The Community Research for Health Equity (CRHE) program, managed by AcademyHealth and funded by the Robert Wood Johnson Foundation (RWJF), supports community-led research to address local health care system issues of importance to communities of color, people with disabilities, LGBTQ+ individuals, and other historically marginalized populations.
Over the past year, we have been featuring interviews with CRHE grantees to showcase and celebrate their work during relevant celebration and recognition months. In the ninth and final interview of this series, AcademyHealth Research Associate, Ellie Jorling (she/her), speaks with Tra Tran and Carolina Torres from the Refugee Community Partnership research team to discuss their current project and to celebrate community-led language justice research on World Refugee Day, the international day to honor people who have been forced to flee conflict or persecution. This project seeks to examine how health care access improves when power and control over language access shifts to refugee and migrant patients.
Ellie Jorling: How did you select your research question for this project? Why this question, and why now?
Tra Tran: This country is getting a huge number of new immigrants and refugees that are dealing with difficult situations. We wanted to know more about what these situations were like. Language access and language justice aren’t the primary focus for a lot of health care providers and institutions, and there is a lack of data [on language access] for all language groups. We wanted to understand how not being a primary English speaker affects the ability to access quality care, and whether there were similarities or differences both inside and outside different communities.
Ellie Jorling: So, what did you find?
Tra Tran: In my focus group* [which included many different language groups], we found a lot of similarities. For example, [most people] tend to believe that it’s easier to find Spanish interpreters or other people who speak both English and Spanish. But finding quality interpretation was a barrier for Spanish-speakers. Some people were denied interpretation. Some people said interpretation took too long. Some people said they didn’t understand their interpreter because they spoke a different dialect. That was consistent across all language groups. I understand that everyone’s time is precious. But if the patient knows that finding interpretation is going to add 15 more minutes [to their appointment], sometimes they’ll decide, “Okay, I don’t need interpretation, I’ll just make do”, which is not going to provide them with quality care. It’s an unfortunate reality that being a limited-English proficiency patient dramatically affects your quality of and access to care.
Ellie Jorling: How does being from the community of focus inform your work?
Carolina Torres: One of the big issues for immigrants and refugees is the fear around speaking a different language and being from a different culture. Especially when you have a doctor who doesn’t speak your language.
Ellie Jorling: Carolina, would you mind sharing your experience with the medical system when you first arrived in the U.S.?
Carolina Torres: My English was more limited than it is now. And I didn’t have any idea that I would be able to request an interpreter. I have a daughter with medical issues, and the first time I went to the doctor here with her, the doctor asked a question, and I tried to answer it, and he said, “No, I’m not asking you. I’m asking my patient” [even though my daughter is a minor]. I felt miserable after that visit because I felt very disrespected by this doctor....I feel so frustrated sometimes, because my Spanish gets misinterpreted. Because I speak a little bit of English, I can tell when the interpretation is just wrong.
Tra Tran: You point to something important, Carolina, because even if you don’t speak Arabic or Burmese or Karen, you can obviously tell when the interpretation is poor quality. The provider should be able to tell when the patient has been talking for five minutes, and the interpreter gives a one-sentence reply [that something isn’t right]. And that happens more often than not.
Ellie Jorling: How do you want to celebrate and think about your work, and the future of language access and language justice, on World Refugee Day?
Tra Tran: We can celebrate, but the end of this project isn’t the end of this work. While we like to celebrate wins, this project provides the data we need to show health care systems that they are doing a poor job providing high-quality access to interpretation and care to a huge subset of their patient population.
Carolina Torres: [This project] provided a safe space and an opportunity to listen [to people who have had similar experiences], which we were able to put in the results.
Tra Tran: I would like to invite every health care provider, every health care administrator, and every health care staff person to consider what it takes to come to this country. The reality is so many things are different [in the U.S.] They need to approach people with the understanding that just because they speak a different language, it doesn’t mean that they’re dumb. You need to have clear, high-quality communication to provide good care.
*RCP conducted 15 community health forums with many language groups including: Arabic, Karen, Spanish, Burmese, Pashto/Dari, and Kinyarwandan.
If you would like to read more about the Refugee Community Partnership's CRHE grant, you can view that here. To watch an interview with CRHE project team members Elizabeth Godown and Huda Muhnaia on the value of community-led research, you can view that here. Earlier posts in this series featured CRHE grantees during Pride Month, Disability Pride Month, National Disability Employment Awareness Month, National Native American Heritage Month, Black History Month, World Teen Mental Wellness Day, National Arab American Heritage Month, and Women’s Health Month. This work is made possible with a grant from the Robert Wood Johnson Foundation (RWJF). The views expressed here do not necessarily reflect the views of RWJF.