(1042) Access to Spanish Language Prescription Medication Labels at Community Pharmacies

Objectives: An estimated 18 million Latinx Americans speak English less than very well, also referred to as limited English proficiency (LEP). Patients with LEP experience a higher rate of medication errors, lower satisfaction with their healthcare provider, and lower medication related self-efficacy than non-LEP patients. Communication using language concordant health information is associated with patient satisfaction, medication adherence, and positive health outcomes. Access to a language concordant label across US community pharmacies is inconsistent. Individuals in our Latinx community reported negative experiences around the access to a language concordant label. Therefore, we evaluated the access to a Spanish language medication label (or "label") from community pharmacies by Latinx patients with LEP.

Methods: We conducted a retrospective cross-sectional study of a convenience sample from a large academic medical center population. Latinx adults (18 years or older) with LEP and receiving at least 2 current prescription medications from a US community pharmacy were eligible to participate. Enrolled participants provided demographic data and responses to closed- and open-ended questions in Spanish during one audio-recorded phone interview. Closed-ended questions included label language preference, ever having received a label in Spanish from a US community pharmacy, knowledge that a label could be requested in Spanish from their community pharmacy, and if they had or would request a label in Spanish. Descriptive statistics were used for quantitative data and are reported in mean, counts, and percentages. Open-ended questions included probing questions such as "Why do you think...?" and third person perspective questions such as "Why would someone...?" to gain a deeper understanding of their quantitative responses. Thematic analysis was used for qualitative data to develop codes, groups of codes, and themes from the transcripts of the phone interviews. Data were analyzed individually in Spanish and English and then discussed collaboratively by 2-3 bilingual researchers to reach a consensus. This observational study received exempt from review status by our institutional review board. Participants received a $25 incentive for completion of the phone interview.

Results: Thirty participants completed a 20±5 minute phone interview from November 2021 to February 2022. Participant mean age was 51±13 years; most were female (n=22; 73%) and of Mexican descent (n=19; 63%). All participants reported that they speak and read English less than very well. All but 1 participant were born outside of the US and have lived in the US for an average of 19±3 years. Most (n=28; 93%) received their formal education in their country of origin.

All participants (N=30; 100%) preferred to receive the label in Spanish. Less than 30% of participants (n=8; 27%) had ever received a label in Spanish from a US community pharmacy; only 13% (n=4) were currently receiving a Spanish language label. Only 20% (n=6) were aware they could request a label in Spanish; 2 participants thought the prescriber had to request. Half (n=13; 50%) of participants not currently receiving a label in Spanish reported that they would request it from their community pharmacy.

Thematic analysis identified 4 main themes around access to a label in Spanish from the perspective of the participant: 1. inability to effectively communicate with English speaking pharmacy staff; 2. perceived relative need of a language concordant label; 3. misinformation about access to a language concordant label; and 4. fear and feeling uncomfortable about attempting communication with pharmacy staff because of "stigma" of being Latinx and LEP.

Conclusions: Over 70% of Latinx participants with LEP had never received a label in Spanish from a US community pharmacy. Future research is needed to elucidate the roles and relative importance of organizational health literacy and provision of language services, and anticipated discrimination around communication with English speaking pharmacy staff.