UCSF

Exploring the Expression of Pain by Limited English Proficient Latino Immigrants in Language and Culturally Discordant Health Encounters

The purpose of this interpretive study was to explore the expression of GI pain by non-English-speaking (NES)/ limited-English-proficient (LEP) Latino immigrants in language and cultural discordant health encounters. Language discordance prevents NES/LEP Latinos from reporting symptoms of abdominal pain to a provider. Furthermore, the extent of this communicative inability was correlated with negative health care outcomes such as longer wait times before receiving primary clinical assessment for acute GI symptoms in the emergency room.

Method. Interpretive phenomenology guided the design and analysis. Two in-depth individual interviews were conducted with a purposive sample of 13 adult Latino participants who had LEP, a history of GI pain, and treatment in U.S. health care. Participants were undocumented, Central Valley residents who were reluctant to participate in research due to fears of deportation. Interviews focused on the history of present illness, beliefs about their illness and treatments needed, and direct narratives regarding receipt of health care in the U.S. for their GI pain.

Results. Participants’ perceived barriers to communicating GI illness concerns included undocumentedness, fear of deportation, personal healthcare beliefs and practices, lack of insurance, low health care literacy, and limited income. Participants reported receiving ineffective/fractured care, and feeling uncared for by doctors. Discriminatory practices, largely because of their ethnicity, LEP and low income were commonplace. Aids to communicating GI illness concerns included trust, time, attention, respect, consistent follow up care, and doctors who showed concern. Latino coping processes included following western medicine advice and prescriptions, as well as reliance on folk medicine, God, and family. Despite these coping strategies, participants experienced considerable untreated pain, delayed or ineffective diagnostic work-ups and limitations on diagnostic tests (i.e., EGD) because of their LEP, insurance status and/or immigration status.

Conclusion: Structural and interpersonal barriers were identified by Latino immigrants regarding communicating GI illness concerns in situations of language and cultural discordance. Improvements at both the interpersonal and institutional levels are required to begin to address the disparities in health care expressed by this population.