Interpreter Access and Language Rights Awareness Among Spanish-Speaking Emergency Department Patients: A Point-of-Care Video Intervention Study

Abstract

Background: Patients with limited English proficiency (LEP) in the United States face significant barriers to safe and equitable healthcare despite federal protections guaranteeing access to qualified interpreter services at no cost. Many patients with LEP remain unaware of these rights, relying instead on informal learning through clinical encounters and community networks which are unreliable pathways that may perpetuate language access disparities. Point-of-care educational interventions grounded in just-in-time and situated learning theory represent a promising but understudied approach to bridging this gap. Objective: The aim was to examine Spanish-speaking emergency department patients’ interpreter access patterns, baseline knowledge of federal language rights, and immediate responses to a brief multilingual point-of-care educational video intervention. Methods: A pre–post survey design was used with a convenience sample of 40 Spanish-speaking adult patients presenting to a large, level 1 trauma center ED in the Southeastern United States between February and April 2025. Participants completed a 22-item iPad-administered Spanish-language survey that included baseline knowledge questions, an embedded 2 min educational video about federal language access rights, and post-video response questions. Descriptive statistics were calculated for quantitative data and thematic analysis was conducted for open-ended responses, with two independent coders achieving substantial inter-rater agreement (κ = 0.75, p < 0.001). Fisher’s exact tests examined associations between interpreter access mode and patient demographic characteristics. Results: Most participants (70%) accessed interpreters passively rather than by self-request, a pattern that did not vary significantly by patient status, age, or length of time in the United States. At baseline, 57.5% knew that federal laws prohibit language discrimination in healthcare and 77.5% knew they were entitled to a free qualified interpreter. Most participants (80%) reported learning something new from the video, with responses centering on rights awareness and anti-discrimination protections. Most participants (70%) reported that knowing their federal rights was helpful, describing increased confidence and reduced anxiety. All participants (100%) reported difficulty communicating without an interpreter and nearly all (97.5%) felt more confident asking questions when one was present. Conclusions: Significant knowledge gaps persist even among patients with some baseline rights awareness; a brief culturally appropriate point-of-care video may meaningfully increase awareness and confidence. The consistently passive pattern of interpreter access across all demographic subgroups underscores the need for proactive institutional practices and patient-facing education that empowers LEP patients to advocate for themselves in healthcare settings.

1. Introduction

In the United States, English proficiency functions as a foundational skill that shapes individuals’ ability to navigate and engage with complex institutions, including healthcare systems. Individuals with a preference for a language other than English and limited English proficiency (LEP) frequently experience barriers to understanding medical information, including diagnoses, treatment plans, and medication instructions (Karliner et al., 2007; Twersky et al., 2024). An estimated 25.7 million people in the United States—approximately 8% of the population ages five and older—have LEP, defined as speaking a language other than English at home and reporting speaking English less than “very well,” a population that has grown substantially over recent decades (U.S. Census Bureau, 2023).

Extensive evidence shows that language barriers are associated with poorer communication, lower quality of care, and higher risk of medical errors, whereas the use of professional interpreters and culturally and linguistically appropriate communication improves comprehension, patient satisfaction, and clinical outcomes; however, such services remain inconsistently available (Karliner et al., 2007; Diamond et al., 2019; KFF, 2023). Without interpreter services, patients with LEP may struggle to accurately convey symptoms, understand diagnoses, or follow treatment instructions, which may compromise the informed consent process and continuity of care (Flores, 2005; McCarthy et al., 2013) disproportionately affecting linguistically marginalized populations (Divi et al., 2007; Flores, 2005). Patients with LEP who do not receive interpreter services are also less likely to ask clarifying questions or disclose sensitive information, further limiting clinicians’ ability to provide safe and effective care (Ngo-Metzger et al., 2003; Schwei et al., 2016). Additionally, the absence of professional interpretation can erode patient trust in the healthcare system, reducing the likelihood of follow-up visits and long-term engagement with care (Jacobs et al., 2004; Ngo-Metzger et al., 2003).

