Listening to patients: cultural and linguistic barriers to health care access.
OBJECTIVE
Full access to medical care includes cultural and linguistic access as well as financial access. We sought to identify cultural and linguistic characteristics of low-income, ethnic minority patients' recent encounters with health care organizations that impede, and those that increase, health care access.


METHODS
We conducted four focus groups with ethnically homogeneous African American, Latino, Native American, and Pacific Islander patients. Study participants were "walked" through the stages of a medical encounter and asked to identify physician and staff behaviors that made the patient feel more comfortable (a surrogate for increasing access) and behaviors that made the patient feel less comfortable (a surrogate for decreasing access).


RESULTS
African American and Native American patients in particular expressed overall satisfaction with their physicians' services. Patients from all groups saw nonphysician staff as frequently impeding access. Based on perceptions of negative stereotypes, Native American and Pacific Islander patients reported hostility toward physicians' efforts at prevention and patient education.


CONCLUSIONS
For the ethnic minority patients in our study, most perceived that cultural impediments to access involved nonphysician staff. Closer collaborations between health care organizations and ethnic minority communities in the recruitment and training of staff may be needed to improve cultural and linguistic access to care.
Barr
Donald A
DA
Department of Sociology, Stanford University, Building 120 MC 2047, Stanford, CA 94305-2047, USA. barr@stanford.edu
Wanat
Stanley F
SF
D000328:Adult; D001741:Black or African American; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D007198:Indians, North American; D008297:Male; D008913:Minority Groups; D044468:Native Hawaiian or Pacific Islander; D017060:Patient Satisfaction; D012959:Socioeconomic Factors; D013240:Stereotyping