Language Access Instruction Outside of Formal Curricula: Insights for Health Promotion and Health Profession Training Programs

Abstract

There is a need for expanded language services in U.S. healthcare and public health systems, and preparing health providers and health educators to work with interpreters is one approach to this end. In this paper, we examine experiences of pre-health and health professions students, health promotion students, and practitioners in an independent online language interpretation training. A state-funded workforce development program provided a 40-hr online medical interpretation training to 80 participants during the 2022–23 academic year. At the close of the program, 17 individuals participated in qualitative interviews regarding their expectations for the training, perceptions of training material and delivery, barriers to participation, personal and professional impact, and reflections on their experiences. Authors coded the interviews through an iterative process and developed matrices to represent the salient themes discovered within the transcript data. Participants were mostly Latina/Hispanic women who were pre-health professions or public health undergraduate students. Participants elected to register for the training, in many cases, because of personal experience with the challenges posed by a language-inaccessible healthcare system. They valued the materials provided and the practical lessons that reinforced the information presented in lectures. Participants’ main feedback was to alter the schedule to be less intensive. There is an existing interest among future providers and educators to be ready to serve patients regardless of the patient’s primary language, but relevant programming is not always accessible to students or professionals. Curriculum developers should consider this demand and the limitations of using an extracurricular interpretation training when developing language access experiences for students.

Keywords

language health access limited English proficiency education

Introduction

Interactions within healthcare and public health systems require linguistically and culturally appropriate communication among providers, educators, and patients. The 5.3 million households that the U.S. Census classifies as “limited English-speaking” households represent just over 4% of all households and millions of individuals (U.S. Census Bureau, 2023). For simplicity, we refer to people who speak English as a second (or more distant) language or not at all as “LX” speakers and people who speak English as a first language as “L1” speakers. While there is considerable diversity among LX speakers, it is well documented that language is an often-unrecognized social determinant of health (Harsch & Santos, 2024). For example, LX speakers report lower satisfaction with primary care providers than L1 speakers (Aelbrecht et al., 2019). Language in healthcare inter‑actions has been implicated in the production of health disparities (Terui, 2017). In the U.S., there are legal requirements for providing language concordant care, including federal protections against national origin discrimination as well as requirements from the Joint Commission (Santos et al., 2022). Thus, language access within healthcare systems and public health programs is vitally important as well as required; training future providers and practitioners on language access is an important strategy to promote inclusion of people whose first language is not the dominant language.

There is an extant literature on preparing future health professionals to work with medical interpreters or medical interpretation services, and perceptions of the roles of interpreters and models of medical interpretation have changed over time (Hsieh, 2024). A recent review and synthesis (Hsueh et al., 2021) examined evidence from research studying minoritized language concordance in health settings (e.g., Spanish-speaking providers and Spanish-speaking patients in the U.S.), finding some evidence of improved outcomes in concordant minoritized language encounters. Studies that provided health professions students with experiential learning opportunities related to working with medical interpreters on a healthcare team found improved confidence in working with LX patients as well as an improved understanding of the role and value of interpretation in the provision of care (Altstaedter, 2017; Nguyen et al., 2024; Quick et al., 2019). Some research has promoted the implementation of organizational trainings under a patient safety framework (Wasserman et al., 2014), and researchers have tested inter-professional trainings (Zhang et al., 2021). However, health professions training programs have expansive remits to train across many topics, which can limit time available for in-depth training on language and interpretation.

A few studies have successfully implemented their own programs to train bilingual medical students as interpreters. At the Penn State College of Medicine, a voluntary 10-to 15-hr program trained 80 bilingual medical students representing 21 languages, finding high satisfaction rates among participants and the opportunity to sit for a certified interpreter exam (Vargas Pelaez et al., 2018). At Loyola University, a program in which 24 bilingual medical students shadowed interpreters and participated in a voluntary 4-hr training had a 71% pass rate on a standardized language assessment (Carlson et al., 2022). Another study demonstrated improved confidence in working across languages by incorporating small-group discussions and trainings into clinical rotation coursework at the University of Minnesota Medical School (Coetzee et al., 2020). In each of these programs, evaluators have focused on quantitative outcomes and on skills. Thus, there is still a critical need to include programs outside of medicine, identify motivations for participation, and leverage exploratory qualitative methods to understand participant experiences in order to expand existing efforts and identify new strategies to improve health professions students’ training on language access.