Adult literacy programs, including English as a Second Language (ESL) and Adult Basic Education (ABE) classes, have increasingly been recognized as important settings for health literacy instruction, given their reach among populations who face low literacy, limited English proficiency, and limited familiarity with the U.S. health system (Rudd, 2007; Paasche-Orlow & Wolf, 2007). Health literacy—defined as the degree to which individuals can obtain, process, and understand basic health information needed to make appropriate health decisions (Berkman et al., 2011; Ratzan & Parker, 2000)—is strongly associated with educational attainment and English language proficiency, making adult education settings a logical venue for intervention (Sentell & Braun, 2012). Studies have shown that integrating health literacy content into adult education curricula can improve participants’ ability to navigate the health system, communicate with providers, and manage chronic conditions (Rudd & Comings, 1994; Muscat et al., 2020; Muscat, 2024). However, health literacy instruction in these settings remains inconsistent and is rarely standardized, with most programs lacking dedicated curricula, trained instructors, or systematic assessment of health literacy outcomes (Rudd, 2007; Muscat et al., 2020). Furthermore, existing health literacy content in adult education programs tends to focus on general wellness and disease prevention rather than on the specific navigational competencies—such as understanding patient rights, requesting interpreter services, or communicating effectively with emergency providers—that adults with LEP most need to engage safely and effectively with the healthcare system (Paasche-Orlow & Wolf, 2007; Howard et al., 2006).

This study is grounded at the intersection of adult learning theory and health literacy research, drawing on three complementary theoretical constructs to explain how people with LEP acquire knowledge about their rights and how point-of-care educational tools may support that process. Situated learning theory (Lave & Wenger, 1991) holds that learning is fundamentally embedded in authentic activity and context, positioning the emergency department (ED) not only as a site of care but as a potential site of learning where patients acquire navigational knowledge through direct participation in clinical encounters (Flores, 2005; Karliner et al., 2007). Much of what patients with LEP learn about the health system occurs instead through incidental learning (Marsick & Watkins, 1990)—as an unintentional byproduct of clinical encounters, family interactions, and informal social networks—a pathway that is inherently unreliable and not systematically oriented toward patient empowerment or rights awareness (Grubbs et al., 2006). In high-acuity, time-pressured environments such as the emergency department (ED), where cognitive load is elevated and patients are unlikely to seek or retain information that is not immediately relevant, just-in-time learning theory supports the delivery of targeted, actionable information at the precise moment of need (Sweller, 1988; Mayer, 2009). Together, these three perspectives suggest that health education for people with LEP may be most effective when it is contextually embedded, linguistically appropriate, and delivered at the point of care—and that intentionally designed educational interventions represent a theoretically grounded strategy for addressing the structural inequities that language barriers produce in healthcare.

The current study examines a brief, multilingual video intervention delivered at the point of care in the emergency department, designed to leverage the just-in-time learning moment to increase awareness among patients with LEP of their federally protected right to a professional interpreter—transforming an incidental and often missed learning opportunity into an intentional educational experience. In the U.S., patients with LEP who receive healthcare in any facility that receives federal funds are entitled to an interpreter at no charge as provided for by federal policies such as Title VI and Section 1557. (Flores, 2005; U.S. Department of Health and Human Services, Office for Civil Rights, 2016). Patient awareness of the right to request an interpreter is a critical but often overlooked component of language access, as many patients with LEP do not know this right exists and therefore do not advocate for themselves during clinical encounters (Karliner et al., 2007; Ngai et al., 2016). Without this knowledge, patients may silently accept inadequate communication, rely on family members or attempt to navigate complex medical interactions in a language they do not fully understand, increasing the likelihood of misunderstanding and harm (Flores, 2005; Ngai et al., 2016). These encounters can be important informal educational moments that add to existing foundational English and healthcare system navigation skills. This study explores the value of a brief, in-language educational video that provides information about language access rights. Specifically, we sought to describe how Spanish-speaking adults access interpreters, understand knowledge of federal language rights and explore the effects of a short educational video. We also sought to compare interpreter access for patients on demographic qualities (patient status new vs returning, age, length of time in the U.S.).

