The Promotion
Of Health Communication Through The Inclusion Of The Kichwa Language At The San Juan De Llullundongo
Health Center (2023-2024)
Promoción De La Comunicación En Salud Mediante La Inclusión Del Idioma Kichwa En El Centro San Juan De Llullundongo
(2023-2024)
David Santiago Agualongo Chela
Bachelor
of Science in Nursing, Master in Surgical Nursing,
Ambato-Iess General Hospital
https://orcid.org/0000-0002-8705-2609
Silvana Ximena López
Bachelor of Science in Nursing. Doctor in health sciences
Bolivar State University
https://orcid.org/0000-0001-9289-8089
Jhoselyn Adriana Toalombo Ninabanda
Bachelor of Science in Nursing
Simiatug
Health Center
https://orcid.org/0009-0005-9031-9588
Edwin Vladimir Chariguaman Rochina
Bachelor of Science in Nursing
La Palma Health Center
https://orcid.org/0009-0007-4379-8760
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In rural and intercultural contexts in Ecuador,
communication between health professionals and indigenous patients is hampered
by language barriers, which compromises the equity and quality of care.
This study aims to establish the relationship
between effective health communication and the use of the Kichwa
language at the San Juan de Llullundongo Health
Center.
A quantitative, descriptive and correlational
approach was applied, with a cross-sectional design. The sample is a census
sample and includes 16 health professionals. A structured survey was used,
validated by experts and analyzed using SPSS software.
The results show that 93.75 % of the personnel have
no or little knowledge of Kichwa, and most of them
are unable to provide medical information in that language. The 87.5% consider
it useful to incorporate bilingual materials. The research concludes that the
lack of linguistic competence limits the quality of care and violates the
patient's right to understand their health process.
It is suggested that incorporating Kichwa is a communicative strategy and an act of cultural
justice. It is recommended to strengthen intercultural training and implement
public policies that guarantee linguistically relevant attention.
Keywords: Communication,
Interculturality, Language, Language Barrier, Health.
Resumen
En contextos rurales e interculturales del
Ecuador, la comunicación entre profesionales de salud y pacientes indígenas se
ve obstaculizada por barreras idiomáticas, lo que compromete la equidad y
calidad de la atención.
Este estudio tiene como objetivo establecer la
relación entre la comunicación efectiva en salud y el uso del idioma kichwa en el Centro de Salud San Juan de Llullundongo.
Se aplica un enfoque cuantitativo, de tipo
descriptivo y correlacional, con diseño transversal. La muestra es censal e
incluye a 16 profesionales de salud. Se utiliza una encuesta estructurada,
validada por expertos y analizada mediante el software SPSS.
Los resultados muestran que el 93,75 % del
personal tiene un conocimiento nulo o bajo del kichwa,
y la mayoría no logra brindar información médica en dicho idioma. El 87,5 %
considera útil incorporar materiales bilingües. La investigación concluye que
la falta de competencia lingüística limita la calidad de la atención y vulnera
el derecho del paciente a comprender su proceso de salud.
Se plantea que incorporar el kichwa es una estrategia comunicativa y un acto de justicia
cultural. Se recomienda fortalecer la formación intercultural y aplicar
políticas públicas que garanticen una atención lingüísticamente pertinente.
Palabras clave: Comunicación,
Interculturalidad, Idioma, Barrera Lingüística, Salud.
Introduction
In the context of primary health care, effective communication between
health professionals and patients is an essential component to ensure the
quality, safety and equity of services. However, in culturally and
linguistically diverse contexts such as Ecuador, such communication is hampered
by language barriers that limit mutual understanding, increase clinical risks
and deepen inequalities in access to care (Estévez
& Estévez, 2021; Maza,
Motta & Motta, 2023). These barriers are particularly critical in
indigenous communities such as San Juan de Llullundongo,
where the majority of patients are Kichwa speakers,
while health personnel communicate exclusively in Spanish.
