Table 3.

Additional Themes and Relevant Quotes

1. High medical care costs and lack of insurance serve as a barrier to accessing healthcare	(see text)
2. Difficulty accessing timely and convenient primary care	(see text)
3. Perceived negative attitudes from pharmacy personnel	(see text)
4. Lack of Spanish-speaking healthcare providers	(see text)
5. Verbal and written medication information is typically provided in English	(see text)
6. Language barrier is a source of confusion regarding medications	“Although we sometimes understand, we don’t understand everything even though we try…. It just goes over our heads. If there was someone who spoke Spanish, it would be better.” (Participant A) “It could be that there are some medicines that you can buy without a prescription but I not know for what it can be used for because everything is in English. If they could show in Spanish on a card that it can help for stomach pain, or it can help for ear pain, things like that so that can sometimes help. But medicines are called differently here. There are other brands. So you don’t know by looking if you don’t have something there that can explain it….Sometimes even though I give the medicine at the right time and the right amount, sometimes it doesn’t work and I don’t know if I can give a little more. So I am not comfortable because I don’t know if the recommended dose is correct. Or, for example, if I buy ibuprofen and I give her [my daughter] a little more than it says to, I don’t know if I’m doing the right thing.” (Participant H) “We try to read it to determine what dose to give her. In English, when we don’t’ understand the instructions too well, let’s say Tylenol or whatever medication for fever, as before I will ask someone who speaks both English and Spanish and ask them to explain the dosage and how to administer the medications…. Certain types of medications which I don’t understand, I would just prefer not to give them to her.” (Participant F) “It’s difficult for us to ask questions about the medicine’s reactions…. It’s very difficult to speak English when it has to do with your health because we don’t know the medical terms to be able to explain what’s going on with us or our children.” (Participant D) “Sometimes a lot [of questions regarding my medications], but because they don’t understand me and I don’t know how to ask those questions I want to ask. Some medications you need to take with food. Others you don’t. There are some that burn your stomach if you don’t eat something and others that are better to take with something. So, it’s difficult to know.” (Participant C) “By not understanding or knowing English, one can’t buy their medication or they don’t have the correct information they need.” (Participant L)
7. Lack of knowledge regarding clinical services available in community pharmacies	Although there was not a direct quote that truly supported this theme, several patients inferred that they did not think to go to a pharmacy for preventative screenings or vaccinations. Even when the interviewer asked about services currently available in many pharmacies (blood glucose/blood pressure/cholesterol screenings, the influenza vaccine, etc), it seemed that the gut response was for the patients to mention how difficult it was to access these services in a physician’s office.
8. Inadequate interpretation mediums	“I would prefer that the pharmacist could do so [speak Spanish] because if someone else does, they don’t say exactly what I mean…. Because at the time it gets translated, they don’t use the same words I want to say to the person and it gets lost.” (Participant H) “Yes, they [the children] are learning English, but they may not understand everything the doctor is saying. Nevertheless, they have to explain it to their parents because their parents don’t speak English very well…. If the doctor says, ‘Don’t eat this,’ the child may understand ‘Only eat this.’” (Participant A) “Sometimes it’s difficult because there’s no one [in the pharmacy] to help me in my language. They don’t want to talk too much. So, you don’t ask…. You get home and you have to ask your kids, ‘What is this word?’ A lot of times they don’t know either. When it’s regarding medications it’s difficult and they don’t really know. I’m left with, ‘What is this for?’” (Participant D) “It would be nice if there was a person who could speak the same language or that the pharmacists attempt to communicate with people. Not exactly that it should be their job. The problem lies with us. The problem of communication is more on us, not on them. It’s just that we go and we buy and part of their job is to understand. If they do, good, and if not, that’s fine. They should try to communicate with us like we try to communicate with them. Not exactly that they should be able to speak 100% or even 50% in Spanish, but that they try to communicate with us in one way or another.” (Participant F) “A lot who speak Spanish don’t have an interpreter or someone to help them.” (Participant E)
9. Lack of knowledge about prescription processes	“They’re waiting for their doctor to send the prescription or something and time passes by. They go to their next visit and they tell their doctor, ‘You didn’t give me a prescription.’ The doctor will say, ‘You just had to pick it up at the pharmacy.’ It’s a problem because now it’s been one or two weeks without taking the medicine.” (Participant A) “Normally, I’m there for a long time, but I don’t know the employees. I don’t know if they are just busy or if they just don’t want to hurry but usually one has to wait 15 to 25 minutes before getting their medication.” (Participant J) “The system is very different from that in Mexico…. Over there, one can go to a government clinic and they don’t ask for so many things like here…maybe because one is from a different place or some people just ask for it, but over there, usually not…. If you’re a blue collar worker [in Mexico], the majority get Medicaid, they go to the corresponding clinic, and they don’t pay… I don’t know about here, but one can go to any doctor. I’ve never had the experience of only being able to go to certain doctors.” (Participant I) “Medication in Mexico is one thing and here it’s another…so we look for someone to guide us. That’s truly what we need.” (Participant K)