2. Material and Methods

2.1. Study Design and Setting

This study consisted of a baseline survey, an embedded educational exposure, and immediate post-exposure questions. This study was conducted at a large, level 1 trauma center emergency department (ED) in the Southeastern U.S from February 2025 to April 2025. The emergency department is part of a public safety net hospital serving several counties in Georgia. The ED sees more than 140,000 patients annually with approximately 10% seeking language assistance.

We focused on Spanish-speaking patients; eligible participants included adults aged 18 or older presenting to the ED for care. Patients presenting for routine dialysis were excluded; the ED at this hospital has an outpatient dialysis unit and those patients presenting for dialysis were not actually ED patients. Using a convenience sample method, all other patients except those who were acutely ill and required immediate emergent care were approached to participate. Some were unable or unwilling to provide informed consent. Patients deemed inappropriate for other clinical reasons were excluded by the attending clinician. This study was approved by two university institutional review boards and the Grady Research Oversight Committee.

2.2. Study Procedures

Eligible patients were identified between 9:00 AM and 6:00 PM while waiting in emergency department rooms to be seen by clinicians. Two ED interpreters reviewed admission records and based on study inclusion criteria, identified potential study participants. Study team members included the 2 ED interpreters, a graduate research assistant, and the study project manager; as a team, they were present in the ED three half-days per week. Recruitment days and times varied from week to week depending on presence of study team members and included different times and days of the week (excluding nights and weekends based on hospital administration request). A study team member accompanied the ED interpreter into the patient’s room and with assistance from the interpreter, explained the study details and obtained informed consent. A copy of the informed consent in Spanish was given to each participant.

After providing consent, participants completed a short survey administered on an iPad. The 22-item survey questions were investigator-designed and based on prior surveys of patients in this ED. The survey was a combination of multiple-choice response and open-ended questions, and covered topics of interpreter access, knowledge of language rights, use of interpreters, responses to the video, and demographics. The survey was originally designed in English and was then translated into Spanish and back translated into English to confirm both linguistic accuracy and content/meaning accuracy by two different professional interpreters.

As part of the survey (after question 6), participants watched a 2 min Spanish language video about language access rights and interpreter services. Two questions regarding language access knowledge came from a 2023 study with 477 multilingual community-based participants who saw a similar video in their own language (Feinberg, 2023; Ogrodnick et al., 2025). These questions were asked before the participants saw the video. The video was created in English using plain language guidelines (Plain Language Action and Information Network, 2011) and health literacy principles of understandability and actionability (Agency for Healthcare Research and Quality, 2020). Spanish-speaking community members participated in the video development through in-language focus groups to ensure cultural and linguistic appropriateness. The script included a description of federal laws guaranteeing interpreter access for patients who receive healthcare in a facility that accepts federal funds and actions to take to ask for an interpreter. The video was analyzed using the PEMAT-AV (Agency for Healthcare Research and Quality, 2020) by two independent researchers experienced with using the PEMAT-AV. The video scored an average of 100% for understandability and 100% for actionability. The video was then translated into Spanish and back translated into English to confirm both linguistic accuracy and content/meaning accuracy by different professional Spanish/English interpreters.

Participants could complete the survey independently in Spanish or have the survey read out loud. All responses were entered in Qualtrics either directly by the participant or with assistance of the ED interpreter. At the completion of the survey, participants were asked demographic questions (e.g., sex, age, time in the U.S., birthplace, English proficiency). Participants received $30 compensation for completing the survey.

2.3. Data Analysis

For quantitative data, descriptive statistics were calculated, including frequencies and percentages for categorical variables and means and standard deviations for continuous variables using SPSS v26. We used NVivo15 for qualitative analysis. Qualitative open-ended responses were analyzed using thematic analysis according to a codebook with the following coding groupings: quality of communicating without an interpreter, being understood in own language, confidence with interpreter, and quality of care in own language. Two researchers coded the data independently. A Cohen’s kappa analysis (Cohen, 1960) was run to determine agreement between two raters, resulting in substantial agreement (k = 0.75, p < 0.001).