Given this problem, the study entitled "Effective communication in
health, associated with the incorporation of the Kichwa
language in the San Juan de Llullundongo Health
Center" was developed with the objective of determining the association
between effective communication in health and the use of the Kichwa language in this facility, during the period October
2023 to February 2024. To this end, three specific objectives were established:
to diagnose the current situation of communication between health personnel and
Kichwa-speaking patients; to identify the level of
knowledge of the Kichwa language by the personnel;
and to develop basic Kichwa-Spanish educational
material to facilitate communicative interaction in the clinical context.
The need for this research is based on previous studies that have shown
that language barriers generate negative consequences such as inadequate
diagnoses, difficulties in understanding medical indications, low adherence to
treatments and high patient dissatisfaction (Lazcano
et al., 2020; De la Torre, 2022). In the specific case of the San Juan de Llullundongo Health Center, 93.75% of the personnel
surveyed had no or low knowledge of the Kichwa
language and more than 56% considered the implementation of support resources
in that language to be very necessary (Toalombo &
Chariguamán, 2024).
This research is justified by the need to make visible and address the
structural inequities faced by indigenous populations in health services. It
also aims to contribute to the construction of more inclusive intercultural
care by incorporating tools that recognize and respect linguistic diversity. As
Petrone (2021) and Arrieta
and Guzmán (2021) point out, effective communication
in health cannot be limited to the transmission of information, but must
consider the patient's cultural context and facilitate a comprehensive dialogue
that promotes shared decisions. From this perspective, the incorporation of the
Kichwa language is recognized not only as a technical
measure, but as an act of communicative and cultural justice, consistent with
the constitutional principles of the Ecuadorian State and with the linguistic
rights recognized in national normative instruments (National Assembly of
Ecuador, 2021; Ministry of Public Health, 2017).
Effective communication in the field of health
Effective communication in healthcare is a fundamental component in
achieving patient-centered care, which considers not only the clinical aspects,
but also the social, cultural and emotional aspects that surround the
experience of the disease process. This form of communication is conceived as a
dynamic, intentional and bidirectional process, through which clear, precise,
understandable and adapted to the patient's context information is transmitted,
facilitating the understanding of diagnoses, procedures, treatments and
subsequent care (Bravo, Jurado & Tejera, 2019). In contemporary health systems,
communication has ceased to be a secondary competence to become a structuring
axis of quality and safety of care.
According to Estévez and Estévez
(2021), effective communication is not limited to the transfer of medical data,
but involves the creation of a bond based on empathy, mutual respect and trust.
This bond allows the patient to express his or her doubts, fears and
expectations, as well as to actively participate in making decisions about his
or her treatment. In turn, the healthcare professional can adapt his or her
language, tone and communicative style according to the patient's individual
characteristics, thus improving therapeutic adherence and satisfaction with the
service received.
The communicative process involves several elements: the sender, the
receiver, the channel, the code, the message and the feedback. Each of them
must work in harmony to avoid distortions, ambiguities or silences that may
affect understanding (Fernández, 2022). Added to this
set are the nonverbal aspects of communication, such as body language, posture,
eye contact, facial expressions and tone of voice, which are especially
relevant when there are language differences or cultural barriers. In fact,
several studies have shown that adequate nonverbal communication can partially
compensate for the patient's lack of language proficiency, generating feelings
of security and respect (Zambrano et al., 2020; Sharkiya,
2023).
The scientific literature has highlighted that good communication is
directly related to the prevention of medical errors, the reduction of
complaints and litigation, and the improvement of clinical outcomes (Petrone, 2021). For example, the World Health Organization
(WHO, 2022) has pointed out that more than 60% of adverse events in hospital
services have their origin in communication failures. This reality acquires
greater weight in scenarios of cultural and linguistic diversity, where effective
communication must respond to multiple dimensions of the subject, including
their worldview, values and their own ways of understanding health and disease.
In the intercultural context, communication not only has an instrumental
but also a symbolic value. The use of one's own language, recognition of
traditional practices and respect for the patient's cultural identity are
elements that strengthen the therapeutic relationship and reduce the feeling of
discrimination or exclusion. As Arrieta and Guzmán (2021) point out, effective communication in health
should be conceived as an inclusive practice that allows the patient to feel
heard, understood and respected, especially when he or she belongs to
indigenous peoples or historically marginalized communities.