Regarding the theoretical orientation of this study, we draw on Situated Expectancy-Value Theory (J. S. Eccles & Wigfield, 2020), which is used in pedagogy to examine motivation for learning. It was originally developed to understand gendered differences in science, technology, engineering, and math education (J. Eccles, 1983). Figure 1 shows a simplified version of the theory illustrating how its key domains relate to choices to participate in a medical interpretation training and performance in the training. Norms around language accommodation in healthcare and the personal characteristics of learners influence their beliefs and experiences. Through a series of potential mediators that are beyond the scope of this paper (J. S. Eccles & Wigfield, 2020) these norms influence (1) Expectancy, which relates to one’s belief in being able to perform a task successfully and (2) Subjective-Task Value, which is the importance a person places on the task. Subjective-Task Value is driven by three types of value (i.e., enjoyment, attainment, utility) and by cost. That is, the theory posits potential students are influenced by how enjoyable they think the class will be, how participation fits into their future plans as healthcare professionals, how participation fits with their personal and professional identities, and the costs of participation. Expectancy-Value Theory has been used to understand participation in language training (Loh, 2019; Nagle, 2021; Wang & Xue, 2022) and in medical education, for example, for teaching best practices in how to write clinical notes (Yonder, 2021). Situated Expectancy-Value Theory provides a strong theoretical basis for building greater understanding of motivations to participate in language trainings.

In the present study, we examined the motivations and experiences of pre-health and health professions students, health promotion students, and practitioners participating in medical interpretation training. Our overarching goal was to improve the capacity of the health workforce serving migrant and seasonal agricultural workers to work with interpreters and consider the role of language in healthcare services. The nationally recognized medical interpretation training we offered was designed to prepare participants to become interpreters; however, it also provided fundamentals of working with interpreters in a complimentary role as a provider or educator. Our study sought to explore how an extracurricular training functioned for pre-health and health professions students, health promotion students, and practitioners – many of whom currently worked or planned to work with interpreters but who did not plan to sit for a certified medical interpretation exam. That is, we asked can an existing language-agnostic, “off-the-shelf” training for medical interpreters be a useful strategy for promoting the capacity of current and future healthcare professionals to work in language discordant care and with interpreters? The following specific questions guided our study: (1) What prior experiences of participants motivated them to enroll in an online medical interpretation training? (2) What were their experiences in engaging with the content and delivery? And (3) what suggestions did they have related to medical interpretation training for students and educators?

Methods

Training and Design

This intervention was implemented as part of a Health Resources and Services Administration-funded workforce development program. The goal of the intervention was to improve the capacity of the workforce in North Carolina to serve agricultural workers, many of whom speak Spanish or an Indigenous language. To this end, we engaged an independent contractor to provide a nationally recognized medical interpretation curriculum that qualifies students to sit for a national certification exam. The training is offered in English, and participants are not required to speak or pass a proficiency exam in a second language. It trains pre-health and practicing professionals who are bilingual on becoming a medical interpreter as well as those who are monolingual on working with medical interpreters. Table 1 provides an overview of the training topics covered, resources, and practice activities.

Table 1.

Overview of Medical Interpretation Training.

Training component	Description
Topics covered on nuances of medical interpretation	• Role of medical interpreters (serving as conduits of conversation, demonstrating impartiality, operating within limitations) and working with interpreters • Body positioning (e.g., where to stand, conduct of conversation, pacing) • Cultural interpretations (e.g., idioms, cultural references, social cues) • Learning medical terminology
Resources provided contained practical guidelines for medical interpretation	Textbook, summary sheets, practice books, medical terminology guide, and videos of various medical interpretation scenarios (materials included real-world examples of interpretation)
Practice activities to enhance participant learning	Homework assignments, quizzes, role play, practice of interpretation process, case studies, discussions, and feedback on assignments and activities

A total of 80 students and health professionals participated in the three offerings over the course of the 2022–23 academic year. We recruited participants through email and social media flyers distributed via pre-health advising offices, student organizations and clubs, and peer networks. Students and health professionals living or working in North Carolina were eligible to participate.

