Healthcare access is often discussed in terms of insurance coverage, transportation, provider availability, and affordability. But the other, equally important barrier is whether patients feel understood once they walk through the door.
Language, culture, and trust are in every healthcare interaction in one way or another. A patient may technically have access to a physician, hospital, or clinic, but can’t comfortably communicate their concerns or believe their values and experiences are being respected, so this access doesn’t translate into effective care.
Language Is More Than a Communication Issue
Imagine receiving a new diagnosis while struggling to understand the language being used to explain it. Now add medication instructions, treatment options, consent forms, and follow-up appointments.
That’s a lot to navigate, so the National Standards for Culturally and Linguistically Appropriate Services (CLAS) recommends providing understandable, respectful care that responds to patients’ languages, health literacy, cultural health beliefs, and communication needs. The standards also call for language assistance at no cost to people with limited English proficiency and discourage relying on untrained individuals or minors as interpreters.
With the strength of evidence varying across studies, a systematic review of 38 studies examining patient-provider language concordance found evidence that communicating in a patient’s preferred language influences interpersonal care, patient and provider behaviors, and potentially health outcomes.
Culture Shapes How We Experience Healthcare
Communication is about translating words and effectively navigating the different cultural perspectives people have about illness, pain, preventive care, mental health, family involvement, medications, end-of-life decisions, and even when it’s appropriate to seek medical attention. That’s why culturally responsive healthcare is about asking, listening, and avoiding assumptions about different groups.
Culturally and linguistically appropriate services provide bridges that improve quality to reduce health disparities by respecting the whole individual and responding to that person’s health needs and preferences. That means training staff in cross-cultural communication, providing materials in commonly used languages, considering health literacy when developing patient information, and learning directly from the communities they serve.
And Then There’s Trust
Trust is difficult to measure, but its importance is hard to overlook. Patients are asked to share highly personal information, follow medical recommendations, take medications, undergo procedures, and make decisions that may significantly affect their lives.
Those actions require confidence in the people and systems providing their care. Language influences that relationship.
One study of patients with limited English proficiency found significantly higher physician trust scores among those communicating with providers in their same language or through professional interpreters, rather than those using ad hoc interpreters. Trust also grows when healthcare organizations engage communities rather than simply designing programs for them.
CLAS guidance recommends partnering with communities to design, implement, and evaluate healthcare practices and services. Meaningful community partnerships help organizations better understand the needs of the populations they serve.
The Final Product of Better Healthcare Delivery
It begins with practical changes, such as making qualified interpreters easily accessible and translating important patient-facing information into commonly spoken languages. It’s also important to use clear, plain-language explanations rather than medical jargon.
Ask patients about preferences rather than assuming them and train both clinical and administrative staff in culturally responsive communication. Include community members in the design of outreach and health programs, and give patients ample opportunity to ask questions and confirm their understanding.
HHS provides healthcare organizations with guidance covering organizational assessments, communication strategies, language assistance, written materials, and cross-cultural communication.
Access is Guaranteeing Being Heard
Healthcare access starts with getting someone through the clinic door. But real access is having patients understand what is happening so they can tell you exactly what they need to participate in their care decisions, and feel respected throughout the experience.
Language services, cultural responsiveness, and community engagement all help and contribute to the trust every healthcare relationship needs. For organizations working to expand access to healthcare, that’s an important reminder.
Sometimes improving access isn’t about creating another door, but it’s about making sure people feel welcome, understood, and heard after they enter. At The Access to Health Foundation, improving access to health care requires recognizing the everyday barriers that stand between people and healthier lives, and working collaboratively to remove them.
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