In this study of Spanish-speaking Latinos, we find that use of interpreters is independently associated with increased satisfaction with health care and doctor and office staff communication. Specifically, the communication and satisfaction scores were highest for patients who needed interpreters and always had one available. Our results suggest that patients who need interpreters, but do not always get to use one, perceived their care to be of lower quality and are less satisfied with communication with providers and office staff. Improving doctor-patient communication is important clinically because evidence suggests that patients that experience superior communication with providers have better diabetes27
and hypertension-related outcomes28
. Moreover, high-quality patient-provider communication is a cornerstone of primary care and a key ingredient in delivering high quality patient-centered care29,30
. Thus, health care organizations serving communities with growing Latino populations can significantly improve the quality of care they provide by always having interpreters available to Spanish-speaking patients who need them.
Our main finding that patients who needed interpreters and always used one had higher scores compared with patients who did not need an interpreter is consistent with that of a previous study of Spanish-speaking families enrolled in health plans participating in the California Children’s Health Insurance Program (SCHIP)22
. In that study, the provision of interpreters resulted in a graded relationship with reports about provider communication. By contrast, we did not find an obvious graded relationship between interpreter use (always/usually/sometimes/never) and the global and composite measures. It is important to note that our study included adult patients in different ambulatory care settings where comparable studies have surveyed Latinos enrolled in health plans22,23
. Moreover, our sample accounts for patients of a different sociodemographics including individuals without insurance coverage. Our results resemble those from a similar survey study of uninsured adult Spanish-speaking patients that received care in urban hospitals and extend that study to incorporate findings for Spanish-speaking Latinos in ambulatory care settings18
Higher ratings of care by patients who needed and always got an interpreter than those who did not need interpreters may be explained by the belief that interpreters do more than interpret for patients; they function as a link between patients and health systems. They are plausibly unofficial health coaches or system navigators who provide linguistic services and beyond, possibly including social support for patients22
Limitations of this study prevent any inferences about causal effects of interpreters on communication between patients and doctors/staff. Our results may not be generalized to other populations with LEP or to all Latinos with LEP in the US. The large number of females in the sample and the site selection criteria—growing Latino populations—may also affect the generalizabilty of the results. In this analysis, the type of interpreter used (e.g., professional, family member, or clinical staff) is not taken into account. Because data are from surveys and not directly observed clinical encounters, one cannot completely discount reporting bias from participants or verify the use of interpreters. Also, we cannot exclude instrument bias as a possible explanation for these results.31,32
Because we made slight changes to some CAHPS® items, we do not recommend benchmarking. Finally, we focused on patient reports of care and did not have systematic clinic-level measures of interpreter service structure for each site that participated in HJ. This potentially biased our results and limited us from profiling individual sites. However, because participating sites were selected from 128 sites based in part on the need for new or expansion of existing language access services for Spanish-speaking Latinos, large differences in our results are unlikely to arise from clinic-level factors. Even if clinic-level language services explain the variation in patient ratings of care by interpreter use, our results would still suggest that having sound structural implementation of interpreter services leads to greater patient satisfaction with care33
. Because some evidence suggests that clinic-level factors are linked to enhanced culturally appropriate provider behavior34
and greater patient satisfaction with care33
, associations between clinic-level variables, interpreter use, and outcomes should be investigated in future studies.
Our study has policy implications. Given the current environment of health care reform, mention should be made that as primary care retools itself with a focus on patient-centered care30
, clinicians should consider incorporating interpreters into primary care teams that provide culturally and linguistically appropriate care35
. When language concordance between doctors and patients is not possible15
, the incorporation of professionally trained interpreter services is essential for clinics that serve limited English speaking populations. Although not consistently enforced, federal regulations require that health care organizations provide culturally and linguistically appropriate care to patients36,37
. Unfortunately, the quality of interpreters may vary greatly across settings because evidence-based criteria for what constitutes a qualified interpreter is lacking. Further research is needed to determine how the quality of interpretation is associated with patient-centered health outcomes.
We conclude that patient ratings of overall health care and doctor/office staff communication vary by availability of interpreters for Spanish-speaking patients in different ambulatory care settings. Our results demonstrate that among Spanish-speaking Latinos, always having an interpreter available for those that need them is associated with higher ratings of patient communication and satisfaction with overall ambulatory care. With the continued growth of Latino populations in the US, health care systems that invest in professional interpreter services will be well positioned to provide high quality of care to linguistically diverse populations.