Patient Listening

Older immigrants in the United States, particularly those who are not native speakers of English, confront many difficulties in obtaining healthcare. In order to learn about the nature of these difficulties and develop approaches to address the problem, it is important to hear from the elders themselves about the specific problems they have encountered and what they feel would be helpful for them.

To this end, staff of Project SHINE, a national service-learning initiative, which offers tutoring for older immigrants and refugees,
conducted focus groups and individual interviews in Philadelphia, Pennsylvania, and San Jose, California, with 101 immigrant elders representing seven major ethnolinguistic groups. In addition, elders completed a checklist indicating the health issues and communication skills that were of greatest interest to them. Findings from these sessions were complemented by information gathering meetings and interviews with service providers who work with elder immigrants. The immigrants who participated in the focus groups and interviews told poignant stories illustrating their struggles related to health literacy and communication. For example, some elders delayed seeking medical care until health problems developed into emergencies because they were unable to read or understand their insurance information to ascertain if they had coverage. Others were unable to make a doctor’s appointment because they could not understand the doctor’s automated phone message. Many could not understand what a doctor said to them during an office visit, had no access to suitable interpreters, and were not able to ask for clarification.

Breakdowns in communication were the source of many healthcare-related mishaps reported by the elders. In order to examine these communication difficulties and develop recommendations for addressing them, the authors describe components that are necessary for effective communication in healthcare settings. Effective communication involves more than language competence, or knowing grammar and vocabulary.

Non-native speakers of English also require cultural competence, which is an understanding of cultural beliefs and practices
that influence language use; strategic competence, the ability to ask for repetition or clarification if one does not understand spoken information; and discourse competence, an understanding of the “big picture” of healthcare systems and how to navigate these systems in order to obtain healthcare. The challenges that elder immigrants experience with these aspects of communication are illustrated throughout the report by quotes and vignettes from elders themselves and the service providers who work with them.

The report examines communication breakdowns that occur as elders schedule appointments, communicate with healthcare providers, and deal with medical bills and insurance coverage. When asked how these communication gaps could be reduced, elders see responsibility for change on both sides—the elders themselves and the healthcare providers and systems that work
with immigrant populations. While many elders are working hard to improve their command of English, they would like support from English as a Second Language (ESL) teachers to learn how to communicate more effectively with doctors and to
understand how to navigate the U.S. healthcare system. Many also felt that ESL classes provided an excellent opportunity for learners to share information about bilingual providers or interpreters in the community. Elders were also acutely aware of the difficulty of mastering a second language and learning medical terminology at their age, and felt that healthcare providers needed to meet them halfway. They expressed the need for providers to offer health information in translation and quality bilingual
interpretation services. Too often elders relied on friends or family members who were not familiar with medical terminology or who might not maintain the confidentiality of the patientdoctor encounter.

The report concludes with recommendations for those who work with the elderly immigrant population, including healthcare providers, senior and immigrant service providers, and ESL instructors. General suggestions are offered on working and
communicating with immigrant elders, followed by specific suggestions for each group of professionals.