted focus groups in Spanish with Spanish-preferring patients who received care from providers who: (1) were Spanish-qualified, (2) used formal interpreters, and (3) used informal interpreters or other communication strategies. We coded transcripts to identify themes and compared patient experiences across provider types. Our study included 62 adult Spanish-preferring primary care patients. Spanish-preferring patients reported preference for continuity with their English-speaking providers despite language barriers because of established rapport. Patients receiving care from Spanish-language-qualified providers reported greater trust, more comprehensive care (i.e., covered more issues with minimal detail), yet with many interactions rushed. Formal interpreters facilitated better understanding and professional communication, however, impersonalized some patient-provider interactions. Informal interpreters or ad-hoc strategies led to mixed experiences, often dependent on patient or provider ability to accurately convey medical information. Overall, Spanish-preferring patient experiences highlighted the necessity for healthcare systems to support robust language and interpretation services that enhance direct communication, ensure interpreter quality, and maintain long-term patient-provider relationships. Improvements in policy and practice are needed to optimize healthcare communication for Spanish-preferring patients, since patient-provider communication is critical for high-quality health outcomes and experiences in multilingual settings.