In-person Interpreters Research Articles

Development and Initial Validation of the Refugee Health Literacy Assessment Tool (RHLAT)

ABSTRACT Background Culturally and linguistically diverse (CALD) refugees and immigrants in the United States (U.S.) face barriers to accessing health care, and are more likely to have worse health outcomes as it relates to chronic disease. Better understanding health literacy for this population can identify gaps in knowledge, facilitate health education, and improve health outcomes. Purpose The Refugee Health Literacy Assessment Tool (RHLAT) was developed to improve patient-centered chronic disease management by identifying aspects of health literacy for which individual refugees require additional support. Methods RHLAT development involved domain identification, item development, expert reviews, and cognitive interviews. Refugee and immigrant patients with uncontrolled diabetes and cardiovascular risk factors were engaged for RHLAT implementation. Results The tool was valid across different types of interpretation, such as in-person interpreter or over the phone, and revealed a wide range of health literacy in this population. Discussion The RHLAT was developed and tested with a CALD refugee population. The tool revealed gaps in health literacy that could be addressed by the care team. Translation to Health Education Practice: This study provides a tool that can be used in practice to identify areas for additional health education to assist CALD patients in navigating the U.S. healthcare system.

Social and Cultural Challenges in Caring for Latinx Individuals With Kidney Failure in Urban Settings

Latinx individuals with end-stage kidney disease (ESKD) constitute 19% of US patients receiving in-center scheduled hemodialysis. Compared with non-Latinx White patients, Latinx individuals often face poor economic, environmental, and living circumstances. The challenges for health care professionals engendered by these circumstances when Latinx individuals present with ESKD and possible solutions have not been well described. To examine the perceptions of interdisciplinary health care professionals who work in dialysis centers in urban settings with large racial and ethnic minority populations about how social challenges affect the care of Latinx patients with ESKD. This qualitative study administered semistructured interviews of interdisciplinary health care professionals at 4 urban dialysis centers in Denver, Colorado, from April 1 to June 30, 2019. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Themes and subthemes of barriers to care. Thirty interdisciplinary dialysis center health care professionals (23 [77%] female; mean [SD] age, 42.0 [11.6] years) participated. Four themes were identified. The first 3 themes and their respective subthemes (in parentheses) describe challenges to kidney care: compromised quality of care attributable to communication and cultural barriers (language interpretation by telephone, in-person language interpretation, burden of ad hoc interpretation, low-quality health care, lack of language- and culturally concordant materials, and health literacy levels), difficulty with health care access (unreliable transportation, economic instability, and loss of insurance benefits), and concerns about patient psychosocial well-being (social isolation, hopelessness, stigma of illness, and balancing personal social challenges). The fourth theme describes solutions to improve care (culturally responsive care, patient empowerment and activation, supporting primary caregivers, and peer support with navigation of the health care system). This study's findings suggest that dialysis center policies are needed that require high-quality language interpretation and the availability of culturally concordant educational materials. Community-based interventions that improve patient activation and provide peer support as well as culturally responsive care may improve the care of Latinx patients with ESKD receiving in-center scheduled hemodialysis.

The Parent's Perspective: A Focus Group Study on Spanish Interpreter Services for Hospitalized Children

BackgroundThe US Census confirms a rise in Spanish-speakers, many of whom have limited English proficiency (LEP) and require interpreters. Parent perceptions of interpreter services throughout hospitalization are unknown. ObjectiveTo explore Spanish-speaking LEP parents’ views regarding roles of interpreters and providers (attending, resident, or nurse) during a hospital encounter, optimal modalities of interpretation, and barriers to services. MethodsSpanish-speaking LEP parents of children discharged from the hospital medicine service participated in focus groups. Sessions were audio-recorded and transcribed in Spanish, translated into English, and verified for translation accuracy. Qualitative methods were used for thematic analysis. ResultsFour sessions (n = 23 participants representing 15 families) were held. Parents felt the interpreter's primary role was to act as a conduit for word-for-word interpretation. They desired kind and trustworthy interpreters with medical knowledge. They saw providers as leaders of the encounter who should allot enough time for interpretation, not use Spanish unless they were fluent, and give frequent medical updates. In-person interpreters were preferred over telephone and video for their ability to convey body language and build relationships. Barriers to requesting interpreters included embarrassment and inability to directly request services, which resulted in using family members as interpreters. On family-centered rounds, parents preferred professional interpreters over bilingual providers. ConclusionsModifications are required to improve interpreter services to meet the needs of LEP families. Parents emphasized in-person interpreters’ social skills, frequent provider updates, and additional navigation support as essential components of effective care. Next steps include implementing guidelines and interventions to optimize interpreter services.