Finally, effective communication is a key tool for improving the quality
of care, reducing inequities and promoting truly people-centered health. Its
strengthening requires not only technical skills, but also cultural
sensitivity, mastery of diverse linguistic codes and an ethical disposition to
establish a horizontal dialogue with each patient.
Language barriers in intercultural contexts
In culturally and linguistically diverse settings, such as many rural
and indigenous communities in Ecuador, language barriers constitute a
structural limitation that directly affects quality and equity in access to
health services. These barriers occur when health
personnel do not understand and cannot express themselves in the patient's
native language, which prevents fluid, clear and bidirectional communication.
The immediate consequence is a decrease in the understanding of the diagnosis,
adherence to treatment, and user confidence in the health system (Lazcano et al., 2020).
In primary care services, where interaction with the community is
constant and profound, the absence of a shared language between health
personnel and users generates a fragmentation of the therapeutic link. Cases
have been documented in which the patient must resort to a family member as
interpreter or limit himself to basic gestures and expressions, a situation
that violates his right to receive dignified, understandable and culturally
relevant care (De la Torre, 2022).
According to Cacace and Giménez
(2022), language barriers constitute not only a communication problem, but also
a form of structural discrimination. On many occasions, the lack of knowledge
of the native language on the part of health personnel is accompanied by
contemptuous attitudes or disinterest towards indigenous cultural practices.
This generates in patients feelings of inferiority, shame and, in many cases,
rejection of institutional health services.
Studies conducted in indigenous communities in the Ecuadorian Sierra and
Amazon have identified that Kichwa-speaking
users face a triple barrier: linguistic, cultural and geographic. The lack of
professionals who speak their mother tongue, the limited availability of
informative materials in their language and the distance from health care
centers create a scenario of exclusion that affects these populations in a
differentiated manner (Jiménez & Loor, 2022;
Falcón, 2021).
Likewise, the absence of intercultural training in health professional
training programs reinforces these barriers. In many cases, personnel have not
received specific training to work in bilingual or multicultural contexts, nor
do they have strategies to overcome communication difficulties with people who
speak Kichwa or other ancestral languages (Petrone, 2021). As a result, the interaction between the
patient and the professional is reduced to minimal and mechanical exchanges,
which prevents a deep understanding of the symptoms, the perceived causes of
the disease and the user's expectations about his or her recovery.
The persistence of these barriers has direct implications on health
indicators. It has been shown that communities with a greater indigenous
presence have higher rates of maternal mortality, chronic child malnutrition
and communicable diseases, compared to urban mestizo populations (PAHO, 2020).
Although these gaps have multiple causes, limited communication between health
personnel and indigenous patients is a determining factor.
In this context, overcoming language barriers is not only a technical
issue, but also an ethical, political and social challenge. It implies
recognizing the language of the other as valid, necessary and enriching for the
care process. Therefore, it is essential to advance towards the training of
bilingual health personnel, the incorporation of community interpreters and the
development of teaching materials in native languages, as part of a broader
intercultural health strategy.
Intercultural approach and native language rights
The intercultural approach to health is based on the recognition of the
cultural, linguistic and spiritual diversity of the peoples and nationalities
that coexist within the same health system. This approach is not limited to
tolerance or inclusion of differences, but seeks to establish horizontal,
respectful and symmetrical relations between different medical knowledge, such
as biomedical and ancestral knowledge, as well as between languages and modes
of communication (Cando & Quilligana, 2022).
In Ecuador, the regulatory framework supports this approach. The
Constitution of the Republic recognizes Kichwa and
Shuar as official languages of intercultural relations, along with Spanish
(National Assembly of Ecuador, 2021). This provision implies that public institutions,
including health institutions, must promote the use of ancestral languages in
their services, guaranteeing the right of indigenous peoples to be attended in
their mother tongue. This norm is complemented by the Regulation for the
Application of the Intercultural Approach in Health Facilities, which
establishes that every health center must have tools that facilitate attention
to users in their native language, and that health personnel must receive
intercultural and basic linguistic training (Ministry of Public Health, 2017).
