The impact of language discordance on acquiring broad social history: A qualitative study of patients, clinicians, and interpreters

BACKGROUND: By acquiring a broad social history (BSH), which includes aspects of patients' social needs in addition to their hobbies and activities, values, and perspectives on care, clinicians can provide more patient-centered care, which is known to improve health outcomes. However, the impact of patient-clinician language discordance on acquisition of BSH has not been well studied. 

OBJECTIVE: To ascertain whether language discordance impacts clinicians' acquisition of patients' BSH by interviewing patients, clinicians, and medical interpreters. 

DESIGN: Qualitative study based on semi-structured interviews, followed by thematic analysis using rapid qualitative data analysis methods. 

PARTICIPANTS (OR PATIENTS OR SUBJECTS): We interviewed 8 Spanish-speaking and 5 English-speaking patients seen for primary care within a public hospital in San Francisco, 6 primary care clinicians, and 8 medical interpreters. 

APPROACH: All interviews were recorded and transcribed. The transcriptions were summarized into domains using rapid qualitative data analysis. The summaries were displayed in a matrix and used to generate themes and subthemes. 

KEY RESULTS: Analysis of interviews highlighted two overarching themes concerning BSH acquisition. One theme was the importance of BSH: namely, it is critical for patient-clinician relationships and personalized care. Commonly elicited BSH facets were social drivers of health, but leisure activities were less frequently asked. The second theme described ways in which language discordance, via the need for interpretation, affects the collection of BSH, both through increasing time pressure, and hindering rapport-building strategies. Cultural barriers pose an obstacle to BSH acquisition and may operate independently of language discordance. 

CONCLUSIONS: Our results suggest two action steps for health systems: (a) apportioning more time for language-discordant visits to increase rapport-building and BSH acquisition, and (b) increasing training for clinicians on acquiring BSH when working with interpreters. Further research is needed to investigate the relationship between language discordance, acquisition of BSH, and patient outcomes.