The training was offered in two formats: (1) once as 5-hr sessions over eight Saturdays and Sundays (October 2022) and (2) twice as 10-hr sessions across four Saturdays (September 2022 and February/March 2023). We received 57 applications from students at 8 academic institutions and from 8 working professionals for medical interpretation trainings offered in September and October 2022. The September 2022 cohort included 21 participants and was offered on 4 Saturdays for 10 hrs each day. The October 2022 cohort included 33 participants and was offered on 4 Saturdays and 4 Sundays for 5 hrs each day. We received 50 applications from 47 students at 10 academic institutions and from 3 working professionals for the February/March 2023 offering. The February/March cohort included 28 participants and was offered on 4 Saturdays for 10 hrs each day.

Two project team members reviewed all applications (which included demographic and academic information and essay responses); ranked applications based on the applicant’s motivation, likelihood of success, and potential benefit of participating; and presented rankings to the entire project team to come to agreement on admissions decisions. Applicants who did not complete the September or October 2022 offerings were allowed to join a later offering on a case-by-case basis (thus, individual cohort participant numbers do not equal the total number of program participants). All offerings were undertaken on top of participants’ existing class and work schedules. Using a qualitative descriptive research design, we conducted a pragmatic, formative assessment of the use of the training for pre-health and health professions students, health promotion students, and practitioners (Evans et al., 2015).

Study Participants

Our goal was to recruit 20 of the participants in the trainings to participate in an evaluation interview. We based this number on the idea of information power (Malterud et al., 2016), and we used a census sampling approach by inviting all to complete ~30-min semi-structured exit interviews on Microsoft Teams after the completion of training. Participants were recruited via email. Seventeen participants completed interviews and received a $15 gift card as an incentive. The East Carolina University and Medical Center Institutional Review Board approved the research protocol under an exempt determination (#22-001294), and all participants verbally consented to participate.

Data Collection and Instrument

In spring 2023, a research associate trained by the first author on qualitative interview methods conducted interviews using a semi-structured interview guide. The guide (Supplemental File 1) included questions about participants’ expectations for participating in the medical interpretation training, their experiences in taking part in the training, barriers and facilitators of participating in the training, and the impact and benefits of the training for them personally and professionally. The third author and interviewer conferred with the first author throughout data collection to determine when data saturation was reached, that is, no additional insights were emerging from subsequent interviews (Guest et al., 2006). We recorded interviews and used professional transcription, removing personally identifying information.

Analysis

We used NVivo 12 Pro qualitative analysis software to code the transcripts and conduct thematic analysis (Braun & Clarke, 2006). After initial close readings of the transcripts, the first and third authors used an iterative process to develop inductive codes, apply the codes to four transcripts, and refine the codebook. They subsequently coded all transcripts, and the first and third authors met regularly to conduct coding quality and reliability checks. The two coders compared each coded transcripts and discussed coding discrepancies until they reached a consensus. The two coders developed summaries of the code outputs and used them, along with the fieldnotes and memos, to develop matrices examining the motivations and experiences of participants (Miles & Huberman, 1994). This enabled crystallization of themes related to how participants became involved in the program, their engagement with the training content, and lessons learned.

To ensure the rigor of the analysis, we maintained memos and fieldnotes throughout the data collection and analysis process; met regularly with the research team to receive input and maintain transparency; and reflected on our own positionality in relation to the topic (Braun & Clarke, 2022). Rather than try to fit the analysis to our theoretical framework, the analysis was constructed from what participants said and the analysts’ interpretation as an exploration of participants’ experiences with the training and with an eye for how to adapt future training efforts.

