Journal of Community Health

, Volume 30, Issue 4, pp 299–307 | Cite as

Use Of A Patient Assistant To Facilitate Medical Visits For Latino Patients With Low Health Literacy

  • Mona Sarfaty
  • Christine Hurley Turner
  • Elizabeth Damotta


In the face of limited resources, evidence-based prioritization is needed to maximize the reach of health services for the under-served. A medical referral project that referred low income uninsured individuals to discounted appointments with office-based doctors found that some Latino patients had difficulty in taking advantage of these appointments. These individuals appeared to face barriers beyond the cultural and linguistic barriers faced by most patients in the project. One additional bilingual staff person, a Patient Assistant, was hired to facilitate doctor visits by these patients. The Patient Assistant performed the duties of a navigator, trouble shooter, and interpreter–and assisted with communications. The project staff derived a screening question to encourage patients to identify themselves as those who would need the help of the Patient Assistant. These patients were subsequently questioned in a waiting room survey designed to characterize them. The characteristics of these patients were compared with a comparison group of project patients. The target group and the comparison group differed in their levels of education. Sixty percent of the target group had less than 4 years of schooling compared to 13% of the comparison group. The target group was comprised entirely of immigrants from South and Central America. This report underscores the conclusions of the recent report of the Institute of Medicine on the problem of health literacy – patients’ ability to understand and act in their own interest – and highlights the needs of Latin American immigrants who are burdened by cultural and linguistic barriers, low health literacy, and minimal education.


literacy health literacy cultural competence cultural and linguistic appropriateness interpreter translator navigator case management patient assistant bilingual bicultural Spanish Latino Latin American uninsured immigrant Project Access 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Doty M. Hispanic Patients’ Double Burden: Lack of health Insurance and Limited English. The Commonwealth Fund, 2003. www.cmwf.orgGoogle Scholar
  2. 2.
    Safran, DG, Kosinski, M, Tarlov, AR,  et al. 1998The primary care assessment survey: Tests of data quality and measurement performanceMed Care36728739CrossRefPubMedGoogle Scholar
  3. 3.
    Schmidely AD. Profile of the Foreign Born Population in the United States 2000. Current Population Reports, Washington DC: US Government Printing Office, 2001Google Scholar
  4. 4.
    Educational Attainment of the Population 15 Years and Over, by Age, Sex, Race, and Hispanic Origin, 2003. Current Population Survey 2002. www.census.govGoogle Scholar
  5. 5.
    Otero-Sabogal R, Stewart S, Sabogal F, Brown BA, Perez-Stable EJ. Access and Attitudinal Factors Related to Breast and Cervical Cancer Rescreening: Why are Latinas Still Underscreened? Health Educ Behav 2003; 337–359Google Scholar
  6. 6.
    Committee on Health Literacy. In L Nielsen-Bohlman, AM Panzer, DA Kindig (Eds.), Health Literacy: A Prescription to End Confusion. Washington DC: National Academies Press, 2004. p. 38, www.nap.eduGoogle Scholar
  7. 7. Scholar
  8. 8.
    Baker, DW, Parker, RM, Williams, MV, Clark, WS, Nurss, J 1997The relationship of patient reading ability to self-reported health and use of health servicesAm J Public Health8710271030PubMedGoogle Scholar
  9. 9.
    Baker, DW, Parker, RM, Williams, MV,  et al. 1996The health care experience of patients with low literacyArch Fam Med5329334CrossRefPubMedGoogle Scholar
  10. 10.
    Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health Literacy: Report of the Council on Scientific Affairs. JAMA 1999; 281:552–557.Google Scholar
  11. 11.
    Hawthorne, K, Tomlinson, S 1999Pakistani Moslems with Type 2 diabetes mellitus: Effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic controlDiabet Med16591597CrossRefPubMedGoogle Scholar
  12. 12.
    Caldwell, JC, Caldwell, P 1991What have we learnt about the cultural, social and behavioral determinants of healthHealth Trans. Rev.1319Google Scholar
  13. 13.
    Caldwell, JC 1993Health transition: The cultural, social and behavioral determinants of health in the third worldSoc Sci Med36125135CrossRefPubMedGoogle Scholar
  14. 14.
    Larsen, LJ. The Foreign-Born Population of the United States, 2003. Current Population Reports 2004, Washington DC: U.S. Census Bureau, 2004, pp. 520–551Google Scholar
  15. 15.
    Flores, G, Fuentes-Afflick, E, Barbot, O,  et al. 2002The health of Latino children: Urgent priorities, unanswered questions, and a research agendaJAMA2888290CrossRefPubMedGoogle Scholar
  16. 16.
    Cultural and Linguistic Standards. Office of Minority Health, Department of Health and Human Services, www.omhr.govGoogle Scholar
  17. 17.
    Flores, G, Abreu, M, Schwartz, I, Hill, M 2000The importance of language and culture in pediatric careJ Pediatr137842848CrossRefPubMedGoogle Scholar
  18. 18.
    Flores, G 2000Culture and the patient–physician relationshipJ Pediatr1361423CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Mona Sarfaty
    • 1
  • Christine Hurley Turner
    • 2
  • Elizabeth Damotta
    • 3
  1. 1.School of Public Health and Health Services, Department of Prevention and Community HealthGeorge Washington University, George Washington University School of Public Health and Health ServicesWashingtonUSA
  2. 2.University of Virginia Medical centerRichmond
  3. 3.Children’s National Medical CenterWashington

Personalised recommendations