Caregiver-Perceived Facilitators and Barriers to Oral Iron Therapy in Young Children with Iron Deficiency Anemia

BackgroundIn the U.S., 2 to 3% of children age 1 to 3 years are affected by nutritional iron deficiency anemia (IDA). Children of Hispanic/Latino ethnicity are disproportionately affected and have rates approximately double that of other racial and ethnic groups. IDA is associated with inferior neurodevelopmental outcomes, poorer executive functioning, and decreased visual and auditory processing time. Treatment with oral iron mitigates against the consequences of IDA. Non-adherence to oral iron often results in treatment failure, and incomplete therapy prolongs the extent of IDA consequences. We aim to characterize barriers to and facilitators of oral iron therapy in young children with nutritional IDA.MethodsInfants and children aged 9 months to 4 years (all racial and ethnic groups) with nutritional IDA (assessed by history and laboratory criteria) and treated with oral iron therapy in the outpatient hematology clinic at a large US tertiary care pediatric hospital are identified. English or Spanish-speaking caregivers of identified children are invited to participate with the goal of conducting half the interviews in each language. In person audio-recorded semi-structured interviews are conducted by a research coordinator trained in qualitative methods using an IDA interview guide developed by a multidisciplinary research team. The guide is divided into 6 broad categories: diagnosis, consequences, experience with oral iron therapy (barriers to and facilitators of adherence), motivation, and alternate treatment options. For Spanish-speaking caregivers, an in-person Spanish interpreter assists with the interview.Verbatim transcripts are reviewed manually by 2 members of the research team to perform thematic analysis and identify common patterns in responses. Interviews and qualitative analysis will continue until thematic saturation is achieved (i.e. no new themes emerge from subsequent interviews). Clinical data, including laboratory values and treatment regimen, are abstracted from the patient's electronic medical record. Here we present findings from the initial six months of the study (February to July 2017).ResultsNine caregivers to date have been approached, and all enrolled. Patients had a mean age of 20 months (range 12 to 32 months); 5 (55%) were male. Nine caregiver interviews were completed; six in English and three in Spanish. All caregivers self-identified as White and Hispanic/Latino. Median hemoglobin concentration at patients' first visit within the hematology clinic was 8.6 g/dL (range 5.4 to 10.4 g/dL). Median duration of oral iron therapy at the time of interview was 4 months (range 2 to 10 months).Caregivers expressed a range of emotions that included fear and anxiety at time of diagnosis and optimism with treatment resolution. Many stated desire to have received information on risk factors and prevention of iron deficiency prior to their child's development of IDA. Regarding the diagnosis of IDA, most caregivers had a basic understanding of the condition, though some misinformation was present. Widely variable consequences of IDA were described, which included: changes in skin color, decreased energy, and potential for more severe disease if undetected. Negative traits of iron therapy, specifically poor taste and difficulty in getting child to take the medication, were barriers. Transition to better tasting formulations overcame these barriers for some families. When presented with information on intravenous iron therapy, most caregivers demonstrated willingness for their child to receive it if oral iron failed. Most caregivers deferred treatment-related decision-making to the recommendation of the physician.ConclusionCaregiver-perceived barriers to oral iron adherence were poor taste and difficulty in getting the child to take the medication. Knowledge regarding the diagnosis of IDA was not a consistent barrier as most caregivers reported a basic understanding of the condition. Specific caregiver-identified motivating factors and facilitators to oral iron adherence have not yet been elucidated. Additional, more targeted qualitative interviews with caregivers will be performed to elicit such information. These results will inform future patient-centered interventions aimed at promoting treatment in children with IDA. DisclosuresNo relevant conflicts of interest to declare.