Regarding positionality, the coders included a research associate who identifies as cisgender male and is fluent in Spanish as a second language and an associate professor of public health and qualitative health researcher who identifies as a foreign-born Black immigrant and is fluent in four languages. Both coders have extensive experience conducting community-engaged health research with immigrant populations. Due to their individual backgrounds and personal experiences, they are familiar with language barriers and access issues that immigrants experience when attempting to navigate social and health services in the U.S.

Results

Table 2 shows the characteristics of participants. Participants reported a variety of academic backgrounds, including in medicine, nursing, and public health, and stages in their education, including undergraduate students and active practitioners. The average age of participants was 24 years.

Table 2.

Demographic Characteristics of Interview Participants, n = 17.

Demographic characteristic	Response category	Total
Education/career status	Undergraduate	6
	Graduate	8
	Working professional	3
Gender	Men	2
Gender	Women	15
Self-reported racial/ethnic identity	Hispanic	10
	Asian	3
	White	2
	Black, African American	2

Our examination of participants’ experiences in the medical interpretation training program revealed three main themes, including perceptions of (1) the value of language access for improving health equity, (2) beneficial aspects of the training program’s content, and (3) recommendations for future program participants and curriculum developers planning to offer such programs.

Theme 1: Perceived Need for and Interest in Language Access to Promote Health Equity

Participants reported applying for and enrolling in the training after receiving information through various modes, including email announcements, social media, and word of mouth. The backgrounds and interests of the participants informed their decision to pursue the medical interpretation training.

Theme 1.1. Personal Experience Drives Interest in Improving Education and Health Services

Personal prior experiences with issues of language access in healthcare settings informed many participants’ decisions to take the training. One explained, “seeing how [my mom] was treated [as a LX patient], sometimes unfairly, made me want to make sure I never do that to anybody” (P17, nursing student). Another stated, “I used to spend a lot of time in the hospital setting because of my little sister. . . I was always there interpreting. The nurses there were always really helpful” (P10, nursing student). As a result of these experiences, many participants noted the importance of being able to connect linguistically with patients whom they serve, and some wanted to develop their existing informal skills in preparation for working with LX patients in their careers. One health professional participant elaborated: “I was doing some interpretation and some translating, and. . . I realized that I did need to have more of an awareness of the medical interpretation . . . because, of course, it’s a very delicate environment” (P13).

Theme 1.2. Recognition of the Value of Working With Interpreters for Career and Educational Advancement

A majority of participants registered for the training because of their interest in public health and/or working directly with patients. Some participants stated an interest in bolstering their resumes with certifications like this training. For example, one participant explained, “I was passed around this opportunity, and I thought it would be a good idea. Not necessarily because I thought medical interpretation was something that I wanted to do, [but] because medical interpretation would look good on my resume” (P5, pre-medicine undergraduate). Other student participants expressed an interest in working with underserved, marginalized communities (e.g., Spanish speaking, rural, or agricultural). Additionally, one participant mentioned an interest in “global health and helping other people in other parts of the world, especially preventative care” (P1, pre-medicine undergraduate).

Theme 2: Elements of the Stand-Alone Interpreter Training Perceived as Beneficial

Participants highlighted several experiences, including resources and assignments received, as being valuable and identified the benefits of practical lessons from the coursework, real-world examples, and knowledgeable instructors. The training materials were perceived to be useful in meeting the learning needs of various students and health professionals. Moreover, the participants described that the instructors involved students in various ways of practicing health interpretation to solidify their knowledge of what this approach of health services delivery entails.

Theme 2.1. Varied Modes of Training Resources Provision Enhance Learning Experience

In terms of resources provided for the training, several participants noted the value of text materials such as a textbook, summary sheets, and practice books: “The textbook and the guided notes that were provided definitely allowed me to understand the concepts during the week [between sessions]” (P6, pre-medicine undergraduate). Participants also reported receiving a vocabulary list for medical terms in a language of their choice, which they said was a useful tool to enhance their in-class instruction. As one noted, “. . .we never really covered it [vocabulary] much but. . . it was interesting to really know the actual terms for certain things” (P7, public health undergraduate). These resources, in conjunction with various assignments, helped reinforce lessons covered during the training. For example, participants indicated their lessons incorporated interactive assignments where they practiced with classmates and received direct feedback. A participant mirrored the opinions of others in describing the value of this participatory approach: “Those were very useful because what is the point of learning lots of information and not having the platform to practice it” (P1, pre-medicine undergraduate).

