In the face of limited resources, evidence-based prioritization is needed to maximize the reach of health services for the under-served. A medical referral project that referred low income uninsured individuals to discounted appointments with office-based doctors found that some Latino patients had difficulty in taking advantage of these appointments. These individuals appeared to face barriers beyond the cultural and linguistic barriers faced by most patients in the project. One additional bilingual staff person, a Patient Assistant, was hired to facilitate doctor visits by these patients. The Patient Assistant performed the duties of a navigator, trouble shooter, and interpreter-and assisted with communications. The project staff derived a screening question to encourage patients to identify themselves as those who would need the help of the Patient Assistant. These patients were subsequently questioned in a waiting room survey designed to characterize them. The characteristics of these patients were compared with a comparison group of project patients. The target group and the comparison group differed in their levels of education. Sixty percent of the target group had less than 4 years of schooling compared to 13% of the comparison group. The target group was comprised entirely of immigrants from South and Central America. This report underscores the conclusions of the recent report of the Institute of Medicine on the problem of health literacy - patients' ability to understand and act in their own interest - and highlights the needs of Latin American immigrants who are burdened by cultural and linguistic barriers, low health literacy, and minimal education. © 2005 Springer Science+Business Media, Inc.

Latino Latin American Immigrant Cultural and linguistic appropriateness Bilingual Bicultural Project Access Translator Navigator Spanish Case management Health literacy Literacy Patient assistant Interpreter Cultural competence Uninsured

education Communication Barriers immigrant comprehension educational status lowest income group interpersonal communication human language ability middle aged medical society controlled study Central America intermethod comparison Hispanic Americans reading Humans Hispanic consultation male female South America leukodystrophy cultural factor Health Knowledge, Attitudes, Practice Article adult health education patient participation Office Visits health care need Emigration and Immigration Cultural Characteristics caregiver Health Services Accessibility health survey