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care

The active role of interpreters in medical discourse – An observational study in emergency medicine

ObjectiveTo study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters. MethodsEnglish proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper. Key themes and differences across interpreter types were established through qualitative analysis. Themes and differences across interpreter type were vetted and updated through member checking interviews. Results6 English proficient and 9 limited English proficient patients were observed. Key themes in communicative tasks included: establishing, maintaining, updating, and repairing understanding and rapport. All tasks were observed with English proficient and limited English proficient patients. The difference with limited English proficient patients was that medical interpreters played an active role in completing communicative tasks. Telephone-based interpreters faced challenges in facilitating communicative tasks based on thematic comparisons with in-person interpreters, including issues hearing and lost information due to the lack of visual cues. ConclusionsProfessional interpreters play an important role in communication between language discordant patients and health professionals that goes beyond verbatim translation. Practical implicationsTraining for interpreters and health professionals, and the design of tools for facilitating language discordant communication, should consider the role of interpreters beyond verbatim translation.

Healthcare Provider Perspectives Regarding Use of Medical Interpreters During End-of-Life Conversations With Limited English Proficient Patients.

Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations. To elicit healthcare providers' opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families. Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center. A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as "standard of care" during EOL and GOC conversations. Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.

Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients.

To evaluate whether language of choice affects compliance with speech therapy for voice disorders. Retrospective chart review. A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance. Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P=.0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance. This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance. IV Laryngoscope, 131:E2298-E2302, 2021.

Patient Perspectives on the Quality of Professional Interpretation: Results from LASI Study

BackgroundThe use of professional interpretation is associated with improvements in overall healthcare of patients with limited English proficiency (LEP). For these patients, it is important to understand whether quality of professional interpretation in-person is preserved using remote interpretation modalities (video-conferencing, telephone).ObjectiveTo compare patient perceptions of professional interpretation quality delivered in-person, via video-conferencing, or via telephone during in-person primary care clinical visits.DesignSecondary analysis of a telephone survey conducted within 1 week after a primary care visitParticipantsThe 326 Chinese and Latino survey participants with LEP who reported using a professional interpreter—in-person, video medical conferencing (VMI), or telephone—during their visitMain MeasuresSix items about the quality of interpretation: five detailed items scored as a scale, and a sixth overall quality item (range 1 = poor to 5 = excellent)Key ResultsWhile there was a range for all modalities, most patients reported “very good” or “excellent” quality on both the scale and the overall single quality measure. In adjusted analysis, patients rated VMI quality the highest, followed by in-person and then telephone on both the 5-item scale (adjusted means: VMI 3.91, in-person 3.86, telephone 3.73) and the overall single quality item (adjusted means: VMI 3.94, in-person 3.85, telephone 3.83); however, no two-way comparisons were statistically significant (p values ranged 0.15–0.95).ConclusionsOur results highlight that, overall, the interpretation experience among patients who used any type of professional interpretation was positive, and that the quality found with in-person interpretation is preserved for remote modalities. Health systems should consider a multimodality approach to interpreter service provision including options for accessing professional interpreters via all three modalities based on communication and access needs.

Mask Up: Academic-Community-Government Partnerships to Advance Public Health During COVID-19.

Mask Up: Academic-Community-Government Partnerships to Advance Public Health During COVID-19.

Assessment of Interpretation Modality and Patient Comprehension in Spanish-speaking Limited English Proficiency (LEP) Patients Presenting to the Emergency Department.

Provider-patient language discrepancies with limited English proficiency (LEP) patients can lead to misunderstandings about diagnoses and follow-up care. To assess interpretation modalities used in the emergency department (ED) in terms of patient satisfaction and understanding of discharge diagnosis. Spanish-speaking LEP patients completed a survey assessing overall satisfaction and discharge diagnosis comprehension. Modalities included in-person (interpreter or physician/nurse), remote (phone or video), or combination. Differences in proportions with correctly identified diagnoses were compared by modality using Fisher's exact test. Patients preferred a Spanish-speaking staff member (52%) or in-person interpreter (33%) over other modalities. Almost 74% of surveyed patients accurately described their discharge diagnosis. Diagnostic accuracy was increased among patients using remote modalities alone compared with in-person alone or combination (p=.02). Taking into account patient preferences and diagnostic accuracy, this study suggests the utility of having different interpreter modalities available for Spanish-speaking LEP ED patients.

