Over the last 30 years, the number of U.S. residents who speak a language other than English at home has nearly doubled to reach 67.3 million. For multilingual or ESL (English as second language) families, the use and choice of native language can look different from one conversation to the next, depending on who they are speaking with and in what setting. 

And when it comes time to discuss important health decisions — whether it be a bilingual couple figuring out where to take their sick child for care, a grandchild talking with an immigrant grandparent about long-term care planning, or a non-English-speaking mom-to-be trying to navigate the birth process with her husband — linguistic barriers can create miscommunications about important health information and impact the quality of care.

When making an important health decision, every individual should have access to resources and tools to effectively engage and communicate their health needs in the language of their choice. 

Improving care delivery and access 

In a recent JAMA study across 21 U.S. hospitals, the health care experience of randomly selected Arabic-, Chinese-, English- and Spanish-speaking pediatric patients and their parents and caregivers were analyzed compared to English-proficient patients. The study found that non-proficient English-speaking families were less likely to ask questions about their child’s path of care and were five times less likely to question the decisions or actions of health care providers than English-proficient patients. For ESL families, access to a native-speaking doctor or medical interpreter can help improve the communication process, instill trust in the health care system, and make for a more seamless process of sharing health information between the provider, patient, and family members.

Providing culturally appropriate care and services for ethno-linguistic groups is also an important factor to help improve maternal and newborn health. Ethno-linguistic moms-to-be may honor a traditional practice that more prominently includes family in the birth process or often seek out family advice in the care setting. And for expecting at-risk mothers, having the right support leading up to, during and after the birth process is vital, especially those trying to navigate the birthing process in a secondary language. 

Point32Health, the health services company that was created from the combination of Harvard Pilgrim Health Care and Tufts Health Plan in early 2021, offers a Doula Program to support soon-to-be-moms who have Tufts Health Plan Medicaid coverage with more than just medical needs, providing family education and even household organization. As part of the program, native-speaking Doulas can help to improve communication about the entirety of the birthing process for ESL mothers and their families.

In addition, Point32Health’s collaboration with Ariadne Labs and UMass Memorial Health on its TeamBirth initiative aims to improve both safety and dignity in childbirth by centering decision-making around the person giving birth. Two primary elements comprise the TeamBirth initiative — efforts to improve communication between the mother, the family, and the clinical care team, which includes a live birth plan, storyboarding, and birth plan “huddles” between the clinical team throughout labor; and decision-making tools aimed at reducing cesarean sections. And as part of TeamBirth training, a key emphasis is put on using the patient’s own words and patient-friendly language to support ESL or non-English-speaking mothers and families. TeamBirth also offers its decision-making support tools and materials in several different languages.

The power of a community liaison 

For older adults, navigating the complexities of Medicare and Medicaid can be difficult, not to mention the added stress of navigating the process while trying to understand nuanced health care phrases and eligibility requirements in a language other than one’s own. One study found that non-proficient English-speaking older adults tend to have worse access to care and poorer health status than that of English-proficient older adults. 

Expert support in the community is essential to help families navigate the health care system and decision-making process with someone who understands the nuances of their language and culture. Point32Health’s Tufts Health Plan Medicare team provides translated materials for their Senior Care Options (HMO-SNP) plans in multiple languages, recently adding resources in Korean and Arabic. However, their aim to improve access and expand language services extends beyond just collateral translation. The team is also comprised of bilingual and multilingual community outreach representatives with native-speaking Chinese, Spanish, Portuguese, Haitian Creole, Cape Verdean, and Vietnamese representatives. 

This unique team employs individuals identified as experts in their neighborhood communities who can help older adults navigate the decision-making process when it comes time to choose a Medicare Advantage plan. Beyond the decision-making process, team members can also connect families with native-speaking doctors, helping them to build a network of resources to better navigate their health needs.

Linda Lin, one of the senior community outreach representatives for Point32Health’s Tufts Health Plan Medicare and Senior Care Options team, has worked with the Chinese community in the Greater Boston area for over ten years. “Helping families find transportation options, setting up doctor’s appointments and fixing issues preventing individuals from getting a necessary prescription is just some of the work I do,” she says. “During the pandemic, I even brought food and groceries to an individual’s house. I’ll never forget her words, ‘you are just like my daughter.’ The meaning of my work each day puts a smile on my face.”

Jacalyn Ruiz, a senior MassHealth eligibility representative for Point32Health, added that her role is to help identify and assist members in gaining Medicaid benefits in order for them to take advantage of the benefits of a managed care program like Tufts Health Plan’s Senior Care Options (HMO-SNP). 

“MassHealth eligibility representatives bridge the gap and walk older adults and their families through the entire Medicaid process.” Jacalyn shares that so many older adults and caregivers are unaware of how the MassHealth process works, as well as the different programs and resources that are available to help them become eligible. Navigating options can be even more difficult if family members run into language barriers when trying to assess their options. For Jacalyn, helping someone who is struggling to have their needs met at home, or to receive the services they need to live independently at home, is part of her daily work. 

“My favorite part of the job is calling to tell someone who is struggling that they now have the support structure in place to keep them moving forward,” she says. “Hearing their gratitude and knowing that I play a role in helping someone who genuinely needs it brings me so much joy. I truly love what I do.” 

Modern ESL and multilingual families continue to represent more households in our nation every year. Culturally appropriate resources and services and authentic community liaisons can help empower families to navigate a complex health care system and support them in health care decision-making, in any language – helping them to have an active role in their own health. 

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Point32Health is a nonprofit health and wellbeing organization, guiding and empowering healthier lives for all. Bringing together over 90 years of combined expertise and the collective strengths of Harvard Pilgrim Health Care, Tufts Health Plan and our family of companies, we help our members and communities navigate the health care ecosystem through a broad range of health plan offerings and tools.