Background

Latino patients make up an increasingly larger proportion of the U.S. population and of community pharmacy patients. Little is known about Latino patients’ experiences with health care providers (HCPs), including pharmacists. The study objective was to describe the nature and quality of the interactions between members of a local Spanish-speaking Latina community with their community pharmacists and pharmacy staff.

Methods

One-on-one interviews were conducted with Spanish-speaking Latina adults in a Southern California community. Interview responses were analyzed for themes, subthemes and representative quotes by three independent readers.

Results

Twenty-four Spanish-speaking Latina adults participated in the study. Five themes were identified: experiences with pharmacists/pharmacies; obtaining and using medication; language barriers; obtaining and understanding health information; and suggestions for improvement. Participants described a variety of positive and negative interactions with local community pharmacies, including experiences related to customer service, time waiting for medication and counseling. Issues related to medication use included sources for acquiring medications, use of herbals and limited insurance coverage. Language was a significant barrier for patients’ interactions with their pharmacists and pharmacy staff. Patients utilized multiple sources of health information besides their pharmacist.

Conclusion

In a community with a majority of Latinos in Southern California, Latina community members reported challenges regarding interactions with their pharmacists and pharmacy staff. Pharmacists need to find ways to improve rapport and communication with their Latino patients, to help patients to make effective use of medications, and to provide accurate medical information.

According to the U.S. Census, Latinos make up approximately 18.4% of the U.S. population and are the largest minority group in the U.S.1  The proportion of Latinos is higher in some regions of the country such as Southern California; in particular, in 2019, the Latino population of our geographic research area was 54.4%.2  Pharmacies are a readily accessible source of health care that provide important services to patients.3,4  Financial, language, interpersonal and other barriers have been reported to complicate pharmacist interactions with minority patients.5,6 

While some studies have described the efforts of pharmacists to provide services to Spanish-speaking patients,712  less is known about the experiences of the patients themselves. Few studies have investigated Spanish-speaking patient perspectives about these interactions with pharmacists and pharmacy staff. Olenik and colleagues reported that Spanish-speaking clients found pharmacies to be convenient but reported language concerns and perceived that pharmacists had negative attitudes toward Spanish speakers.6  In a survey of 101 Spanish-speaking patients, Kim-Romo and colleagues reported that patients valued their clinical pharmacists’ cultural rapport with the community, demonstrated through a use of Spanish-language communication and cultural sensitivity.13  Overall, subjects in this latter study were satisfied with their clinical experiences.13  Another study found that Latino patients did not receive prescription information from pharmacies in the Spanish dialect that they desired.14  However, little is known about Spanish-speaking patients’ experiences with pharmacists and pharmacy staff in a Southern California community with a large Latino population.

The objective of this study was to determine the nature and quality of the interactions between a cohort of Spanish-speaking women with their community pharmacists and pharmacy staff in an Inland Empire community in Southern California.

Study Design

This qualitative, descriptive, cross-sectional study was reviewed and approved by the Institutional Review Board of Loma Linda University. Loma Linda University sponsors mentoring/tutoring programs in the nearby underserved, predominantly Latino community, allowing university students to interact with children in a low-resource population via academic tutoring and music instruction. This program provides otherwise inaccessible resources to the community but also provides university students the opportunity to develop skills in cross-cultural communication and cultural competence. Faculty and students from Loma Linda University, including three of the investigators, have volunteered on a regular basis with one of the programs and are well-known by the program participants. This community-engaged approach utilized an existing network of trusting relationships and included an investigator who was a member of the community from which survey participants were obtained. Development of a trusting relationship enables collaboration with the community, and inclusion of a member of the community within the research team facilitates entry into the community, especially when investigating minority populations.15  Data for this study was collected in 2015.

Recruitment of Participants

Family members waiting for children participating in a tutoring program were asked to participate in one-on-one interviews, each interview lasting approximately 45 minutes. A small monetary gift of $20 was offered to all participants for their time. All individuals who were asked agreed to participate in the survey. Survey participants who spoke English as well as Spanish were interviewed in English by the English-speaking investigators. Survey participants who spoke only Spanish were interviewed by a bilingual investigator who was also a member of the community from which survey participants were obtained. The responses of two male family members were not included in the analysis as they shared and referred to the same experiences as their spouses, who were also surveyed.

