title: Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina.
abstract: BACKGROUND
  Health services research of Latinos with limited English proficiency (LEP) have largely focused on studying disparities related to patient-provider communication. Less is known about their non-provider interactions such as those with patient registration systems and clinic front office staff; these interactions precede the encounter with providers and may shape how comfortable patients feel about their overall health services experience. This study explored Latino patients with LEP experiences with, and expectations for, interactions with patient registration systems and front office staff.
  
  
  METHODS
  We conducted 20 in-depth interviews with Latinos with LEP (≥ 18 years of age) who seek health services in the Piedmont Triad region, North Carolina. We analyzed participants' quotes and identified themes by using a constant comparison method. This research was conducted by a community-academic partnership; partners were engaged in study design, instrument development, recruitment, data analysis, and manuscript writing.
  
  
  RESULTS
  Qualitative analysis allowed us to identify the following recurring themes: 1) inconsistent registration of multiple surnames may contribute to patient misidentification errors and delays in receiving health care; 2) lack of Spanish language services in front office medical settings negatively affect care coordination and satisfaction with health care; and 3) perceived discrimination generates patients' mistrust in front office staff and discomfort with services.
  
  
  CONCLUSIONS
  Latino patients in North Carolina experience health services barriers unique to their LEP background. Participants identified ways in which the lack of cultural and linguistic competence of front office staff negatively affect their experiences seeking health services. Healthcare organizations need to support their staff to encourage patient-centered principles.
authors.affiliation: Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Cubillos
authors.affiliation: Cone Health Family Medicine Residency Program, Greensboro, NC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Breen
authors.affiliation: Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Hall
authors.affiliation: Center for New North Carolinians, University of North Carolina, Greensboro, NC, USA.
authors.forename: Krycya Flores
authors.initials: KF
authors.lastname: Rojas
authors.affiliation: The Partnership Project, Greensboro, NC, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Mooneyham
authors.affiliation: The Partnership Project, Greensboro, NC, USA.|Greensboro Health Disparities Collaborative, Greensboro, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schaal
authors.affiliation: The Partnership Project, Greensboro, NC, USA.|Greensboro Health Disparities Collaborative, Greensboro, NC, USA.|Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Christina Yongue
authors.initials: CY
authors.lastname: Hardy
authors.affiliation: North Carolina Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.|Division of General Medicine and Clinical Epidemiology, University of North Carolina, Old Clinic Bldg, 5039, Chapel Hill, NC, 27599, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Dave
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mónica Pérez
authors.initials: MP
authors.lastname: Jolles
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.|North Carolina Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Nacire
authors.initials: N
authors.lastname: Garcia
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA. daniel_reuland@med.unc.edu.|North Carolina Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC, USA. daniel_reuland@med.unc.edu.|Division of General Medicine and Clinical Epidemiology, University of North Carolina, Old Clinic Bldg, 5039, Chapel Hill, NC, 27599, USA. daniel_reuland@med.unc.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reuland
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003142:Communication; D003144:Communication Barriers; D005260:Female; D057220:Health Literacy; D006296:Health Services; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007802:Language; D008297:Male; D008496:Medical Receptionists; D008499:Medical Records; D008875:Middle Aged; D009657:North Carolina; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011369:Professional-Patient Relations; D012111:Residence Characteristics; D057170:Translational Research, Biomedical