Theme 2.2 Interactive Learning Leads to a Deeper Understanding of the Practical Aspects of Medical Interpretation

Activities in the virtual classroom related to practical ways of conducting interpretation sessions – that is, where to stand, how interact, the importance of cultural context, matters relating to the interpreter’s responsibility “in the room” – were instructive and invaluable from the perspectives of nearly all participants. Participants indicated that they learned the importance of cultural interpretation; they reported learning that interpreters need to be aware of idioms, references, and beliefs that might impact communication. The instructors used both examples from videos and real-world scenarios as a starting point for discussions. One participant mentioned, “She [the instructor] used a lot of personal experiences, and I thought that was a good way to show us how everything works” (P10, nursing student). Another stated that it was “very insightful to watch a video, be able to listen, and point out all the things that were done incorrectly by that interpreter where we could tell if that interpreter had been trained” (P16, dental student). This activity enabled the class to directly view the practical importance of what they studied in class. Additionally, a few participants commented on the positive qualities they observed from the instructor. One stated, “The instructor was very helpful. She obviously knew what she was doing. She was experienced, and she wanted us to do our job correctly” (P16, nursing student).

Theme 3: Strategies for Success, Recommendations for Students and Curriculum Developers

Participants were asked how they managed the training and what suggestions they might have for both other students and curriculum developers for future trainings. In addition to providing feedback on their experiences, participants shared recommendations for the instructors or for how the training could be administered differently in the future.

Theme 3.1. Time Commitments and Experiences Integrating Training With Other Responsibilities

All participants had other commitments of school or work, with some participants having to manage the training alongside both. One described, “I was starting finals but mainly I had to give up a day of work because my family runs a food establishment and so I work full days whenever I’m not in school and so I had to give up a day and my parents had to take on a little bit more of the burden” (P2, biology undergraduate).

To stay on top of their obligations while enrolled in the training, most participants reported needing to finish other assignments during the week (prior to weekend class meetings) or to structure their time more rigidly to accommodate the additional workload. For example, one explained, “I just made sure that both of them were a priority. So, I would make sure I got everything done that I needed to for nursing school, to make sure that my Saturdays were free” (P17, nursing student).

Many participants reported that at least reviewing training material immediately following the class, if not completing assigned homework, was important to not fall behind in the highly condensed training. A few echoed the following suggestion for future program participants offered by one participant: “Just find the time to go over what you learned in class when it’s fresh before you forget so that you don’t have to encounter any problems later when you’re trying to do homework or study for the exams” (P1, pre-medicine undergraduate).

Theme 3.2. Recommendations for Improving Training Times, Maintaining Best Practices, and Addressing Program Limitations

Participants expressed that if they could change something about the training, it would be the schedule. Nearly every participant commented on the rigor of the training, the long hours on weekends, and the density of information covered. For example, one participant stated, “I know it’s hard to make a program like this longer than a month, but just so it doesn’t feel like so much information is like being thrown at us in a short period of time, especially since it’s from 8 a.m. It’s a lot” (P3, public health undergraduate). Numerous interviewees shared this kind of feedback, noting the difficulty of staying engaged over such long hours online: “It’s 8 a.m. to 6 p.m., I wish there were more of, like, breaks in between, like even five-min breaks, because it is a long time to be sitting down at a computer” (P14, nursing student). Another participant added that they felt like the information contained in the training could have been covered over a much shorter period.

One participant indicated that some of the medical information conveyed during the training was incorrect, saying “the final course on medical terminology had a lot of, I’d say, pretty substantial misinformation” (P12, medical student). The participant, a third-year medical student, went on to specify that “some of the [inaccurate] things that were said [by the instructor] was that men get osteoporosis less frequently than women because they work outside more often and get more sunlight, and that women need to get Pap smears every year, and that someone who has kidney failure just pees water but retains all of their toxins, things that were just completely not medically accurate at all.”