Survey Tool

Twenty-one questions were formulated by the investigators to explore possible interactions of community members with pharmacists and pharmacy staff (Table 1). The interviewers asked participants to describe their experiences with pharmacists and pharmacy staff: participants were also asked about language resources, participants’ level of comfort and satisfaction with pharmacy services and participants’ sources of health information and medication. Multiple questions were asked per topic (e.g., experiences with pharmacists, language resources, etc.) in order to elicit more detailed descriptions. Consistent with an inductive grounded theory approach no prior hypotheses were generated, allowing conclusions to be drawn directly from the experiences of the survey respondents.16  The bilingual investigator provided the Spanish translation in a dialect appropriate to the community, and the Spanish survey was back-translated by a second independent bilingual individual to confirm its’ accuracy. Questions posed during the interview are listed in Table 1. To avoid caregiver discomfort and the possibility of damaged trust, personal demographic data or specific pharmacy use information was not collected.

Table 1:

Survey questions

Survey questions
Survey questions

Data Analysis

Each conversation was transcribed verbatim, translated into English as necessary by the bilingual investigator and analyzed by three independent readers. Themes were developed inductively from reading the transcription and comments were numerically tagged according to theme. Within each theme, subthemes and representative comments were identified and also numerically tagged. The analyses performed by three independent readers were compared. Similar themes or subthemes were grouped and a final list was developed. The final list of themes and subthemes was renumbered and compared with the original data and with each reader’s analysis. Disagreement among the readers was resolved by consensus. Data from the two male study participants were removed from the analysis, as they shared and referred to the same experiences as their spouses, who were also surveyed. Microsoft Excel 2010 was used for the identification and tagging process. Two community members who participated in the interviews were asked to read the draft results to determine if they were consistent with their experiences; both found the results to be consistent with their experiences.

The focus of this study was the nature of the interaction between Spanish-speaking community members and pharmacists and their pharmacy staff. Previous research has noted language barriers in obtaining and understanding health information are highly correlated themes.7,1719  A post-hoc analysis was performed on selected questions to determine if our results were consistent with previous findings. Although the number of survey respondents was not designed for analysis of numeric data, selected questions from the survey were categorized and compared by Pearson chi-square. IBM SPSS Statistics 2021 was used for this analysis.

The interviews of the 24 female subjects were included in the study. We found the following themes (Table 2):

  • Language barriers (151 comments).

  • Experiences with a pharmacist/pharmacy (114 comments).

  • Obtaining and using medication (113 comments).

  • Obtaining and understanding health information (96 comments).

  • Suggestions for improvement (61 comments).

Table 2:

Themes and Major Subthemes With Numbers of Comments

Themes and Major Subthemes With Numbers of Comments
Themes and Major Subthemes With Numbers of Comments

Language Barriers

Language was reported to affect the ability of participants to interact and obtain information from their pharmacists; brackets represent individual responses. “When I talk to them and they speak to me in English I just say yes, yes. But when they speak to me in Spanish or when they use a translator I ask questions.”[13] “My English is pretty bad. It’s easier for me to talk and describe what I need when they have people who speak Spanish.”[23] Spanish-speaking pharmacists were appreciated but were not always available, especially at night. “The pharmacist speaks Spanish where I go to regularly, but the pharmacist at nighttime they don’t.”[13] However, 18 of 26 participants indicated that either Spanish-speaking employees and/or interpretation services were available at the pharmacies they attended, although five mentioned that available times of language services were limited. “It would improve my pharmacy experience if they have interpreters at night” [22] “Interpreters are helpful when they are there.”[6] Participants did not always request available Spanish resources because of long wait times to access these services or because they felt staff were reluctant to provide them. “The time to wait for a translator is long.”[9] “Some speak Spanish but they don’t want to speak Spanish to me.”[3] “I don’t use them. I feel they don’t want to talk to me.”[2] Seventeen of the 26 participants also indicated that Spanish language labels and/or literature were available on request.