3. Results

3.1. Participant Characteristics

A total of 60 Spanish-speaking patients were approached to be in the study; 40 Spanish-speaking participants consented and completed the survey. The survey took an average of 16.7 min to complete, including the 2 min video. Of the 35 participants who completed demographic questions, over half were male (n = 19, 54.3%) and over half were patients who previously presented to the ED (n = 22, 55.0%). Five participants declined to answer several demographic questions but completed the other survey questions. The age range of participants was 18–76 with a mean age of 46.1 (14.4). The number of years participants lived in the U.S. ranged from 1 to 34 with a mean of 16.6 (10.6) years and median of 20 years. Most (n = 32, 80.0%) reported they spoke English medium-well with only one participant reporting they spoke English very well. More than half were from Mexico (n = 23, 57.5%). Demographic characteristics are summarized in Table 1.

Table 1. Patient demographics (n = 40).

		Patient Status
	Total Sample n = 40	Returning n = 22 (55.5%)	New n = 18 (45.0%)
Gender	n = 35	18	17
Male	19 (54.3%)	9 (50.0%)	10 (55.6%)
Female	16 (45.7%)	9 (50.0%)	7 (38.9%)
Declined *	5 (--)	4 (--)	1 (--)
Age (years)	n = 35
Range	18–76
Mean (SD)	46.1 (14.4)
Median	47
Declined *	5
Time in U.S. (years)	n = 33
Range	18–76
Mean (SD)	16.6 (10.6)
Median	20
Declined *	7
English Proficiency	n = 40
Speak Very Well	1 (2.5%)
Speak Medium	32 (80.0%)
Speak Not Very Well	7 (17.5%)
Birthplace	n = 33
Mexico	23 (69.7%)
Central America	6 (18.2%)
South America	4 (12.1%)
Declined *	7

* The same 5 participants who declined to respond to gender also declined to respond to age, time in U.S. and birthplace.

3.2. Interpreter Access

Patients were asked how they accessed an interpreter in the ED (How did you get an interpreter?). Response options included: I asked for one, one was offered to me at registration or by a staff member, one showed up in my room, I used the ISpeak tool (a written document with multiple languages asking if patient wants an interpreter) (U.S. Census Bureau, n.d.) or other. We organized these responses as either active (I asked for one/I used the ISpeak tool) or passive (one was offered to me/one showed up in my room). More than 2/3 (n = 28, 70.0%) were offered an interpreter at registration or a staff member offered one, thus receiving interpreter services passively. This was true regardless of the patient status (new or returning). Fisher’s exact tests (Fisher, 1922) were used to determine the relationship between patient status (new vs. returning), length of time in the U.S., and age and interpreter access mode; none were significant (OR = 1.14, OR = 1.26, OR—1.32 respectively, p = 1.000 for all). See Table 2 for details.

Table 2. How patients accessed an interpreter in Grady ED (n = 40).

	All Patients (n = 40)		Returning (n = 22)		New (n = 18)
	n	%	n	%	n	%
ACTIVE: I or my family member asked for one	9	22.50%	6	27.27%	3	16.67%
ACTIVE: I used the “iSpeak” tool to ask for one	1	2.50%	0	0	1	5.56%
Subtotal ACTIVE	10	25.00%	6	27.27%	4	22.22%
PASSIVE: One was offered at registration or staff member offered one	19	47.50%	11	50.00%	8	44.44%
PASSIVE: Interpreter showed up in my room	9	22.50%	4	18.18%	5	27.78%
Subtotal PASSIVE	28	70.00%	15	68.18%	13	72.22%
Other	2	5.00%	1 *	4.55%	1 **	5.56%

* Other response: “Yes”, ** Other response: “My wife speaks English, so they didn’t give me an interpreter.”

