Table 3.

Drivers of Effective Communication with LEP Patients and Families

Subthemes	Quotes
Driver 1: Utilizing a team-based approach between medical providers and interpreters
Mutual understanding to optimizecurrent resources	• “[Medical staff need to] request the interpreter in advance, without waiting until the last minute, [and provide] a realistic and accurate estimate of the time and need for a live interpreter” … “I wish [medical staff] knew how hard it is to coordinate interpreter resources… [and that] we are not machines but human beings…We are not a burden but a tool to get job done.” (interpreters) • “In-person [interpretation] is fantastic but [has] logistic challenge[s]. When an iPad/phone [is] ready in the room… and available immediately, [it] saves time [and] reduces hassle.” (physicians)
Shared expectations for a patient encounter via presession	• “Communicating with LEP families goes [well when] interpreter services [communicate] back to [medical staff] that one is not available or time has changed.” (nursing staff) • “Communicating with LEP families goes well when a presession was conducted and all parties know what to expect from the interpreter” … “[and] medical staff receive[d] training on how to work with interpreters” … “[It helps] when the nature of the bedside interaction is considered … [and] physicians … inform the interpreter of needed info by the sessions begin.” (interpreters)
Driver 2: Understanding the role of cultural context in providing culturally effective care
Provider perception of the family’s culture	• “When caring for LEP families, [medical providers] need to… increase their cultural competency…stop making cultural judgments, [and] avoid practicing their “language knowledge” with the families… [while] interpreters need to be transparent, accurate, culturally sensitive.” (interpreters) • “Communicating with LEP families goes well when there is some understanding of cultural differences in communication” … “[and] cultural context [that would inform us on] how best to convey information and interact with families”. (physicians)
LEP family’s knowledge about the culture and healthcare system in the US	• “I wish LEP families knew to speak directly to healthcare providers [and] the hospital… [and learn about] their medical rights, the meaning of HIPAA, [and] the new culture in the US different than their own.” (interpreters) • “When providing interpreter services to LEP families, I believe that the most important source of time loss in each encounter is too many jokes … [or] idioms that don’t translate to other languages.” (interpreters)
Provider insight into one’s own preconceived ideas about LEP families	• “If I could change one thing about working with medical staff when providing interpreter services, [it is] medical staff assumptions that family members are capable to interpret for patient/family.” (interpreters) • “When providing interpreter services at discharge, I [worry] assumptions of providers that LEP patients are familiar with US life style; [physicians] need to avoid promising help that can’t be provided or sustained by the health system.” (interpreters)
Driver 3: Practicing empathy for patients and families
Respect for diversity	• “The best part about taking care of LEP families is appreciating other cultures, getting to know other people with different backgrounds, feeling like you are impacting someone’s life and their views of the US [by] helping them feel welcome and [that their] voice [is] heard.” (nursing staff) • “The best part about taking care of LEP families is having diversity in patient care [and] learning about different cultural perspectives; [There is a] different sense of fulfillment [that comes from] attempting to fill in holes in their medical knowledge that other providers may not have done.” (physicians) • “The best part of providing interpreter services in the hospital is… seeing people connect despite language barrier.” (interpreters)
Display of humanism and compassion toward LEP families	• “The way we take care of LEP families would completely change if we took [the] time to learn about their struggles to come to this country and [in] everyday life” … “[Medical providers] need to be more friendly [and] patient with LEP families… It takes longer, but it’s for a reason” (interpreters) • “When caring for LEP families, physicians need to… leave their egos at the door” … “I wish the physicians would actually … [and] really listen… [and] avoid side conversations” (interpreters)
Driver 4: Using effective family-centered communication strategies
Verbal communication	• “Communicating with LEP families goes well when everyone pauses frequently for the sake of accuracy… takes turns talking … [avoids] repetitive questions” … “[and] uses simple and clear instructions.” (interpreters) • “Communicating with LEP families goes well when there are short, concrete phrases used… [with] moderately frequent intervals of interpreting [and the] team understands importance of avoiding jargon … giv[ing] time for interpreter to interpret.” (physicians)
Nonverbal communication	• “Using interpreter services goes well during rounds when the team, family, and interpreter are all on time and present” … “and awake” (nursing staff) • “I wish physicians would look at [and] address the families directly when using an interpreter.” (physicians) vs [Medical providers] need to talk to the families (mother and father) if they are present, because sometimes they only speak to the patient. [Furthermore] providers [tend to] speak to English-speaking parent only, ignoring the other parent with LEP. [Most] of the time, the mother has LEP, [which] is a problem since mom is the one taking care of the child.” (interpreters)
Assessment of family understanding and engagement	• “Communicating with LEP families goes well when families are actively invited for feedback and questions … [and] when we remember to do teach-back and better gauge understanding; [it is] a clear confirmation that communication was clear and successful.” (physicians)

Abbreviations: LEP, limited English proficiency; US, United States.