“Que nos Tomen en Cuenta’: Qualitative Investigations into Healthcare Language Access

Language barriers entrench health disparities by limiting healthcare access and quality for migrant communities. In this thesis, I take a qualitative approach to understanding patient perspectives on language access in medical institutions. First, I review qualitative studies on patient and family experiences with language discordance in healthcare systems globally. Interviewees reported disparities in care access and quality due to absent or inadequate language services, as well as a general preference for professional over ad hoc interpretation. Next, I investigate language access in the emergency departments (EDs) at Barnes Jewish Hospital (BJH) and St. Louis Children's Hospital (SLCH) through semi-structured interviews with Spanish-speaking patients and the parents of underage patients. I perform an interpretative phenomenological analysis (IPA) of interview transcripts to identify recurring themes from these conversations and describe the language services available at BJH and SLCH. The most common language barrier in these EDs was a lack of interpretation services at security and triage, which mirrors findings from other qualitative studies. Participants also reported feelings of powerlessness and responsibility for learning English when they encountered language disparities. I apply my findings to recommend that the BJH and SLCH EDs hire more bilingual staff members, increase access to interpreting services, guarantee the translation of discharge papers, and support future studies into language access. Healthcare institutions on a global scale must dismantle language barriers to support the health of migrant communities.