Experiences With a Pharmacist or Pharmacy Staff

Participants were asked several questions regarding their interactions with pharmacists. Although all participants reported some degree of interaction with a local community pharmacist, the extent of contact varied from routine interactions to trusted relationships. “I don’t really talk to them, just pick up and they tell me it’s for pain and I leave.”[26] “They do their job at checking and giving the medications. We have been going to the same pharmacy for years.”[10] “In my case, my pharmacist reminds me to take my meds and explains them to me very well. He is not just someone behind the counter but someone who is aware and cares about my health.”[16] Customer service was important to participants’ pharmacy experiences. Fifty-five comments addressed the participants’ perceptions of the attitude or personality of pharmacy personnel. Accessibility was a related factor that affected participants’ experiences with pharmacists. Fifteen comments described pharmacists as being inaccessible or in too much of a hurry to spend time with patients. “Cold, they’re not friendly. They don’t smile. Some details can make a big difference but they don’t provide them.”[13] “They just told me to go away after telling me the price for a prescription and did not offer to help or say anything else.”[3] “The pharmacist talked to people while drinking coffee and didn’t have time for me. ... I don’t go there anymore.”[14] Participants perceived that the attitudes of pharmacists and/or staff were negatively affected by their (participants’) use of Spanish (eight comments). “The pharmacist gets angry when I ask if they can speak Spanish; it makes me feel bad.”[5] “Sometimes when they do not speak Spanish they make faces.”[13] “The only problem that I have found is that they do not speak Spanish. Sometimes I feel afraid to talk to them because of that.”[21] Thirty-five comments addressed wait time as a concern when obtaining medication or counseling from the pharmacist, and time affected their ability to obtain medication. “It’s easier for me to just get medicine over the counter and not make an appointment with the doctor since appointments are long waits.”[14] “I don’t like to go to the pharmacy. I like the drive through because I have three kids who tend to run around.”[13] Inconvenient store hours was also a concern. Some participants indicated that they were not able to get to the pharmacy during typical working hours. “Not having many hours. And on weekends, sometimes I need medicine and it’s closed.”[15] “Most of my concerns are store hours and medicine prices.”[19]

Obtaining and Using Medication

Forty-eight comments (25 survey respondents) described current or past prescription medication use by someone within the household. Daily or chronic use was mentioned by 14 participants, regular use as needed (allergies, asthma) by three and occasional use by six. Although participants were not asked about health insurance explicitly, five comments mentioned limitations to insurance coverage that decreased prescription medication access. “My allergy medicine is not covered by insurance so I take an over-the-counter one.”[15] “No, no problems with the pharmacy. Just the insurance, my insurance did not cover my medicine but it’s not the fault of the pharmacy.”[25]

Twenty-four comments described household use of over-the-counter (OTC) medications, predominantly vitamins and medications for fever, pain, allergies or flu. Six comments mentioned obtaining prescription products and other medications from Mexico, possibly for economic reasons. “When we go to TJ [Tijuana] my mom gets these meds called XL3 for fever or cold or something like that and antibiotics.”[8] “We used to go get medicine but now we have health insurance. We went to the doctor and bought medicine there [TJ] when we didn’t have insurance; downtown TJ every corner there’s a pharmacy.”[24]

Thirty-five comments reported and/or advocated use of teas, herbals or other alternative products for minor ailments. These were grown at home or obtained from family members or Mexican grocery stores. Manzanilla (chamomile, 10 comments), yerba buena (mint, five comments), commercial mixtures (five comments) and combinations of honey, lemon, garlic and onion (five comments) were most frequently cited, with savila (aloe vera), green tea, ginger and cinnamon were also mentioned. “I believe more natural products are better and should only use medicine for a serious illness or condition.”[14] “The grocery store has a stand with medicine from Mexico, jarabe (syrup) for coughing, ointments containing zinc, and Pomada de la Campana. Those are found in Mexican grocery stores.”[16] “I use chamomile tea, aloe vera and mint regularly. I have my herbs in my garden and my mom brings me dry herbs.”[13]