3.3. Knowledge of Federal Language Rights/Interpreter Access Rights

Participants were asked two true–false questions before they watched the video to assess baseline knowledge of federal laws and interpreter access rights. For the first question (Is the following statement true?—There are federal laws against language discrimination for non-native English speakers when they come to a hospital to get healthcare.), which assessed awareness that federal laws prohibit language discrimination in healthcare settings, more than half of patients (n = 23, 57.5%) selected “true” indicating that just over ½ of patients knew there were federal laws protecting language access. For the second question (Is the following statement true?—Under federal law, I have the right to a qualified medical interpreter at no cost.), which assessed understanding that qualified medical interpreter services must be provided at no cost to the patient, over two-thirds (n = 31, 77.5%) of patients selected “true”, indicating that ¾ of patients knew they had a right to an interpreter at no cost.

3.4. Impact of Brief Educational Video

Participants were asked whether they learned anything new from the video and whether knowing they had a federal right to an interpreter was helpful. Most participants (n = 32, 80%) reported learning something new from the video. The other 20% reported they did not learn anything new from the video. Most open-ended responses fell under the theme of having the right to have an interpreter. Open-ended responses include patient’s perceptions such as: “I have the rights to ask for an interpreter.; “Learned about discrimination and the government laws regarding it.”; and “That it is against the law to discriminate based on religion, color of my skin or language.” One interesting comment was “The hospital has interpreters 24 h a day” which was not stated in the video.

When asked “Does it help you to know that you have a federal right to an interpreter?” most participants (n = 28, 70%) reported that it did help knowing they had this right. Open-ended responses when asked to describe how it helps included: “To have more confidence when arriving at the hospital.”; “It makes it easier for me to communicate with doctors, and I understand my medical process better.”; “I feel more secure and calm that they will speak to me in my language.”; and “I’m not going to worry about there being a misunderstanding anymore.” One interesting comment was “Because at any moment if I encounter police or anything like that i know that i can obtain an interpreter”.

3.5. Perceived Benefits of In-Language Healthcare When Communicating with Healthcare Provider

Participants were asked about experiences communicating with their doctor. First, we assessed their self-reported ability to speak English (very well 2.5%, medium 80%, not very well 17.5%). All participants reported having a lot of trouble communicating with their doctor or nurse without an interpreter and reported that they understand more of what is wrong with them and how to take better care of themselves when explained in their own language. Almost all participants (n = 39, 97.5%) reported feeling more confident asking healthcare providers questions when they have an interpreter. See Table 3 for sample open-ended responses to these questions.

Table 3. Perceived benefits of in-language healthcare when communicating with healthcare provider.

Statements	Responses (n = 40)	Responses when Prompted “Can You Share an Example”
I have trouble communicating with my doctor or nurse without an interpreter. Responses:	A lot 25 (62.5%) A medium amount 7 (17.5%) A little 8 (20%)	I only know enough English to do my job, but here in the medical field it is very difficult for me. I said what hurt but I couldn’t explain myself well. Because at my age instead of learning english i am actually forgetting it. Because i would not understand anything.
I understand more about what is wrong with me when it is explained in my own language.	Yes 40 (100%) Somewhat 0 (0%) No 0 (0%)	Because when an interpreter explains to me in my own language, I can understand if something is right or not in my opinion, and if someone speaks to me in English, I hardly understand anything. I knew what my medications were and what they were for. It is much easier to understand my own language Because these are serious matters and we have to know what is happening.
I feel more confident asking my doctor or nurse questions when I have an interpreter.	Yes 39 (97.5%) Somewhat 0 (0%) No 0 (2.5%)	I can ask any question without making a mistake. Because I’m sure of what they want to tell me At another appointment i asked my doctor about the medications i was getting because it seemed to be too many. With the interpreter her was able to explain that it was due to my eye having an infection plus my diabetes. I feel more comfortable to ask questions because there someone here who understands me.
I understand how to take care of myself better when it is explained in my own language	Yes 40 (100%) Somewhat 0 (0%) No 0 (0%)	When I explain myself in Spanish I understand it much better. There are things that I only understand in my language. Because for example earlier i was about to be given a medication that i may not need and i was able to express myself and understand better. For example, the dosage of medications, the schedules and how it affects our body.

