Co-authored by Alejandra Ullauri, Au.D, MPH, ABA-CISD.
It is well documented that hearing loss makes it more difficult for patients to communicate with their healthcare provider¹. This is complicated even further when the patient and the provider do not speak the same language. This can have negative consequences, including an adverse effect on the provider-patient relationship², increased risk of misdiagnosis by the professional, and provision of care that is neither culturally or linguistically appropriate.
However, when patients receive language-concordant care, they have an improved understanding of their condition, are more likely to ask more questions, are more likely to adhere to clinician recommendations and experience better outcomes³.
Undergoing cochlear implant (CI) assessment can be particularly stressful for patients, especially if they do not speak the same language as their audiologist. Similarly, it can be stressful for clinicians to make decisions about CI candidacy when language barriers cause uncertainty about the evaluation results and the communication skills of the patient. In this article, we will review tips and resources that audiologists can use to provide Spanish speaking patients with care that is culturally and linguistically appropriate.
- Partner with bilingual audiologists/clinicians in your area:
- Bilingual professionals can share testing materials, protocols, and counseling ideas to improve patient care. You may also consider referring to them for the candidacy assessment.
- Work with professional interpreters:
- Spanish proficiency is important when performing a full audiology test accurately. Professional interpreters reduce the risk of errors and improve outcomes⁴. Untrained interpreters, such as bilingual staff or family members, are often unaware of privacy and confidentiality rules and make twice as many errors as professional interpreters⁵.
- Find support in your team:
- Many patients are also working with other team members, such as speech-language pathologists (SLPs) or social workers, who may be bilingual. Consider joint appointments as they can make communication and the overall experience easier for the patient and the clinicians involved.
- Be aware of and document potential limitations in your testing:
- You may encounter limitations when scoring speech perception testing with the aid of an interpreter who has not been trained in speech perception testing. There are additional complications if you or the interpreter are not familiar with the patient’s accent, as the patients’ articulation patterns may be mistaken as speech perception errors. It is important to note these factors may have influenced the results. Documenting such limitations will help you and your team interpret the results and make recommendations accordingly.
- Find out details about the patient’s bilingualism:
- Understanding when the patient learned the second language, and whether the patient has a dominant versus a non-dominant language, can help clinicians understand their patients’ needs. Studies have shown that early bilinguals (those who learned both languages early in life) and native speakers may perform similarly in speech perception testing, especially in quiet. However, late bilinguals (those who learned a second language later in life) may perform worse when tested in their non-dominant language, especially in noise⁶. Also, to better understand each patient’s individual communication needs, a clinician may choose to test the patient in both languages and counsel or make recommendations accordingly.
- Encourage family members to join:
- In many Hispanic cultures, family and connections are very important. Encourage patients to bring family members to the visit so they can be part of the patient’s hearing journey. Also encourage your office staff to remind patients about the value of bringing family members to the appointment if they wish to do so. This extra support can help patients feel more confident about their care.
- Use validated Spanish testing and counseling materials:
- There are multiple resources in Spanish to assess, counsel and support Spanish speaking patients throughout their hearing journey. Choose testing materials that have been translated and validated into Spanish. You may also refer to this ProNews article that links out to Spanish counseling resources.
- Last, but not least, consider learning Spanish:
- Join us! We need more bilingual audiologists whose Spanish language skills are appropriate for clinical care. Whether you are starting to learn Spanish, or you know Spanish and are looking to expand your language skills, your efforts will help more patients experience the benefits of language-concordant care.
For additional resources, please check out the following links:
National Standards for Culturally and Linguistically Appropriate Services (CLAS) ⁷. This document focuses on standards intended to advance health equity, improve quality, and help eliminate health care disparities by focusing on diverse cultural health beliefs, preferred languages, health literacy, and the communication needs of patients.
Ten Attributes of Health Literate Organizations ⁸. Organizational health literacy refers to our duty to provide patients with information that is easy to find, understand, and use to make informed decisions. About half of the population (51%) may have limited health literacy ⁹. It is our duty to help our patients’ gain as much knowledge as possible about their hearing loss and treatment options across their lifespan. Knowledge empowers patients to be active participants in their healthcare. The Ten Attributes of Health Literate Organizations document breaks down strategies to insert health literacy in everything we do at all levels of our organizations.
Key point to remember: Always check for understanding at every point of contact. In clinic, practice the teach-back method and ask patients to repeat back to you, in their own words, their understanding of what they need to know or do about their own health. We hope you found this information helpful.
If you have additional questions and would like to contact someone on our team, please feel free to email our Clinical Services Audiologist, Maryann Flores, at mflores@cochlear.com.
