Event 1: Meet Luisa

Luisa Sanchez is a 69-year-old Hispanic woman who is having acute neck pain. Her pain began two weeks ago, after she spent two days making tamales for a church function. She only speaks Spanish. Throughout this case, you'll see videos of both Luisa speaking in her native language as well as a medical interpreter translating for Luisa into English.

Introduction to Mrs. Sanchez.

Medical Interpretation


"Hi, my name is Luisa. I am coming to see the doctor because my neck hurts. It started about 2 weeks ago.  I was making tamales for two days to get ready for an event at church. The pain started at the end of the first day. The pain is in the back of my neck and I have some headaches but not every day.  I am having trouble driving, going to church, taking care of things around the house, and taking care of my grandchildren. I am 69 years old and I live at home with my husband, one of my daughters and 2 grandchildren.  I have 4 children and 12 grandchildren. I came to the United States 50 years ago with my husband. I miss going to church and visiting with others in my community."


There are three main events that will be covered in this module. The first event is Luisa’s visit with a primary care provider, followed by physical therapy outpatient referral which consist of two visits- initial visit and discharge visit, and then a visit with a primary care provider for recheck.

Language and Cultural Barriers in the Hispanic Population in Iowa

Let’s discuss language and cultural barriers that exist in the Hispanic population in Iowa.

Education and Language


There are 57.5 million (18%) of United States population as of 2016, and Hispanics are the 2nd largest racial or ethnic group after whites.

Immigrant Information

34.4% of Latinos are immigrants, and about 72.4% of immigrants have lived in the United States for more than 10 years.

English Language Proficiency

37 million people, ages 5 and older speak Spanish at home.

Educational Attainment and Education

61.3% graduate from high school, 23.6% complete some college or a 2-year degree, and just about 15% of Hispanics have a bachelor’s degree or higher.

Barriers: Hispanic Population Description and Income in Iowa

The Iowa Latino population in Iowa totals approximately 189, 818 people.

In Johnson County, where Luisa lives, Hispanic individuals make up approximately 5.7% of the population. It is common for Latino grandparents to be living with their grandchildren, and it’s about one third or 3,452 people are responsible for the care of their grandchildren.

Based on a 2017 report from the State of Iowa, the country of origin for Hispanics is varied.  The countries of origin and the percent of the Latino population include: Mexico 77.6%, Puerto Rico 4.1%, Guatemala 2.9%, El Salvador 2.7%, and Cuba 2.0%.


Hispanic Population and Income in Iowa
Metric Hispanics Iowa
Median Household Income $46,376 $58570
Health Insurance Coverage 13.9% 4.7%
Poverty Rate 18.0% 10.7%
High School Education 62.7% 92.1%
Unemployment Rate 5.7% 3.6%
Own Home 48.4% 71.6%


Latinos in Iowa: State Library of Iowa and The Office of Latino Affairs, September 2018

Barriers: Hispanic English Language Proficiency in Iowa

English proficiency is the ability to use English for verbal and written communication. For the Hispanic population, English proficiency can be another barrier for education, language, employment and culture in the United States. In the state of Iowa, 55% of those with limited English proficiency communicate with Spanish. In Johnson County, where Luisa resides, 87% of those with limited English proficiency utilize Spanish for communication.  This demonstrates that Luisa lives in an area with a higher use of the Spanish language for communication.



Hispanic Cultural Considerations (1/4)

Involvement of a bilingual interpreter is key for those who have limited English proficiency. It is also important to understand and identify subgroups within the Hispanic population and culture. Latino culture is a mixture of many factors such as cultural background, socioeconomic status, education level, language, and region of origin.

These factors may also be impacted by the culture related to location in a rural or versus urban environment.



Barriers - Hispanic Cultural Values (2/4)

Hispanic culture and cultural values may differ from the culture where they reside and can be an additional barrier for relationships with the Hispanic population. Etiquette is an important Hispanic cultural value. Most Hispanics tend toward formality in etiquette. A firm handshake is common at the beginning and end of an encounter. They also like to wear formal attire to church, social gatherings, and work. Hispanics are more reserved in public speaking, and more relaxed about time in non-formal settings.


Clutter, AW and AC Zubieta. “Understanding the Latino Culture 2009 The Ohio State University http://citeseerx.ist.psu.edu/viewdoc/download?doi=

Barriers - Hispanic Cultural Values (3/4)

An additional cultural consideration which may be a barrier for the Hispanic population is the country of origin.  There are many countries in the world that include Hispanic cultures. It is important to have a person-centered approach and consider that the Hispanic culture varies from region to region. It is important to consider the country of origin and the culture within the country.   In the United States, the top 5 cultures for Hispanics include Mexico, Puerto Rico, El Salvador, Cuba and the Dominican Republic.

Barriers - Hispanic Family Values (4/4)

In the Hispanic culture, the family is a close-knit group and an important social unit.  The family typically includes parents, children, and extended family. In most families, the father is the head of the family and the mother is responsible for the home. Important family values in the Hispanic culture includes honor, good manners, respect for authority, and respect for elders. Hispanic families aid each other in many aspects of life, including finances, employment, health, and life Issues. It is also common for many social events celebrated as a family:  including holidays, birthdays, Baptisms, 1st Communions, graduations, and weddings. It is common for Hispanic families to stay with family when traveling.

Test Your Knowledge

Question 1

As part of your conversation with an individual of Hispanic culture, you determine that they speak primarily Spanish and have brought a family member to the appointment. How would you proceed with the appointment?

Correct. In this situation, involving a bilingual medical interpreter is the best answer because the patient speaks primarily Spanish.

Question 2

Select the most important Hispanic cultural value for your healthcare interaction with an individual with a Hispanic background.

Correct. Family is a primary cultural value in the Hispanic population.

Question 3

In the United States, what is the estimated number of Hispanics who speak Spanish at home?

Correct. Over 35 million Hispanics speak Spanish at home.

Next: Primary Care Visit

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