Patients who speak little or no English often have trouble communicating with doctors about their health concerns. They become frustrated from the situation and avoid health care providers they can't understand. Sometimes, they avoid seeking care at all. Others travel great distances to seek care from a provider who does speak their language.

The School of Public Health at the University of North Texas Health Science Center at Fort Worth is implementing several new initiatives to improve the situation and enable English-speaking doctors and hospitals to communicate more effectively with their Spanish-speaking patients. The initiatives are part of a new program called Hablenos de su Salud, or Let’s Talk About Your Health.

“Spanish-speaking patients often feel that nobody’s really listening to what they say,” said Holly Jacobson, PhD, principal investigator for the grant. “The program we’ve developed will try to improve the way we communicate with Spanish-speaking patients. Hopefully, it will have a beneficial effect on the quality of the health care they receive as well.”

The health science center is one of nine health organizations in the country selected to address the growing issue of language barriers in health care by The Robert Wood Johnson Foundation (RWJF) through its national program, Hablamos Juntos: Improving Patient-Provider Communication for Latinos.

“People with a limited ability to communicate in English face significant barriers to quality health care in the United States,” said Pamela Dickson, senior program officer at RWJF. “The nation is becoming more diverse, and we need to take steps toward solving this problem now. Our hope is that the projects developed through the Hablamos Juntos program will ultimately serve as models for other language groups.”

Last year, UNTHSC and other grantees received a one-year planning grant to design innovative and affordable approaches to improve patient-provider communication, including language interpretation services, printed materials and signage. SPH will now receive an additional $850,000 over the next two years to implement the initiatives it proposed.

The health science center will develop practical approaches that will increase the availability and quality of interpreters at collaborating health care provider sites, improve Spanish-language capacity, develop Spanish materials, and create easy-to-understand ways for non-English speaking patients to navigate health care facilities. This will include testing a newly developed system of symbols for health signage that may be more effective at guiding patients than existing written signage.

Through the RWJF grant, the health science center has been working with a diverse group of community partners, including Planned Parenthood of North Texas, Mental Health Mental Retardation of Tarrant County and the American Cancer Society. Other partners include the family medicine clinics operated by the health science center’s Texas College of Osteopathic Medicine and by the Osteopathic Health Systems of Texas. Alianza Comunitaria of Tarrant County and Salud para su Corazon of North Texas, two programs that focus on educating the Latino community about cardiovascular disease, are also integrally involved.

Trained interpreters with the program will be placed in six sites around Tarrant County, including the emergency room at the Osteopathic Medical Center of Texas, JPS Health Center – Diamond Hill, and Planned Parenthood’s Arlington clinic. The new Fort Worth Northside Community Health Center, the MHMR Tarrant Youth Recovery program, and the American Cancer Society’s Hispanic outreach programs are also intervention sites for the program.

UNT Health Science Center is also developing advanced training and education for interpreters that will lead to a Master of Public Health degree in health applied linguistics. The faculty is currently recruiting experienced interpreters to enroll in the new linguistics program. Classes are set to begin in January, and scholarships are available.

The program will also develop materials for patients in original Spanish, instead of translating English-language materials. In addition to educational brochures and posters, the team is working on developing a new process to demonstrate patients’ informed consent to treatment.

“Patients are often not informed about what they’re signing and it’s truly not an informed consent,” Dr. Jacobson said. “At a minimum, the form needs to be in Spanish, but it’s the whole process that needs improving.”

Workshops on interpretation will be offered to help clinic staff improve their ability to work with interpreters. In addition, bilingual clinical staff will participate in language proficiency testing. “Just because you speak two languages doesn’t mean you’re qualified to be an interpreter,” Dr. Jacobson said.

Workshops and seminars about the role of language services in the hospital or clinic will also be offered to administrators and managers. “They need to know how quality language services can improve their bottom line, minimize their legal responsibilities and influence health care policy,” Dr. Jacobson said.

“We recognize that better communication between patients and their health care providers can enhance health care,” said Fernando Treviño, PhD, MPH, UNTHSC School of Public Health dean. “We want to develop ways to improve patient-provider communication today and lay the groundwork so that the situation in the future is even better.”

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