Obtaining and Understanding Health Information

Doctors and nurses were most frequently mentioned as sources of health information (18 comments), followed by the internet (16 comments), family and friends (12 comments), television or radio (10 comments) and books or magazines including catalogs (eight comments). “I call my insurance for nurse advice before I decide to give anything to my family.”[4] “I take advice from family and doctors. From TV advertisements too.”[21] “I Google everything.”[15] However, for most participants (22/26), the pharmacist was not considered as a source of general health information. “I directly call the pediatrician but not the pharmacist. It never comes to my mind to call the pharmacist.”[13] “I don’t call the pharmacist. For all health issues I call the doctor.”[26] Participants did ask medication-related questions of their pharmacists (35 comments) and preferred in-person discussion rather than telephone conversations. “I never called. I like to do it more in person because the communication is hard for me.”[23] “I have never called a pharmacist to ask questions because they do not speak Spanish and I do not speak English.”[22] Twenty-two comments described satisfactory understanding of medication information, while eight comments described deficiencies in understanding. “I understand everything, I don’t speak English well but I understand English well. So, I am able to understand the instructions, especially how to take medicine and when to take it.”[26] “The medication info they give me is sufficient. If it is not, I keep on asking until I am satisfied.”[25] “Sometimes, pharmacists don’t explain the medication well. Sometimes they think I know but I don’t.”[20] Medication information was reportedly better understood by participants when it was provided in Spanish (eight comments) or in writing (six comments). “Yes, I understand because they say that in Spanish using a translator.”[11] “Nowadays, they give information about all the medication and its side effects, I like reading all of them.”[25] “I like reading the information more than talking to the pharmacist.”[14]

Suggestions for Improvement

When asked what improvements they would suggest, the two most important themes were customer service (22 comments) and language (26 comments). “They should learn customer service to deal with people that do not understand [the English language] or are confused.”[2] “People should be polite when treating others and pharmacists should take classes for that too.”[21] Participants suggested that pharmacies should have Spanish-speaking pharmacists and staff as well as resources that allow pharmacists to communicate with Spanish-speaking patients. They also recommended that pharmacy students learn Spanish. “I think they should learn languages because this is a diverse country and they should learn how to handle people from different backgrounds.”[20] “That they take Spanish classes. More empathy with Spanish speakers. For example, do not say ‘I am sorry I don’t have anybody’ [to interpret] when it’s about health”[12] “Learn different languages. It’s very hard to try to help someone if you can’t talk to them.”[14]

Post-Hoc Correlation

Although the sample size was chosen for qualitative rather than quantitative analysis, answers to questions 1, 2, 16, 17, 18, 19 and 20 were categorized and examined by Pearson chi-square analysis. Results showed a positive correlation between attitude toward pharmacists and the availability of a Spanish speaker (p = 0.002) and between understanding of health information and availability of written resources in Spanish (p = 0.014).

Spanish-speaking community members addressed several issues related to their experiences with pharmacists and pharmacies; these issues mostly involved communication and other barriers to care. This study contributes to the growing research highlighting the need for cultural sensitivity and awareness of social determinants of health as they impact disparities and inequalities.20  Perceived negative attitudes of pharmacists and pharmacy staff were a concern, with comments indicating that pharmacy staff appeared to be annoyed that their clients spoke Spanish. This negative perception of Spanish speakers by health care providers has also been reported by Olenik6  and could contribute to participants’ reluctance to ask pharmacy staff for information. “Health care anxiety associated with needing to use a secondary language could impose an additional barrier between patient and providers,”21  Post-hoc Pearson chi-square results did show a positive correlation between attitude toward pharmacists and the availability of a Spanish speaker (p = 0.002). Participants also believed that lack of time may have contributed to pharmacists’ negative attitudes. Several participants suggested that pharmacists should take Spanish classes to enhance communication and rapport, a suggestion echoed by others.7,8,13,18,19,2225  Work and family schedules further limit participants’ access to pharmacists, further limiting effective interaction.