From a human rights perspective, care in the mother tongue is related to
the principle of non-discrimination and the right to cultural identity. The
United Nations (UN, 2019) has pointed out that indigenous peoples have the right
to culturally appropriate health systems that recognize their languages,
customs and traditional ways of healing. This principle is essential to build
trust between the user and the health system, and to prevent practices of
exclusion or mistreatment by staff.
Care in the native language has positive effects both clinically and
psychologically. On the one hand, it allows the patient to better understand
his or her diagnosis, the medical indications and the possible risks of
treatment. On the other hand, it promotes a greater emotional connection with
the health professional, which helps to reduce the anxiety and stress generated
by the disease (Sharkiya, 2023). In addition, the use
of one's own language in institutional contexts revitalizes its social value,
strengthens collective self-esteem and fosters pride in identity.
However, despite the current regulatory framework, the practical
implementation of the intercultural approach has been limited. Many health
units lack bilingual personnel, educational materials in Kichwa
or institutional strategies to ensure respectful attention to the language and
culture of their users (Falcón, 2021; Guapisaca,
2022). This demonstrates the urgent need to move from normative discourse to
concrete operational policies, with an allocated budget, monitoring mechanisms
and participatory evaluation by the communities.
In short, the intercultural approach to health requires not only changes
in the curricular content of professional training, but also profound
institutional transformations. It requires recognizing the native language not
as a barrier, but as a key tool for equity, inclusion and quality of care. The
incorporation of Kichwa into health services should
be understood as a collective right, an act of linguistic justice and an
indispensable component of a culturally relevant public health policy.
Contributions of previous
studies on intercultural health communication.
Empirical research on intercultural health communication in indigenous
contexts has gained relevance in recent years, in response to the persistence
of structural inequalities in the access, quality and acceptability of health
services ( ). Several studies in Latin America have shown that the use of the
native language in health care contributes significantly to improving the
patient experience, strengthening trust in the health system and promoting more
positive clinical outcomes (Cuaila, 2022; Arrieta & Guzmán, 2021).
In the case of Peru, Cuaila (2022) conducted a
quantitative study in health centers in the district of Huaylas,
where it was found that patients attended by personnel with medium or high
knowledge of Quechua reported greater satisfaction with the care received,
better understanding of the medical indications and a more favorable
disposition towards treatment follow-up. In contrast, users who were not
attended to in their native language reported confusion, fear and distrust,
factors that were associated with lower therapeutic adherence.
In Ecuador, Falcón (2021) designed a bilingual manual for oral health
promotion in Kichwa-speaking communities in the Cañar
canton. The results showed a significant improvement in the knowledge of oral
hygiene practices after the use of the material. Similarly, Guapisaca
(2022) developed an educational guide in Kichwa-Spanish
for caregivers of bedridden people in rural communities of Chimborazo, and
reported that the understanding of the content increased significantly when
presented in the participants' mother tongue.
These studies agree that intercultural communication is not reduced to
the literal translation of content, but requires a cultural and pedagogical
adaptation that takes into account the prior knowledge, traditional practices
and life contexts of the communities. Therefore, the production of bilingual
materials should be accompanied by community validation processes,
participatory workshops and continuous training for health personnel (Petrone, 2021; Jiménez & Loor,
2022).
In addition, the studies highlight the need to institutionalize these
efforts through public policies that ensure their sustainability. The isolated
production of materials or the occasional hiring of interpreters are not enough
if they are not integrated into an intercultural health strategy that includes
a budget, impact evaluation and active participation of indigenous peoples in
decision-making (Cacace & Giménez,
2022).
The accumulated evidence confirms that the use of the Kichwa language in health services not only improves the
quality of communication, but also constitutes a key tool for reducing
inequities, respecting cultural rights and strengthening ties between the
health system and indigenous communities. These studies provide a solid
foundation to continue promoting applied research that generates contextualized
and culturally relevant solutions.