Juntos en la pandemia de COVID-19 (together in the COVID-19 pandemic): health-care professionals and the Latinx community

Juntos en la pandemia de COVID-19 (together in the COVID-19 pandemic): health-care professionals and the Latinx community

Refugee women's well-being, needs and challenges: implications for health policymakers.

Refugees face circumstances where their health and well-being are compromised. In this qualitative study, the aim was to understand Syrian refugee women's needs for care and the predisposing and enabling factors to healthcare access and utilisation. Out of 945 Syrian mothers who gave birth in our university hospital between 2014 and 2018, 195 were reached; out of which, 47 women were included. Semi-structured in-depth interviews were conducted and were later analysed using a qualitative content analysis approach. Depression was assessed by the Patient Health Questionnaire-9 at the end of the interview. Social isolation and maternal depression, language barrier and challenges while navigating the healthcare system emerged as the main themes of the study. Low educational and occupational status of the women, poor social resources, limited Turkish proficiency and unfamiliarity with the host healthcare system were identified as the predisposing factors for poor healthcare services utilisation. Recommendations include bridging language gaps, improving the navigation of the healthcare system by visual support or in-person interpretation, and psychosocial support. Providing hospital-based language courses to mothers and social integration programs for families will improve the mothers' well-being and indirectly care of the child.

Effect of Dedicated In‐Person Interpreter on Satisfaction and Efficiency in Otolaryngology Ambulatory Clinic

In a large academic children's hospital ambulatory clinic, the increasing demand for Spanish interpretation exceeds the Interpreting Services Department capacity, necessitating telephone interpretation. By adding a dedicated Spanish interpreter in the otolaryngology clinic, we aimed to decrease visit times for Spanish-speaking patients and increase satisfaction. Additional aims explored if dedicated Spanish interpreters could increase patients seen per session. A quality improvement initiative investigated baseline state compared to 2 tests of change using video interpretation and dedicated, in-person interpretation. Time permitting, interpreters contacted patients before the visit to decrease missed appointments and late arrivals. Measures included clinic visit times, late arrivals, missed appointments, and family/employee satisfaction scores. Actuarial statistics forecasted if on-site Spanish interpreters would affect patients seen per session and the potential addition of sessions. In-person interpretation reduced visit times for Spanish-speaking patients from 55 to 48 minutes (P = .01) and 57 to 48 minutes for all patients (P < .0001). Nearly 50% of video calls experienced technical difficulties. Families and employees preferred in-person over video and phone interpretation. No-show visits decreased by 25% and late arrivals by 17%. Implementing dedicated Spanish interpreters may increase productivity and enhance family experience. Reducing patient visit time by 9 minutes permits 2 additional patients per clinic session (1560 visits, 390 surgeries per year). Applied institution-wide, the intervention could create 29% more capacity in the ambulatory schedule (31,000 additional visits) and reduce actuarial need for ambulatory sessions in the same clinic space.

Factors influencing the use of video interpretation compared to in-person interpretation in hospitals: a qualitative study

BackgroundFacilitating access to professional interpretation services is key to equitable hospital care for migrants with limited language proficiency; however, interpreter underuse has been documented. The factors that potentially enable or hinder professional interpreter use are not well understood. We aimed to compare perceptions held by hospital managers and healthcare practitioners of the factors influencing the use of remote video interpretation and in-person interpretation.MethodsThis study employed a retrospective qualitative design. Two hospitals, located in Austria and Norway, with adequately similar baseline characteristics were purposively selected. Both hospitals used in-person interpreters, and the Austrian hospital had recently introduced remote video interpretation as an alternative and supplement. Fifteen managers and healthcare practitioners participated in focus groups and individual interviews. Data were thematically analysed with the aid of behavioural system theory.ResultsAcross sites, the facilitators of interpreter use included individual factors (knowledge about interpreter services, skills to assess when/how to use an interpreter, beliefs about favourable consequences), as well as organisational factors (soft budget constraints). Barriers were identified at the individual level (lack of interpersonal skills to handle difficult provider-interpreter situations, lack of skills to persuade patients to accept interpreter use, lack of trust in service professionalism), and at the organisational level (limited interpreter availability, time constraints). The introduction of remote video interpretation services seemed to counteract the organisational barriers. Video interpretation was further perceived to enable patient confidentiality, which was regarded as a facilitator. However, video interpretation introduced specific barriers, including perceived communication deficiencies.ConclusionThis study has identified a range of factors that are perceived to influence the use of interpreters in hospitals. The research suggests that-implementing remote video interpretation services lessens the barriers to use and that such services should be introduced in hospital settings as an alternative or supplement to in-person interpreters. Further intervention functions should be considered to bring about change in the use of interpretation services, including developing guidelines for interpreter use, educating staff in the appropriate use of video technology, and training staff in communicating with interpreter and patients with limited language proficiency.