Lack of insurance has previously been mentioned as a barrier to obtaining health care.6  Although no participants described a current lack of health insurance, seven comments mentioned inadequate drug coverage by their insurance carrier as a limiting factor in obtaining medication. Several participants reported that they obtained medications such as antibiotics from pharmacies in Mexico. Products obtained from Mexico may be cheaper, obtainable without a prescription, and presumed by users to be stronger or better than similar products obtained in the U.S.2629  In addition to prescription and OTC medications, some participants and their families reported concurrent use of teas and herbals, consistent with findings from previous studies.3032  Use of herbals may in fact be underreported, as others have found that Latino patients are reluctant to disclose their use of herbals to health care providers.3133 

Participants most commonly cited doctors and nurses, the internet or family and friends as primary sources of health information but only four mentioned pharmacists. It is not clear why these participants did not prioritize pharmacists. One possibility is that most pharmacy staff in Mexican pharmacies have low levels of training and supervision as well as a financial incentive to sell more products.29  This perceived lack of training of pharmacists could contribute to Latino patients preferring to receive health care information from physicians rather than from pharmacists.14 

Results of this study are consistent with previous reports that Latino patients rely on interpersonal networks as an important source of health information.33  However, participants mentioned the internet more often than friends and family, in contrast to previous reports, indicating less reliance on internet health information in Latino versus non-Latino individuals.3335  Our study participants were somewhat comfortable with using the internet for health information even though the quality of some of the information on the internet may be poor.36  A previous study reported that a majority of patients using the internet (60%) rated the information as being either the “same as” or “better than” the information provided by their physicians. Furthermore, about 60% of these internet searchers did not discuss this information with their health care providers.37 

Availability of Spanish-speaking staff as well as interpretation services was of concern to participants. Lack of language-concordant care is known to be a barrier to provision of effective health care and specifically to understanding of health information.7,1719  In the absence of a Spanish-speaking provider, interpretation has the potential to improve patient care. In a study conducted by Moreno and others where 69% of patients surveyed used interpreter service, patients received significantly more verbal information about the new medication (side effects, medication directions and medication purpose) compared to those who did not have an interpreter.38 

However, our survey participants indicated that they did not always request interpreter services owing to longer wait times for those who requested these services. Similarly, Devraj and Young found that pharmacists reported computer-based and telephone-based language resources to be easily accessible and helpful but nonetheless did not use them, relying instead on other store personnel or family and friends of the patient.22 

Consistent with other research,6,39  17 participants reported having Spanish-language labels and literature available at least some of the time. This is encouraging and some patients utilized these resources. However, there is a possibility that translations could be inaccurate, affecting patients’ use of medication. Some inaccuracies include phrases that could not be translated, spelling errors and incorrect grammar.6,39  Leyva and colleagues found that even with a drug information sheet written in Spanish, only 29% of those surveyed read, understood and administered the medication correctly.19  Zun and colleagues found that the health literacy of Hispanic patients in a trauma center was less than their self-assessment of English would predict, indicating serious potential issues in communication.40  Posthoc Pearson chi-square results showed a positive correlation between understanding of health information and availability of written resources in Spanish (p = 0.014).

Suggestions offered by survey participants echoed themes discussed previously. Language and customer service were especially important, and participants recommended that these skills be taught to pharmacy students. Indeed, cultural sensitivity, empathy and the development of interpersonal skills are included in the Center for Advancement of Pharmacy Education (CAPE) learning outcomes.41 

The study had a number of limitations. First, the study focused on the expressions of a convenience sample of female family members accompanying children who were enrolled in a mentoring program and thus was not representative of the wider community. Second, the survey was created by the investigators in order to reflect the concerns of the community being surveyed and has not been validated. Third, the sample size was small, thus further limiting the generalizability of these study findings. These findings may not apply to all Latino or Latina residents in Southern California or the U.S. as a whole, although results do appear to be consistent with findings previously reported in the literature. Fourth, we cannot determine causality given the cross-sectional nature of the study. Fifth, a grounded theory approach is subject to preexisting biases of investigators generating the questions and themes; other investigators might arrive at different conclusions. However, credibility and entrustability of results were addressed by different methods as described by Lincoln and Guba.42  In particular, results were analyzed by multiple readers, and the written summary was validated by two members of the community. Sixth, due to the close relationships between the investigators and the community, it is possible that some participants may not have been forthcoming in expressing their opinions because of these relationships. Seventh, we did not collect personal information such as age, occupation, education, etc. to maintain privacy and confidentiality.

