'Families are Intimidated…Really Confused…Afraid': Healthcare Service Disparities for Spanish-Speaking Patients Witnessed by their Language Interpreters.

Abstract

Spanish-speaking individuals represent one of the fastest growing populations in the United States. Spanish-speaking patients with limited English proficiency (LEP) face a range of structural, cultural, and financial barriers within U.S. healthcare systems. Language barriers are closely linked to challenges in healthcare access and quality, contributing to persistent disparities in health outcomes. Medical interpreters serve as a critical link between Spanish-speaking patients and healthcare providers. This study uses a social determinant of health (SDoH) framework to examine medical interpreters' experiences, with a focus on identifying opportunities to improve care quality for Spanish-speaking patients. Twelve medical interpreters in the southwestern U.S. from a range of healthcare contexts were interviewed for this study. Virtual interviews were recorded and transcribed for qualitative analysis. A reflexive thematic analysis approach was used to analyze data in multiple rounds of collaborative coding to produce themes from participant narratives. Four interrelated themes emerged that were linked to patient experience, organizational practices, and health outcomes: (1) lack of prioritization of interpretation services; (2) rushed clinical interactions; (3) failure to center patient understanding; and (4) manifestation of bias at the system level. Findings highlight the need for healthcare system changes to improve care quality for Spanish-speaking patients. Improving the availability and integration of interpretation services, along with expanding time for interpreted encounters and strengthening collaboration between interpreters and providers, may enhance patient understanding and engagement. Policy and training efforts that support culturally responsive care and reimbursement for language services are also needed to address persistent disparities.