Lost in Translation: The Role of Interpreters on Labor and Delivery.

During the Coronavirus (COVID-19) pandemic, in-person interpreters have been deemed “nonessential,” and thus eliminated to minimize viral exposure and conserve personal protective equipment. Considering alarming patterns of interpreter underuse, we evaluate how substitution for remote modalities (telephone or video) may exacerbate existing inequalities for patients with limited English proficiency. The inherent intimacy, dynamic physicality, and cultural nuances of labor and delivery pose unique communication challenges. Using clinical scenarios, we illustrate the vital role interpreters have in providing accessible obstetric care. We argue that eliminating in-person interpreters in this setting is not justified by COVID-related harms given the potential to exacerbate underlying health disparities.

98. LOST IN TRANSLATION: SIMULTANEOUS SPANISH MEDICAL INTERPRETATION DURING FAMILY CENTERED ROUNDS FOR IMPROVED RESIDENT AND FAMILY ENGAGEMENT

Background Language barriers significantly contribute to medical errors compromising patient safety, quality of care, and resident engagement with patients. Spanish speakers account for the fastest growing population of patients within US pediatric hospitals. However, the communication needs of limited English proficiency (LEP) patients frequently remain unmet. PURPOSE: The purpose of this study is to implement equipment assisted simultaneous medical interpretation (EASMI) for Spanish speaking families on family centered bedside rounds (FCR) and determine family and trainee provider satisfaction. Methods In-person interpreters joined FCR at a tertiary care academic children's hospital. All medical discussion on FCR was interpreted simultaneously from English to Spanish. Interpreters wore a noise-cancelling microphone connected to a transmitter and family members were given a receiver with an earpiece. Qualitative interviews were performed with family members on their experience (N=25). Online qualitative and quantitative surveys were completed by medical students, residents, fellows, attendings, and nurses (N= 136). Results Surveys demonstrated 94% of physicians and 100% of nurses were “very satisfied” with EASMI. Common themes from the resident and fellow survey were improved efficiency of rounds, increased family engagement, improved understanding of the care plan, decreased communication errors and improving patient safety. After the intervention Spanish speaking families reported an increase in the domains of communication with physicians and nurses on the Child HCAHPS survey. Conclusion Medical interpretation for LEP patients and families is critical for improved healthcare and reduction in health disparities. Overall, EASMI is both an efficient and effective patient-centered intervention during pediatric FCR for increased trainee engagement with patients.

Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review.