Even in a community with a Latino majority, Latina community members reported challenges in regard to interactions with their community pharmacies. Most survey participants utilized pharmacies and pharmacy resources and had access to Spanish-language resources, although there were participant responses indicating that these resources were not fully utilized. Pharmacists and the staff they supervise need to find ways to improve rapport and communication with Spanish-speaking patients to help these patients to use medications effectively and to provide accurate medical information. Study participants also reported using alternative sources of information that, if relied upon, could result in harm. Pharmacists should be aware of the possibility of patient self-medication and provide guidance to avoid potential drug overdose, interactions and antibiotic resistance. These potential factors for harm underscore the need to continue development of comprehensive, effective, responsible and accessible health care from our community-based pharmacies.

The authors thank each of the participants for their involvement in this study and Community Academic Partners in Service at Loma Linda University and program volunteers for their facilitation of community outreach. We also thank Ms. Maria Knecht for editorial assistance.

1.
United States Census Bureau.
Quick Facts: United States; San Bernardino County, California; San Bernardino city, California; cV2021 [cited 2022 March 2].
2.
U.S. Department of Health and Human Services office of Minority Health.
Profile: Hispanic/Latino Americans
;
3.
Manolakis
PG,
Skelton
JB.
Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: The emerging role for pharmacists to address the shortage of primary care providers
.
Am J Pharm Educ
2010
Dec
15
;
74
(
10
):
S7
.
doi:
.
4.
Tsuyuki
RT,
Beahm
NP,
Okada
H,
Al Hamarneh
YN.
Pharmacists as accessible primary health care providers: Review of the evidence
.
Can Pharm J (Ott)
2018
Jan
2
;
151
(
1
):
4
5
.
doi:
.
5.
Gonzalvo
J,
Schmelz
A,
Hudmon
KS.
Community pharmacist and technician communication with Spanish-speaking patients: needs assessment
.
J Am Pharm Assoc (2003)
2012
May–Jun
;
52
(
3
):
363
6
.
doi:
.
6.
Olenik
NL,
Gonzalvo
JD,
Snyder
ME,
Nash
CL,
Smith
CT.
Perceptions of Spanish-speaking clientele of patient care services in a community pharmacy
.
Res Social Adm Pharm
2015
Mar–Apr
;
11
(
2
):
241
52
.
doi:
.
Epub 2014 Jul 15.
7.
Dilworth
TJ,
Mott
D,
Young
H.
Pharmacists’ communication with Spanish-speaking patients: a review of the literature to establish an agenda for future research
.
Res Social Adm Pharm.
2009
Jun
;
5
(
2
):
108
120
.
8.
Muzyk
AJ,
Muzyk
TL,
Barnett
CW.
Counseling Spanish-speaking patients: Atlanta pharmacists’ cultural sensitivity, use of language-assistance services, and attitudes
.
J Am Pharm Assoc (2003)
2004
May–Jun
;
44
(
3
):
366
74
.
doi:
.
9.
Young
HN,
Dilworth
TJ,
Mott
DA,
Cox
ED,
Moreno
MA,
Brown
RL.
Pharmacists’ provision of information to Spanish-speaking patients: A social cognitive approach
.
Res Social Adm Pharm
2013
Jan–Feb
;
9
(
1
):
4
12
.
doi:
.
Epub 2012 May 2.
10.
Young
HN,
Hwang
MJ,
Dilworth
TJ,
Mott
D,
Cox
ED,
Moreno
MA.
Development and evaluation of an instrument to measure community pharmacists’ self-efficacy beliefs about communicating with Spanish-speaking patients
