Table 5.

Community informed recommendations

Sub-theme	Quote
Patient and caregiver recommendations
Need for bilingual staff	PT 12 commented: “[I recommend] having bilingual personnel at the hospital during the different shifts, whether morning, afternoon, or night, to always have someone as part of the personnel, one or two individuals, who can serve as interpreters.”
Need for more in-person interpreters to mitigate shortages and delays	PT 13 remarked: “Add more interpreters. We need it. For those of us who only speak Spanish—I can understand a little, but I can’t make a long conversation because I don’t understand.”
Need for accountability for interpreters of all modalities to promote accuracy and quality	CG 5 commented: “I think there should be a way to create accountability from those people who are (…) being the translators. It can’t just be that they show up, translate, and leave. How do you know if they did a good job?”
Need for interpreters to streamline language and consider health literacy of patients and families	CG 6 said: “When interpreters speak, (…) they use the medical terms that they should use as a professional interpreter, but (…) they say something and we don’t understand (…) they should use words that we, as people without a medical background, can understand.”
Need for healthcare team to understand importance of interpreter services and be aware of how to access them	PT 10 said: “I’ve noticed that there [are medical] personnel that [are] still not familiar with [virtual interpretation services] (…) They need to be ready to know about that tool and be aware that they have that resource available to provide it.”
Need for interpreter training	PT 14 remarked: “I think that the people who work on interpretation should go to training, so they can be more accurate.”
Need for patients to become more health literate	PT 1 said: “We could be more knowledgeable regarding the use of the correct words in relation to our disease. Also, the names of body parts and symptoms. We don’t typically use those words every day. This causes problems with communicating with doctors because sometimes [patients] don’t understand what the [doctor] is saying.”
Community leader recommendations
Increase community awareness of right to interpreter services during healthcare interactions	CL 3 stated: “When I visit a patient, one of the things that I let them know is about interpreters available. Many of them don’t know this. (…) I don’t know if it’s given to all the patients, but it’s a note asking if they will be needing interpreter services. They are informed that the service is free, and they request it at any time. Once more, the patients who have been here for a long time, know very well how to use these services. New patients may not know much about it. (…) When they are coming to the clinic, they could be notified in their language—otherwise they will not understand—that those services exist.”
Consider techniques such as the teach back method to ensure understanding during discussion and decision making among Spanish speaking patients	CL 1 said: “[The patient] didn’t understand the gravity of [his condition] (…) I would think that they should use some psychology, and they could draw, like a diagram, or they could write it down, and ask him more questions, see if he understands, and allow the patient to ask more questions and communicate more.”
Need for initiatives to improve health literacy	CL 2 expressed: “[Patients] are not going to understand a word like ‘hospice.’ We’re talking about different levels of education. When it comes to translating, you have to explain. You can’t trust what words the person is familiar with (…) However, there will be other words, such as ‘hospice,’ where patient education is necessary. It was to be visual education, not with words.”
Need for community health workers or patient navigators who can serve as interpreters and advocates during the entire healthcare	CL 2 recommended: “There should be a liaison—someone who connects the patient’s needs with services and not only interprets. (…) It needs to be someone who understands the patient’s needs so that the patient’s health improves. (…) Someone who advocates for them so they don’t come back to see the doctor when they’re dying.”
Need for community initiatives to support care and decision making for Spanish speaking populations	CL 1 said: “A community leader remarked: “It would be a good idea to have a community group where the patients could go to. (…) There could be a support group at a church or in the community, or in a nonprofit organization. Something that makes the patient feel there is support in the community when it comes to decision-making, and there is a language barrier that prevents them from deciding. This could work as a cushion or a pillar for someone.”