4. Discussion

This study provides insights into how people with LEP navigate interpreter access in the ED, their feelings about having an interpreter, and their perceptions about learning they have a federal right to access an interpreter at no cost.

People with LEP acquire knowledge about accessing healthcare through informal social networks, direct clinical experiences, and sporadic formal instruction in adult education settings. From an educational perspective, this patchwork of learning opportunities reflects a broader absence of intentional, structured health navigation curricula designed for linguistically diverse adult learners (Rudd, 2007; Jacobson et al., 2016). Adult education programs, including English as a Second Language and civics courses, represent an underutilized but promising context for delivering health literacy instruction, given that they already serve many individuals with LEP and can provide linguistically and culturally appropriate learning environments (Sentell & Braun, 2012; Soto Mas et al., 2015). Integrating explicit instruction on health system navigation—including patients’ rights, interpreter access, and how to communicate with providers—into existing adult education frameworks could help bridge the knowledge gap that leaves many people with LEP underprepared to advocate for themselves in clinical settings (Jacobson et al., 2016; Rudd, 2007).

Just-in-time learning—the delivery of targeted, actionable information at the precise moment of need—may be an effective strategy for health education in acute care settings, where patients are highly motivated to understand and act on information directly relevant to their immediate situation (Mayer, 2009; Sweller, 1988). Unlike didactic instruction delivered in formal educational settings, just-in-time health information is contextually anchored, meaning that patients encounter it in direct relation to a lived experience, which may enhance learning, relevance, and retention (Lave & Wenger, 1991; Marsick & Watkins, 1990). There is growing evidence that health education delivered at the point of care—even in brief, single-encounter formats—can have some lasting effects on patient knowledge, self-efficacy, and health-seeking behavior beyond the immediate clinical encounter (Berkman et al., 2011; Paasche-Orlow & Wolf, 2007). This potential for durable impact is particularly salient when understood through the lens of critical health literacy, which moves beyond the functional ability to read and follow health instructions toward a higher-order capacity to take what is learned and apply it in a future situation (Nutbeam, 2000; Freedman et al., 2009). From this perspective, a just-in-time intervention that informs a patient with LEP of their right to an interpreter does more than resolve an immediate communication need—it may initiate a process that patients apply during future healthcare encounters, enabling patients to advocate for themselves more effectively over time (Nutbeam, 2008; Schulz & Nakamoto, 2013). This aligns with broader goals in adult education around the development of learner agency and empowerment, suggesting that well-designed point-of-care tools may have the potential to function not merely as informational aids but as catalysts for longer-term health literacy development among populations with LEP (Nutbeam, 2000).

One participant reported they did not request a qualified medical interpreter because their spouse spoke English. While family members, friends, and bilingual staff are commonly used as informal interpreters in healthcare settings, a substantial body of evidence demonstrates that these arrangements introduce significant risks that qualified medical interpreters are specifically trained to avoid (Flores, 2005; Karliner et al., 2007). Informal interpreters frequently lack the medical terminology, ethical training, and procedural knowledge required to accurately convey complex clinical information, and are more likely to omit, add, or alter information in ways that compromise clinical accuracy and patient safety (Flores, 2005; Divi et al., 2007). The use of family members as interpreters raises ethical concerns around confidentiality, as patients may be unwilling to disclose sensitive information in the presence of a relative, potentially leading to incomplete histories and inappropriate or delayed care (Karliner et al., 2007; Schenker et al., 2008). Children are especially problematic as interpreters, as they may lack the cognitive and emotional maturity to manage complex medical content, and their use places an inappropriate burden on minors while exposing them to information that may be distressing or developmentally inappropriate (Flores, 2005). By contrast, qualified medical interpreters are bound by professional codes of ethics requiring accuracy, impartiality, and confidentiality, and research consistently demonstrates that their use is associated with improved comprehension, reduced medical errors, greater patient satisfaction, and clinical outcomes comparable to those of English-speaking patients (Karliner et al., 2007; Flores, 2005; Divi et al., 2007).

