The Policies Are There, but the Barriers Remain: A Qualitative Study of Health Care Access and Utilization Among Latinx Individuals with Limited English Proficiency

Background and Purpose:
Persistent and widening racial and ethnic health disparities in the United States have renewed attention to systemic barriers that limit equitable access to high-quality care. Latinx individuals, the largest and one of the fastest growing minoritized populations in the U.S., are disproportionately affected, particularly those who speak languages other than English. Prior research highlights Latinx individuals face significant structural barriers to health care access, including limited access to language-concordant services, discrimination, and cost-related obstacles. These barriers have the potential to contribute to fragmented care and poorer health outcomes. Less is known, however, about how these challenges intersect across the patient journey, that is, from identifying a provider to follow-up care. This study examines the healthcare experiences of Latinx individuals with Limited English Proficiency and explores how barriers accumulate across the patient journey, shaping access, utilization, and continuity of care.

Methods:
We conducted three focus groups (N=21) in June 2025 with Spanish-speaking Latinx adults in Hartford, Connecticut. Participants were recruited using non-probability, agency-based sampling in partnership with local organizations serving Spanish-speaking populations. Focus groups explored participants’ experiences of accessing and using healthcare services. Data were transcribed, translated, and managed using NVivo 12. We utilized a thematic analysis approach, with iterative coding and theme development. Findings were organized post hoc using a patient journey mapping framework to capture barriers across five key stages: identifying a provider, scheduling appointments, visit check-in, clinical encounters, and follow-up care. To enhance credibility and accuracy, a summary of findings and recommendations was shared with participants in Spanish, and member checking was conducted.

Results:
Participants (N=21; 19 female) described barriers across all stages of the patient journey. Key challenges included difficulty identifying providers who offer language-concordant care, limited knowledge of available services, and long wait times for appointments. At the point of care, participants reported negative interpersonal interactions with front desk staff, inconsistent availability and quality of interpretation services, and frequent miscommunication with providers. Experiences of discrimination, particularly due to insurance type, and instances of delayed or denied care were also reported. Financial concerns, including fear of medical debt and medication costs, further limited access and adherence. Participants also described challenges navigating healthcare systems, including difficulty using patient portals and coordinating follow-up care. These barriers often compounded across the patient journey, disrupting care continuity, and discouraging ongoing engagement with the healthcare system.

Conclusions and Implications:
Standards for culturally and linguistically appropriate care (CLAS) were established 26 years ago, yet access remains gravely insufficient. The cumulative barriers identified across the patient's journey may contribute to delayed care, reduced healthcare utilization, and poorer health outcomes, and reinforcing persistent health disparities. Findings underscore the need for system-level interventions to improve language access services, strengthen patient-provider communication, and enhance care navigation supports.