Other suggested changes included requests for additional interactive practice exercises, which were perceived positively by many participants. Some participants felt that certain homework assignments were superfluous to their learning.

Discussion

Principal Findings

In this research, we sought to explore motivations to participate and experiences related to a novel strategy for increasing language access training among pre-health professions and health professions students and health promotion students outside of their formal training curricula. We used a 40-hr language-agnostic, “off-the-shelf” medical interpretation training program implemented outside of formal curricula. Among the participants, we found clear interest in language access and interpretation, and we found a positive reception to the use of the training for this purpose. Participants described how they valued language accommodation, how – for many – their family or lived experience drove their views on the importance of quality interpretation services in health services, and how improving language accommodation fit with their personal and professional identities.

These findings largely fit with the Situated Expectancy-Value Theory (J. S. Eccles & Wigfield, 2020), and our rich qualitative approach also highlights areas that may be important for program planners and curriculum developers as well as theorists. First, our results resoundingly confirm the importance of the situatedness of the training. That is, our participants’ interest and motivation reflected their personal characteristics (e.g., identity as having LX-speaking parents), their prior experiences with education and healthcare, and their beliefs and behaviors related to the importance of language access. These are all influenced by the cultural milieu of norms around language access, as described by J. S. Eccles and Wigfield (2020), and provide further evidence supporting the decision by Eccles and Wigfield to add “Situated” to Expectancy Value Theory (2020). Second, in this extracurricular training, we did not hear from participants about their expectations of success in the training. Participants had already completed the training at the time of the interviews and thus may have been less focused on expectations of their success. Additionally, a lack of discussion of expectations of success in the training may be related to the fact that participants were already planning for, in, or had completed rigorous health professions training programs, and they did not consider whether they could succeed in an extracurricular training that did not require specific language skills. Third, and again reflecting how Situated Expectancy-Value Theory was developed to understand gendered choices in choosing science, technology, engineering, and math field participation, this study underscores the importance of participants’ lived experiences and identities in pursing extracurricular training. Specifically, experiences with interpretation services in healthcare for LX family members were very salient among our participants. Our results thus suggest an powerful role for present and future participants’ experiencing, witnessing, or wanting to work against poor treatment based on language (i.e., national origin discrimination) in their choices around participation in language access training. These experiences undoubtedly influence participants’ valuation of how well a language training fits with future plans and with one’s personal and professional identity. They also resonate with a reminder from the developers of Situated Expectancy-Value Theory that the role of identity influences all aspects of the model and is not just constrained to the boxes on the left hand side (J. S. Eccles & Wigfield, 2020). Fourth, our findings clearly implicate the importance of cost, which in this case was the time commitment required for participation.

As for implications for curriculum developers specifically, we received positive feedback on the value of the information gained through the training. However, we also identified some challenges of using an “off-the-shelf” interpreter training for pre-health professions and health professions students and health education and promotion students. Specifically, we found (a) voluntary training outside the formal curriculum may draw students who are already interested in or experienced with language discordant encounters and could miss students who would most benefit from the training, (b) the time commitment of the training represented a substantial cost for students with other obligations, and (c) the positioning of the training outside of the formal curriculum may leave room for inaccuracies in medical information. Thus, this strategy may have some value in increasing the capacity of the future health workforce to reduce disparities based on language discordance. But, it is not a perfect strategy for broadly reaching students, and researchers and curriculum developers should consider it as one, imperfect – but beneficial – tool while also considering integrating trainings into formal curricula.

Results in Context

Given the growing population of LX speaking people in the U.S., healthcare systems and public health programs need to be prepared to implement efforts to be inclusive and to promote language access in ways that reduce health inequities. Indeed, there are well-established legal requirements to provide language access (Basu et al., 2017). Training healthcare providers and health promotion practitioners to work with language access services and interpreters will be critically important to ensure legal requirements are met and care management improvements are implemented in ways that improve healthcare access and quality – and ultimately promote fairness in health.

