Spanish-speaking patients place high value on language-concordant prenatal clinicians

Key takeaways:

• Participants highly valued strong Spanish language proficiency and positive interpersonal dynamics when choosing a prenatal care clinician.
• Less valued were appointment wait times and continuity of care.

Women with Spanish language preferences strongly preferred prenatal care clinicians with the highest level of Spanish language proficiency along with positive clinician-patient interpersonal dynamics, researchers reported.

“Section 1557 of the Affordable Care Act mandated meaningful access to language services by requiring the use of qualified bilingual clinicians or interpreters in clinical settings with patients with limited English proficiency. Clinician oral proficiency assessments in languages other than English are used to ensure safe medical communication between clinicians and patients,” Haylie M. Butler, MD, medical student in the department of obstetrics and gynecology at the Beth Israel Deaconess Medical Center at Harvard Medical School, and colleagues wrote in Obstetrics & Gynecology. “Few studies have evaluated patient perceptions of clinician Spanish language skills and how patients define language-concordant care.”

Butler and colleagues administered a discrete choice experiment to 166 women (mean age, 30.4 years) identified from electronic medical records with preferred Spanish language and self-identified limited English proficiency from two large academic medical centers in Boston. All participants were pregnant with a completed fetal anatomy scan or had given birth within the past 12 months. The discrete choice experiment included eight attributes considered by participants when selecting prenatal care clinicians.

Overall, 150 women completed the full discrete choice experiment and 16 completed at least one of the eight discrete choice experiment choice tasks. More than half (59.1%) of participants reported their primary prenatal care clinician spoke to them in Spanish only and 30.5% reported a mix of Spanish and English, the researchers wrote.

The most important attributes reported by participants when choosing prenatal care clinicians were positive interpersonal dynamics within the patient-clinician dyad and clinician Spanish language proficiency, according to the study. Wait time for appointments and continuity of care were ranked as lowest importance to participants.

Though participants highly preferred prenatal care clinicians to be “fluent or near fluent in Spanish,” the second highest preferred option was for clinicians to have basic Spanish proficiency with some possible misunderstandings. Participants also preferred in-person vs. video or phone interpreters.

“Participants placed positive utility on their clinicians being able to speak some Spanish,” the researchers wrote. “Meeting a patient partway on the language-concordance continuum, with a mix of Spanish and English or even limited Spanish phrases, demonstrates a desire to build human connection and trust, so long as a qualified interpreter is also present to ensure meaningful language access.”

In addition, participants reported very strong preferences for clinicians who always made them feel seen, heard and cared for.

“Future innovations in prenatal care design to achieve equitable pregnancy care experiences and outcomes require attending to patient preferences, including those who speak languages other than English, and implementing national standards for linguistically and culturally appropriate care,” the researchers wrote.