The objective of the review was to identify, critically appraise and synthesize evidence on the impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency. A key strategy to facilitate effective communication between limited-English-proficient migrant and refugee families and healthcare providers is the use of professional interpreters. Despite awareness of the importance of professional interpreters, interpreters are underutilized. This results in suboptimal care, including poor access to health care, increased risk of serious medical events, increased admission to hospital and inadequate health literacy. Limited-English-proficient migrant, refugee or asylum-seeker families with a hospitalized child aged 0 to 18 years, who had used a professional interpreter, were considered for this review. Comparators included standard care or no interpreter, and reported results of comparisons of the duration, frequency or mode of interpreter delivery. Outcomes were length of stay in hospital, unplanned readmission rates to hospital, non-attendance at hospital clinic appointments and ambulatory care, child and/or parent satisfaction with care in hospital, adherence to treatment, medication errors, and other adverse events relating to patient safety. The review considered all studies conducted using a quantitative approach. A three-step search strategy was used. Databases were searched in December 2018 for published and unpublished articles. Studies published in English were considered for inclusion. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used. Six articles reporting results from three randomized controlled trials and one observational study were included. Studies were undertaken in the United States involving Spanish-speaking participants. Three studies were in emergency departments. There was a total of 1813 families, of whom 1753 had limited English proficiency. Migrant and refugee families with limited English proficiency reported greater satisfaction with aspects of care when a professional interpreter service was used compared with using ad hoc interpreters. Using professional in-person interpreters resulted in a shorter total emergency department throughput time compared to using professional interpreters via telephone. There was no difference in concordance of child's discharge diagnoses between parents assigned professional interpreters and those assigned bilingual physicians. Video interpretation provided better understanding of diagnoses than phone interpretation. There is evidence that use of ad hoc interpreters or no interpreter is inferior to use of professional interpreters of any mode. Although video and in-person interpreters are more favorable for some outcomes, mode of delivery may not be as important as the fact that a professional interpreter is being used. The mode of professional interpreter delivery should be based on accessibility, availability, language requirements and patient preference. PROSPERO CRD42017058161.

Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families.

* Abbreviations: CIF — : children in immigrant families COVID-19 — : coronavirus disease DACA — : Deferred Action for Childhood Arrivals ICE — : Immigration and Customs Enforcement LEP — : limited English proficiency SDH — : social determinant of health TPS — : temporary protected status WIC — : Women, Infants, and Children Program Like many health conditions that disproportionately impact vulnerable populations of color, we expect that the coronavirus disease (COVID-19) pandemic will inequitably affect the health and livelihoods of immigrant families. One in 4 children (>18 million) in the United States lives in an immigrant family, in which the child or ≥1 parent was born outside the United States.1 Among children in immigrant families (CIF), >7 million live in “mixed-status” families, meaning ≥1 parent is not a US citizen.2 Before the COVID-19 pandemic, immigrant families faced increasingly restrictive policies and discrimination. Regardless of legal status, CIF experience increased health and social risks compared with peers in nonimmigrant families, including lower rates of health insurance coverage and higher poverty levels.3 The COVID-19 pandemic amplifies existing inequities and introduces new ones as immigrant families navigate school closures, lack of health insurance and paid leave, and decisions to seek medical care or public services amid ongoing immigration enforcement. Additionally, immigrant families are more likely to live in multigenerational households,4 heightening the risk of COVID-19 for multiple family members. Families with limited English proficiency (LEP) must decipher rapidly evolving public health directives, such as “shelter-in-place” orders and recommendations for mask-wearing, without multilingual and culturally relevant messaging. Underlying these challenges is the implicit presumption of a safe place in shelter-in-place and social distancing directives. For immigrant families seeking safe haven in the United States, “place” may include violence and abject poverty, both in home countries and at the US border. For CIF in US communities coping with persistent fears of immigration enforcement and family separation, … Address correspondence to Rushina Cholera, Duke University School of Medicine, 200 Morris St, 3rd Floor, Durham, NC 27701. E-mail: rushina.cholera{at}duke.edu

Self-Reported Barriers to Healthcare and Interpreter Preferences for Patients with Limited-English-Proficiency in an Urban Emergency Department

Introduction: In the United States, limited English proficient (LEP) patients often use emergency departments (ED) as their primary source of healthcare. Beyond language barriers, little is known about what other barriers LEP patients face to utilizing emergency care. The authors attempted to identify other barriers as well as gather data regarding patient preference for interpretation modality. Methods: A survey was administered to LEP patients at an urban, academic ED from June 2016 to September 2018. Participants rated 17 predetermined barriers and reported preferred interpretation modality. Results: The study population included 87 LEP participants from 13 countries, speaking 8 primary languages. The most common barriers “of high concern” were “paying the bill” (n=19), “wait time” (n=18), and “belief that professional care probably would not help” (n=15). A majority of participants (n=60, 61%) preferred in-person professional interpreters to other forms of interpretation. Conclusions: Addressing these specific barriers may improve access and utilization of emergency care for LEP patients. In-person professional interpreters should be utilized whenever possible.