Methodology
The present study was framed within a quantitative approach, with a
descriptive and correlational scope, and a non-experimental cross-sectional
design. This type of research allowed us to observe and analyze the variables
as they appeared in their natural context, without direct manipulation by the
researchers, and facilitated the collection of data at a single point in time,
which was adequate to identify associations between effective communication and
the use of the Kichwa language in the health care setting.
The study population consisted of the health personnel of the San Juan
de Llullundongo Health Center, located in a rural
area with a majority Kichwa-speaking population. Due
to the small size of the total population, a census sample was chosen, that is,
100% of the available health personnel was included,
consisting of 16 professionals including physicians, nurses, dentists and
health technicians. This decision made it possible to carry out a comprehensive
analysis of the perceptions and knowledge of all the actors directly involved
in the care process.
The main technique used for data collection was the structured survey,
applied directly and in person at the health facility, with prior authorization
from the institutional management and the informed consent of the participants.
The collection instrument was a questionnaire prepared by the authors, composed
of 20 items distributed in three sections. The first section included
sociodemographic questions (age, sex, profession, years
of experience). The second section addressed aspects related to the diagnosis
of the communication situation between health personnel and Kichwa-speaking
patients. Finally, the third section inquired about the level of knowledge of
the Kichwa language and the perception of its
importance in health care.
The content validity of the instrument was verified through the judgment
of experts, who evaluated the relevance, clarity and coherence of the items
with respect to the objectives of the study. Subsequently, a pilot test was carried
out with a small group of professionals in another health center with similar
characteristics, which allowed the instrument to be adjusted before its
definitive application.
Once the information was collected, the data were organized and analyzed
using IBM SPSS Statistics software, version 25.0. Descriptive statistical
analyses (frequencies, percentages) were applied to characterize the main
variables, and correlations were made between the level of knowledge of the Kichwa language and the perception of communicative
efficacy in attention, using cross tables and graphs that facilitated the
interpretation of the results.
The entire methodological process was carried out respecting the ethical
principles of health research, guaranteeing anonymity, confidentiality and
voluntary participation. Formal approval was obtained from the operating unit
and any type of pressure or conflict of interest was avoided during the
application of the instruments.
The methodology used made it possible to systematically and objectively
identify the communication situation in the health center, as well as to
establish relationships between the use of the Kichwa
language and the perceived quality of the interaction with indigenous patients,
constituting a solid basis to support the proposals for improvement developed
in the research.
Results
The results obtained through the application of the questionnaire to the
health personnel of the San Juan de Llullundongo
Health Center reveal a worrisome situation in relation to effective communication
with the Kichwa-speaking population. Through
statistical analysis it was possible to characterize both the level of
knowledge of the Kichwa language and the staff's
perception of their communicative capacity, identifying patterns that allow us
to understand the barriers faced by the health care system in intercultural
contexts.
First, the level of knowledge of the Kichwa
language turned out to be remarkably low. As shown in Table 1, 62.5% of the
personnel reported having no knowledge at all, while 31.25% reported a low
level. Only 6.25% reported an intermediate level and no professional reported a
high level of proficiency. This finding is significant considering that the
majority of the population served communicates in Kichwa
as their first language. The lack of basic proficiency in the local language
severely limits professional-patient interaction and reflects a lack of
intercultural language training in the training processes of health personnel.
Table 1: Level of knowledge of the Kichwa
language among health personnel
|
Knowledge level |
Frequency |
Percentage |
|
Null |
10 |
62,50% |
|
Under |
5 |
31,25% |
|
Intermediate |
1 |
6,25% |
|
High |
0 |
0% |
|
Total |
16 |
100% |
Source: Own elaboration based on survey data, 2024.
Regarding the ability to explain medical procedures or provide relevant
information in Kichwa, 62.5 % of the staff indicated
that they are unable to do so, which implies a direct limitation in conducting
clinical interviews, offering treatment indications or informing about
preventive measures. This lack of effective communication is also evident when
receiving information from the patient: 56.25 % reported difficulties in
understanding when the user expresses him/herself only in Kichwa.
