New study bridges the language gap in healthcare

Every day in health clinics across the country, bilingual employees step into exam rooms to help patients and providers understand one another. They translate symptoms, questions, fears and instructions – often without any formal training. These moments can shape the outcome of a visit, yet the nation’s interpreter shortage shows no sign of slowing.

A new study led by Baylor University linguists and physicians with Waco Family Medicine, a local Federally Qualified Healthcare Center, offers a hopeful, practical solution to the interpreter shortage – a replicable and affordable training model that turns heritage Spanish-speaking clinic employees into qualified medical interpreters. By leveraging the unique linguistic and cultural strengths of heritage speakers, the model strengthens communication and improves health equity for millions of patients in a valuable, cost-effective manner.

The research, published in the influential journal Annals of Family Medicine, demonstrates that with the right training, heritage speakers – people who have a cultural connection to Spanish or grew up around it but don’t necessarily speak Spanish at home – can quickly gain the skills needed to interpret accurately and professionally in busy clinics.

A growing need and an untapped resource

The collaboration began years ago with a single day of observation at Waco Family Medicine, when lead author Karol J. Hardin, Ph.D. , professor of Spanish and director of Spanish for Health Professions at Baylor University, noticed that medical interpretation often sounded fluent but was riddled with errors that changed meaning and limited patient care. Some interpretations were accurate, others deeply flawed – and most clinicians had no way to tell the difference.

Watching patients instinctively turn to interpreters for understanding and advocacy, Hardin saw both the risk of miscommunication and the unrealized potential of heritage Spanish speakers who had cultural trust but little formal medical training. That moment sparked a long-term effort to create a practical, human-centered model that strengthens language accuracy while preserving dignity, connection and access in health care settings.

“We like to think that we provide equal care for everybody, but the reality is when you’re getting your care through an interpreter or in another language that you don’t quite understand, you're automatically not getting the same kind of care,” Karol Hardin said.

More than 1,400 community health centers serve more than 31 million Americans – nearly 10% of the U.S. population – and more than a quarter of these patients are best served in a language other than English. Yet many clinics cannot afford the steep cost of remote or in-person professional interpretation, especially since that cost is not reimbursed. That gap often leaves bilingual staff – medical assistants, front-desk workers and receptionists – carrying the weight.

If heritage speakers already embedded in clinics could be formally trained and assessed, health centers could expand language access while meeting federal requirements for qualified interpreters.

“It’s important to recognize and respect the language that people speak because when you are ill, it is challenging (or impossible) to have to speak another language with your doctor,” Karol Hardin said. “We have to be able to communicate with people compassionately and effectively if we're treating them in healthcare.”

Study findings

The research team enrolled 137 Spanish-speaking employees from Waco Family Medicine and guided them through a 40-hour online interpreter training course, along with nationally recognized language proficiency assessments and medical interpretation tests.

Key findings from the study included:

• Heritage speakers significantly underestimated the advanced language skills required for medical interpreting.
• Employees below Intermediate-High proficiency in Spanish were unlikely to become qualified interpreters, even with training, while higher general oral proficiency strongly predicted stronger post-course interpreting scores.
• After completing the online course, participants’ interpreting scores improved substantially.
• 72% of those who completed the process qualified as medical interpreters.

These findings give clinics something they’ve never had before – a data-driven way to identify who is ready for training and who may need more support first.

"An interpreter can make or break a visit,” said corresponding author D. Mike Hardin Jr., M.D., chief clinical officer of Waco Family Medicine and president of the WFM – Institute. “It isn’t easy to both interpret the words of a message and capture the many nuances of communication. It requires language proficiency – but it is also a learned skill. While clinics want to comply with regulations, they often lack the expertise to know how. The process we studied allows any clinic to confidently train and assess an employee to qualify as a dual-role interpreter. It is not a perfect solution, but it moves the needle in the right direction.”

For Jackson Griggs, M.D., CEO of Waco Family Medicine, the impact of this research is significant.

“This highly relevant research offers a practical, evidence-based option to strengthen language access in community health centers,” Griggs said. “Safety and care quality are core priorities for health centers, and that commitment must fully include patients who are more comfortable speaking Spanish.”

A cost-effective model for clinics across the country

Interpreter services can cost up to $3.50 per minute or $150 an hour. The Baylor-supported model costs roughly $500 per employee – a fraction of the ongoing expense of remote or outsourced interpretation.

“Usually when you turn on that remote interpreter, it costs more than the visit by the time you're done,” Karol Hardin said.

Because the program uses widely available online coursework and standard proficiency tests, it is highly portable. Any clinic with bilingual staff can adopt it. And the benefits go far beyond cost savings.

Better communication means:

• Fewer medical errors,
• Clearer diagnoses,
• Stronger relationships between patients and providers,
• Better adherence to care plans and
• Better health outcomes for communities who need them most.

Measuring community impact

For a Spanish linguist, Karol Hardin finds it “profoundly meaningful” when there are practical ways that linguistics can be applied to serve the local community.

“This research highlights how physicians and linguists can work together across disciplines to improve language access for Spanish-speaking patients by creating workplace training that is practical, tailored to a local context and economical even for low-resource clinics,” she said.

The team hopes to expand the work by studying how trained dual-role interpreters affect clinical conversations, patient satisfaction and long-term outcomes such as medication adherence and chronic disease management.

“This model is replicable and affordable and shows promise for community health centers across the country, potentially benefiting millions of people served each year,” Griggs said. “We’re proud to partner with Baylor University on research that helps neighborhoods, families and America’s workforce thrive.”

About the Authors

• D. Mike Hardin Jr., M.D., Chief Clinical Officer and President of Waco Family Medicine — Institute Residency Program
• Jesús Andrés Osornio, B.S. (biology/Spanish, Honors Program) ’22, M.H.A., third-year student doctor at Sam Houston State University, College of Osteopathic Medicine
• José R. Peña III, D.O., former family medicine physician at Waco Family Medicine
• Esther Hur, Ph.D., assistant professor of Spanish Linguistics, Baylor University
• Karol J. Hardin, Ph.D., professor of Spanish, director of Spanish for Health Professions, Baylor University

ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian University and a nationally ranked Research 1 institution. The University provides a vibrant campus community for 20,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 100 countries to study a broad range of degrees among its 12 nationally recognized academic divisions. Learn more about Baylor University at www.baylor.edu.

ABOUT WACO FAMILY MEDICINE

Waco Family Medicine was established in 1969 by the McLennan County Medical Society to address a shortage of doctors, lack of primary care access for low-income community members and economic development issues in Waco. The center was developed from a coalition of business, political, and medical leaders pulling together to solve these community problems. 

The Waco Family Medicine Residency Program, housed at WFM Central site, trains some of the region’s best family physicians with an emphasis on compassion and culturally sensitive care. 

* Federally Qualified Health Center (FQHC) This designation means we treat underserved populations, offer an income-based sliding fee scale, provide comprehensive health services, and qualify for enhanced reimbursement from Medicare and Medicaid, among other requirements and benefits.