Yo Entiendo: I Understand

Purpose: Low health literacy is a pervasive and widespread issue that affects virtually every aspect of health care delivery. The purpose of this qualitative study was to better understand health literacy and cultural barriers faced by Spanish speaking heart failure patients.

Methods: This qualitative study measured multiple aspects of the patient care experience in one-to-one interviews with seven (2 inpatient, 5 outpatient) Heart Failure Spanish speaking patients that received care at UCLA between 2011 and 2015. Consent was received from all participants using a Spanish speaking community health educator who was also present during six of the seven interviews. A standardized interview template was used to interview all patients. In addition, the UCLA phone interpreter service was used for one of the inpatient interviews. Using the Patient Voice Toolkit, the interview data was synthesized and three core themes emerged: cultural competency, coordination of care, and communication/interpreter services. Sub-committees were developed for each of the three core themes to follow through on the action items that were discussed.

Results: The patient interviews highlighted three themes: cultural competency, interpreter services, and care coordination. Cultural competency is an awareness of culture, folklore, customs and beliefs. The patient interviews revealed the importance of family and identifying caregivers, role of wife and children, hierarchical and patriarchal culture and especially the role of food in culture. The second theme conveyed low utilization of interpreter services by providers. In addition, inadequate assessment of learning styles and the use of teach-back methods were often not utilized by providers, which compounded the effects of low health literacy on health outcomes. Finally, there was lack of care coordination, especially in the outpatient setting. Thus, patients were confused with many providers and having limited understanding of the US health system and available outpatient resources. 

Conclusion: Providing medical care in a culturally sensitive manner includes more than word for word language translation. Consideration of culture, emotions, inflection differences, intonation differences, and regional differences are just as important as words for effective communication. Moving forward, the Cultural Competency Project will evaluate current UCLA cultural and linguistic competency tools and modules as well as more detailed, layered and culturally specific tools and modules as they relate to the Spanish speaking/Latino culture.