.
Res Social Adm Pharm
2011
Dec
;
7
(
4
):
330
7
.
doi:
.
Epub 2010 Oct 2.
11.
Bailey
SC,
Pandit
AU,
Curtis
L,
Wolf
MS.
Availability of Spanish prescription labels: A multi-state pharmacy survey
.
Med Care
2009
Jun
;
47
(
6
):
707
10
.
doi:
.
12.
Weiss
L,
Scherer
M,
Chantarat
T,
Oshiro
T,
Padgen
P,
Pagan
J,
Rosenfeld
P,
Yin
HS.
Assessing the impact of language access regulations on the provision of pharmacy services
.
J Urban Health
2019
Aug
;
96
(
4
):
644
651
.
doi:
.
13.
Kim-Romo
DN,
Barner
JC,
Brown
CM,
Rivera
Jo,
Garza
AA,
Klein-Bradham
K,
Jokerst
J,
et al.
Spanish-speaking patients’ satisfaction with clinical pharmacists’ communication skills and demonstration of cultural sensitivity
.
J Am Pharm Assoc (2003)
2014
Mar–Apr
;
54
(
2
):
121
9
.
doi:
.
14.
Sleath
B,
Blalock
SJ,
Bender
D,
Murray
M,
Cerna
A,
Cohen
MG.
Latinos’ sources of medication and medication information in the United States and their home countries
.
Patient Educ Couns
2009
May
;
75
(
2
):
279
82
.
doi:
.
Epub 2008 Nov 28.
15.
Israel
BA,
Schulz
AJ,
Parker
EA,
Becker
AB.
Review of community-based research: Assessing partnership approaches to improve public health
.
Annu Rev Public Health
1998
;
19
:
173
202
.
doi:
.
16.
Glaser
BG,
Strauss
AL.
The discovery of grounded theory: Strategies for qualitative research
.
Chicago
:
Aldine
;
1967
.
17.
Diamond
L,
Izquierdo
K,
Canfield
D,
Matsoukas
K,
Gany
F.
A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes
.
J Gen Intern Med
2019
Aug
;
34
(
8
):
1591
1606
.
doi:
.
Epub 2019 May 30.
18.
Sleath
B,
Wallace
J.
Providing pharmaceutical care to Spanish-speaking patients
.
J Am Pharm Assoc (Wash)
2002
Sep–Oct
;
42
(
5
):
799
800
.
doi:
.
19.
Leyva
M,
Sharif
I,
Ozuah
PO.
Health literacy among Spanish-speaking Latino parents with limited English proficiency
.
Ambul Pediatr
2005
Jan–Feb
;
5
(
1
):
56
9
.
doi:
.
20.
World Health Organization.
Rio political declaration on social determinants of health
.
Geneva
:
World Health Organization
;
2011
. p.
2
40
. www.who.int/publications/m/item/rio-political-declaration-on-social-determinants-of-health
21.
Zhao
Y,
Segalowitz
N,
Voloshyn
A,
Chamoux
E,
Ryder
AG.
Language barriers to healthcare for linguistic minorities: The case of second language-specific health communication Anxiety
.
Health Commun
2021
Mar
;
36
(
3
):
334
346
.
doi:
.
Epub 2019 Nov 20.
22.
Devraj
R,
Young
HN.
Pharmacy language assistance resources and their association with pharmacists’ self-efficacy in communicating with Spanish-speaking patients
.
Res Social Adm Pharm
2017
Jan–Feb
;
13
(
1
):
123
132
.
doi:
.
Epub 2016 Feb 23.
23.
VanTyle
WK,
Kennedy
G,
Vance
MA,
Hancock
B.
A Spanish language and culture initiative for a doctor of pharmacy curriculum
.
Am J Pharm Educ
2011
Feb
10
;
75
(
1
):
4
.
doi:
.
24.
Mueller
R.
Development and evaluation of an intermediate-level elective course on medical Spanish for pharmacy students
.
Curr Pharm Teach Learn
2017
Mar–Apr
;
9
(
2
):
288
295
.
doi:
.
Epub 2017 Feb 6.
25.
Sleath
B,
Blalock
SJ,
Bender
DE,
Murray
M,
Cerna
A,
Cohen
MG.
Latino patients’ preferences for medication information and pharmacy services
.
J Am Pharm Assoc (2003)
2009
Sep–Oct
;
49
(
5
):
632
6
.
doi:
.
26.
Coffman
MJ,
Shobe
MA,
O’Connell
B.