There is a demand for training on this topic. Participants voluntarily participated in this rigorous extracurricular training and were motivated to be more prepared to work with LX populations. While some participants saw value in making their applications to subsequent health professional programs stronger, others were inspired by their own personal or family experiences and professional identities. In addition to supporting our theoretical approach as noted above, this is consistent with other research showing that health professionals’ personal and professional identities and professional practice can be influenced by personal history and experiences (Conway-Hicks & de Groot, 2019).

Integration of language access training into formal education and continuing education/professional development would likely be met with interest and would also reduce trainees’ time burden and the potential for incorrect medical information as a result of training outside of the curriculum. While integration of language access training in medical education is limited, there is some evidence of successful implementation among medical students (Aitken, 2019; Carlson et al., 2022; Coetzee et al., 2020; Vargas Pelaez et al., 2018).

The participants in this program described clear benefits to language access training, and this is consistent with the broader literature on improving language access skills. Medical and dental students have reported greater confidence in working with LX speaking populations after completing language access programs that have been integrated into their regular course work (Altstaedter, 2017; Coetzee et al., 2020; Quick et al., 2019), echoing the benefits identified by many participants in this training. The results of past studies and positive reflections of program participants together suggest the utility of expanding language access training in the standard course of health professions and health promotion education.

Strengths and Limitations

This paper adds a rigorous qualitative analysis of perceptions of a diverse group of students and practitioners to a literature that has largely focused on quantitative outcomes. However, it has limitations. These include its geography, which was limited to a single state, and use of interviews with a convenience sample of participants that limits the study’s generalizability. Additionally, given the small sample size, we did not examine the experiences of subsets of students to understand how racial/ethnic identities and other identities might have shaped perceptions of the program. Further, training health professionals is but one potential intervention. It also does not address other barriers to access to healthcare such as the languages available to patients of healthcare organizations through websites, reception, billing, etc. For example, others have found that many community health centers do not include information in languages commonly used in their catchment area (Rodriguez et al., 2019).

Conclusion

In this study, we found a strong interest among students and professionals in language access training even when offered outside of formal curricula. Use of an existing language-agnostic, “off-the-shelf” training for medical interpreters provided useful information and skills and was positively received. However, this approach of using an existing training for interpreters to train future health professionals has some limitations, specifically related to time and medical accuracy. Combined with legal requirements and professional duties to provide language access in healthcare and health promotion, there is evidence of a critical need to develop language access competency in formal health professions and health promotion education.

Implications

Given the importance of language access in healthcare and health promotion and existing challenges related to ensuring language access despite legal requirements, curriculum developers, educators, and directors of health promotion and health professions training programs should consider the inclusion of language access training for health promotion and health professions students. Clear requirements for language access already exist in health education and health promotion job duties, for example, “utilize program materials developed in the language of and at appropriate reading levels of the priority population” (National Commission for Health Education Credentialing, 2023). However, training programs should consider how language access can be most effectively integrated into formal programs as well as how to maximize use of extracurricular offerings like the one presented here. Additionally, training programs can draw on the experiences, fit with professional plans, and alignment with personal/professional identities for marketing voluntary programs. Without additional focus on how to best deliver skills related to language access, health education, promotion, and services will be stymied.

Supplemental Material

sj-docx-1-php-10.1177_23733799261461796 – Supplemental material for Language Access Instruction Outside of Formal Curricula: Insights for Health Promotion and Health Profession Training Programs

Supplemental material, sj-docx-1-php-10.1177_23733799261461796 for Language Access Instruction Outside of Formal Curricula: Insights for Health Promotion and Health Profession Training Programs by Leslie E. Cofie, Joseph G. L. Lee, Emery L. Harwell, Modjulie A. Moore and Catherine E. LePrevost in Pedagogy in Health Promotion

Footnotes

Acknowledgements

We thank Mahdi Sesay for conducting the interviews and Dr. Julianna Nieuwsma for her expertise with theory.

ORCID iDs

Joseph G. L. Lee

Modjulie A. Moore

Catherine E. LePrevost

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $198,890 with 0% financed with nongovernmental sources (grant number H8F41601). The views contained herein are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online at .

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