Empowering patients with LEP to request interpreters supports shared decision-making, strengthens the therapeutic relationship, and promotes greater engagement with preventive and follow-up care (Betancourt et al., 2003; Schwei et al., 2016). Although over 2/3 of our study participants (70.0%) reported that an interpreter was proactively offered or showed up in their room, the remaining participants had to advocate for themselves to get an interpreter despite self-identifying at admissions as a native Spanish speaker. These findings highlight variability in how people with LEP receive language assistance at this ED and may underscore inconsistencies in institutional processes—despite federal mandates for meaningful language access (Flores, 2005; Karliner et al., 2007). Such inconsistencies may contribute to uncertainty and uneven informal learning about interpreter availability and patients’ rights, a pattern echoed in prior research showing that routine organizational practices serve as powerful informal “lessons” shaping patient expectations (Brach et al., 2012).

Despite these variable experiences, almost 2/3 of participants demonstrated baseline knowledge of federal language rights, with 57.5% knowing that language discrimination is prohibited in healthcare settings by federal laws and 77.5% knowing that qualified medical interpreters must be provided at no cost to the patient. These findings are similar to our 2023 study with 477 non-native English speaking community-dwelling participants where 48% knew about federal language laws and 63% knew that qualified medical interpreters must be provided at no cost to the patient (Feinberg, 2023; Ogrodnick et al., 2025). In both studies, these results indicate knowledge gaps, aligning with previous studies documenting that people with LEP often lack reliable, formalized information and instruction about language access and interpreter rights (Grubbs et al., 2006; Linares, 2025). Persistent knowledge gaps may suggest a need for intentional, structured educational interventions—grounded in just-in-time and situated learning principles—that meet LEP patients at the point of care and provide the kind of reliable, actionable information that informal networks and incidental encounters alone cannot consistently deliver (Lave & Wenger, 1991; Nutbeam, 2000).

All respondents (100%) reported understanding their health condition and self-care instructions better when information was delivered in their own language. Nearly all (97.5%) reported feeling more confident asking questions when an interpreter was present. These consistent findings highlight the central role interpreter services play in fostering comprehension, shared understanding, and patient-centered communication—key components of high-quality, equitable care (Institute of Medicine, 2004). From an educational standpoint, these findings reflect situated learning theory, which holds that meaningful learning is most likely to occur when information is delivered in a language and context that allows full participation—a condition that qualified interpreter services uniquely enable for patients with LEP (Lave & Wenger, 1991). Interpreter services function not merely as a communication support but as a foundational precondition for the kind of informed, engaged patient participation that underlies both safe clinical care and longer-term health literacy development (Nutbeam, 2008; Paasche-Orlow & Wolf, 2007).

Limitations

This study has several limitations. It was conducted in a single emergency department with a small sample using convenience sampling, which limits generalizability to other settings or linguistic groups. Recruitment occurred only during daytime weekday hours as requested by hospital administration, which may have limited the population we could draw from. All data were self-reported, introducing potential recall and social desirability biases, especially regarding how patients accessed interpreters or what they learned from the video. The hospital interpreters provided access to the patients and were part of our study team; our data may be further biased due to interpreter influence and response shaping. The possible influence of social desirability and the data collection context may have caused our findings to be highly positive with near-uniform responses. The study also assessed only immediate post-video knowledge and self-efficacy, so there was no evaluation of pre–post knowledge gain; additionally, longer-term retention and behavioral impacts remain unknown. Finally, because the study focused on Spanish speakers and our sample was 50% from Mexico, the findings may not reflect the experiences of other Spanish-speaking or non-Spanish-speaking patient populations.