Self-prescription practices in recent Latino immigrants
.
Public Health Nurs
2008
May–Jun
;
25
(
3
):
203
11
.
doi:
.
27.
Sanchez
J.
Self-medication practices among a sample of Latino migrant workers in South Florida
.
Front Public Health
2014
Aug
4
;
2
:
108
.
doi:
.
eCollection 2014.
28.
Sanchez-Birkhead
AC,
Kennedy
HP,
Callister
LC,
Miyamoto
TP.
Navigating a new health culture: experiences of immigrant Hispanic women
.
J Immigr Minor Health
2011
Dec
;
13
(
6
):
1168
74
.
doi:
.
29.
Homedes
N,
Ugalde
A.
Mexican pharmacies: Benefits and risks for border residents in the United States of America and Mexico
.
Rev Panam Salud Publica
2013
Mar
;
33
(
3
):
196
204
.
doi:
.
30.
Gardiner
P,
Graham
R,
Legedza
AT,
Ahn
AC,
Eisenberg
DM,
Phillips
RS.
Factors associated with herbal therapy use by adults in the United States
.
Altern Ther Health Med
2007
Mar–Apr
;
13
(
2
):
22
29
.
31.
Green
RR,
Santoro
N,
Allshouse
AA,
Neal-Perry
G,
Derby
C.
Prevalence of complementary and alternative medicine and herbal remedy use in Hispanic and Non-Hispanic white women: Results from the Study of Women’s Health Across the Nation
.
J Altern Complement Med
2017
Oct
;
23
(
10
):
805
811
.
doi:
.
Epub 2017 Sep 15.
32.
Malika
NM,
Desai
AK,
Belliard
JC.
Herbal use and medical pluralism among Latinos in Southern California
.
J Community Health
2017
Oct
;
42
(
5
):
949
955
.
doi:
.
33.
Cutilli
CC.
Seeking health information: what sources do your patients use?
Orthop Nurs
2010
May–Jun
;
29
(
3
):
214
9
.
doi:
.
34.
Din
HN,
McDaniels-Davidson
C,
Nodora
J,
Madanat
H.
Profiles of a health information-seeking population and the current digital divide: Cross-sectional analysis of the 2015–2016 California Health Interview Survey
.
J Med Internet Res
2019
May
14
;
21
(
5
):
e11931
.
doi:
.
35.
Gonzalez
M,
Sanders-Jackson
A,
Wright
T.
Web-based health information technology: Access among Latinos varies by subgroup affiliation
.
J Med Internet Res
2019
Apr
16
;
21
(
4
):
e10389
.
doi:
.
36.
Berland
GK,
Elliott
MN,
Morales
LS,
Algazy
JI,
Kravitz
RL,
Broder
MS,
Kanouse
DE,
Muñoz
JA,
Puyol
JA,
Lara
M,
Watkins
KE,
Yang
H,
McGlynn
EA.
Health information on the Internet: Accessibility, quality and readability in English and Spanish
.
JAMA
2001
May
23–30
;
285
(
20
):
2612
21
.
doi:
.
37.
Diaz
JA,
Griffith
RA,
Ng
JJ,
Reinert
SE,
Friedmann
PD,
Moulton
AW.
Patients’ use of the internet for medical information
.
J Gen Intern Med
2002
Mar
;
17
(
3
):
180
5
.
doi:
.
38.
Moreno
G,
Tarn
DM,
Morales
LS.
Impact of interpreters on the receipt of new prescription medication information among Spanish-speaking Latinos
.
Med Care
2009
Dec
;
47
(
12
):
1201
8
.
doi:
.
39.
Sharif
I,
Tse
J.
Accuracy of computer-generated, Spanish-language medicine labels
.
Pediatrics
2010
May
;
125
(
5
):
960
5
.
doi:
.
Epub 2010 Apr 5.
40.
Zun
LS,
Sadoun
T,
Downey
L.
English-language competency of self-declared English-speaking Hispanic patients using written tests of health literacy
.
J Natl Med Assoc
2006
Jun
;
98
(
6
):
912
917
.
41.
Medina
MS,
Plaza
CM,
Stowe
CD,
Robinson
ET,
DeLander
G,
Beck
DE,
et al.
Center for the Advancement of Pharmacy Education 2013 Educational outcomes
.
Am J Pharm Educ
2013
Oct
14
;
77
(
8
):
162
.
doi:
.
42.
Lincoln
YS,
Guba
EG.
Naturalistic inquiry
.
Newbury Park, Calif
:
Sage Publications
;
1985

Funding Support None