Breaking Down Barriers

“We’ve seen that Latinos have a disproportionately high percentage of COVID-19 cases — higher than you would expect from the population,” said Dr. Karol Hardin, associate professor of Spanish. “Here in Waco, at one point 68 percent of our COVID-19 cases were Hispanic. A colleague of mine in North Carolina said 75 percent of the cases where she lives were Hispanic.”

Talking Their Language

Hardin has spent much of her time at Baylor doing research into the ways that patients can more effectively receive treatment from healthcare professionals, overcoming the language and cultural barriers that can get in the way. She is part of a group of researchers from universities across the United States trying to make sure that such barriers do not prevent Spanish speakers from accessing healthcare services — especially during the COVID-19 pandemic.

“The disproportionately high number of cases among Hispanics is/was at least partially because they were just not getting the information they needed in a language they understood,” Hardin said. “The information about the virus wasn’t getting out to the Spanish-speaking community, so as you can imagine, there were a lot of myths [being circulated], and people just didn’t know what to do. Not everyone reads the Centers for Disease Control website.”

“The disproportionately high number of cases among Hispanics is/was at least partially because they were just not getting the information they needed in a language they understood.”

Dr. Karol Hardin R.

The communities that were successful in getting accurate information about COVID-19 to Hispanics, Hardin said, were those that used modes of communication already familiar to bilingual and Spanish-speaking audiences.

“That included Spanish-speaking radio broadcasts,” she said. “Some family health centers started doing [Spanish language] podcasts, and using local [Spanish language] TV and Facebook.”

The Value of Interpretation

Using funds from a grant awarded by the Patient-Centered Outcomes Research Institute (PCORI), Hardin and other researchers were able to go into the field and talk to Spanish-speaking patients to find out exactly what problems they faced in accessing appropriate healthcare.

“We went to different cities in Ohio and interviewed focus groups of patients to see what their language barriers and obstacles were and what their experience were. We heard all kinds of things,” Hardin said. “Problems with getting good [Spanish] interpretation was one of the big ones, while having no interpreters available at all was another one. We always think about [needing an interpreter] during a doctor’s visit, but there’s so much beyond that. You have to go to the pharmacy, you have to see a mental health counselor for your daughter, or you have postpartum depression. One time, the social worker didn’t speak Spanish very well, and the patient actually ended up in a mental health facility, locked in a room, because of a simple misunderstanding. These problems are systemic.”

By using grant funding, Hardin said they also have been able to bring Spanish language interpreters into the discovery process.

“The idea is to also engage interpreters in the research because they have so much to do with Latino patients, but the interpreters don’t really get a voice. They’re just expected to be a voice box and nothing else,” she said.

In May 2020, Hardin and four other university linguists joined forces with Spanish-language specialists to present a virtual webinar attended by about 300 people. The webinar reported on the results of the patient-centered research done in Ohio, with presenters looking at different aspects of the problem.

“One person talked about marianismo (a stereotype of Latina women’s gender roles that venerates traditional feminine virtues)and how women were the voices for healthcare in the family. In Latina families, when it comes to healthcare, it’s the woman who does all the talking,” Hardin said. “Another presenter talked about remote interpretation and how Latino patients told us they viewed it as la máquina — 'the machine — and they didn’t like it. They want personal contact.”

Seeking Equity

The research supports the idea that the COVID-19 outbreak has simply exposed and exacerbated healthcare inequities among minority populations that have existed for some time. Investigating practical ways to eliminate those inequities in the future was one of the main purposes of a new venture, the inaugural National Workshop on Spanish in Health Care, that Hardin and other linguists from The Ohio State University, the University of Akron, the University of California and Wichita State University took part in online in January 2021 — again supported by grant funds from PCORI. 

The three-day workshop was designed to respond to the urgent need to advance “language access and health equity” in Spanish-speaking communities by gathering together doctoral students and junior faculty who are interested in pursuing language access research in those communities. During the workshop, Hardin made presentations on “Language Access During COVID-19” and “Doing Community Based Participatory Research with Spanish-speaking Communities,” and she facilitated discussions on a variety of topics.

Hardin said the workshop was a valuable starting point for expanding research and crafting an engagement plan for future efforts by language researchers in their own communities.

“The pandemic has magnified already existing inequities in the U.S. healthcare system. Our experience highlights missing voices from patients and applied linguists who have not adequately participated in language-related healthcare research until now,” Hardin said. “We hope to build on momentum from the focus groups, webinar and workshop by continuing to engage these voices in advancing knowledge about language and health in Spanish-speaking communities.”