These figures reflect a fragmented communicative environment, where the absence
of a common linguistic channel generates discomfort, insecurity and potential
errors in care.
Table 2 shows the level of staff's ability to communicate in Kichwa according to different clinical situations, such as
the explanation of diagnoses, the indication of treatments, the understanding
of information and the promotion of preventive practices.
Table 2: Ability of staff to communicate in Kichwa in specific clinical situations
|
Clinical situation |
You
can communicate |
Cannot
communicate |
Partially
communicates |
|
Explain medical diagnosis |
2 (12,5 %) |
11 (68,75 %) |
3 (18,75 %) |
|
Indicate treatment or medication |
1 (6,25 %) |
12 (75 %) |
3 (18,75 %) |
|
Receive patient information in Kichwa |
4 (25 %) |
9 (56,25 %) |
3 (18,75 %) |
|
To provide prevention indications in Kichwa. |
1 (6,25 %) |
13 (81,25 %) |
2 (12,5 %) |
Source: Own elaboration based on survey data, 2024.
The analysis of this table shows that the greatest limitations occur
when providing preventive indications and explaining medical treatments or
diagnoses, since more than 75% of the personnel are unable to express
themselves in Kichwa in these contexts. This
limitation directly compromises the patient's right to be informed and to
understand the procedures applied to him/her.
Likewise, more than half of the staff (56.25%) cannot adequately
understand the information that Kichwa-speaking
patients express in their language, which represents an obstacle both for the
construction of the clinical history and for the identification of key
symptoms. Only a small percentage manage to
communicate effectively or partially, which reinforces the need for institutional
intervention.
Another relevant finding is that 87.5% of the staff stated that it would
be useful or very useful to have educational materials or bilingual
communication tools (Kichwa-Spanish) in the facility.
This opinion represents a concrete opportunity to design practical and
accessible resources that facilitate communicative interaction, improve the
quality of care and increase user confidence in the health system.
In summary, the results evidence a situation of high linguistic
vulnerability in the clinical context of the health center studied. The absence
of functional knowledge of Kichwa and the lack of
institutional strategies to address this deficiency reinforce inequalities in
health care. Nevertheless, a positive willingness on the part of the staff to
incorporate support tools is recognized, which represents a favorable basis for
the implementation of training actions and intercultural materials that promote
more equitable and culturally relevant care.
The results obtained in this research highlight a structural problem in
the intercultural rural health system: the absence of an effective
communication channel between health personnel and Kichwa-speaking
patients. This finding is in line with De la Torre (2022), who argues that
language barriers are one of the main limitations in providing quality care to
indigenous populations in Ecuador.
This coincides with previous studies that identify a low level of
intercultural linguistic training in health professionals (Falcón, 2021;
Jiménez & Loor, 2022). This deficiency directly
compromises the effectiveness of the medical act, especially in the stages of
diagnosis, treatment and health promotion. Difficulty in expressing and
understanding medical information in the patient's native language prevents the
construction of a solid therapeutic bond and undermines the principle of equity
in care.
Likewise, the data reveal that most staff cannot explain procedures,
indicate treatments or provide preventive guidance in Kichwa,
which has a negative impact on the patient's understanding of their health
condition and the actions necessary for their recovery. This communication gap,
as indicated by Lazcano et al. (2020), can lead to
medical errors, non-compliance with treatments, increased clinical complications
and mistrust of the health system.
However, a noteworthy aspect of the findings is the positive disposition
of health personnel to receive institutional support, as evidenced by the 87.5%
who valued as useful or very useful the incorporation of bilingual materials in
Kichwa and Spanish. This data is key
for the formulation of sustainable public policies that include continuous
linguistic training, creation of visual and didactic tools, and strengthening
of the intercultural approach in health facilities. As Cacace and Giménez (2022) point
out, the intercultural approach cannot be limited to a regulatory framework,
but must be a living and daily practice in professional practice.
From a normative point of view, the absence of bilingual staff and
materials in Kichwa represents a contradiction with
the provisions of the Constitution of Ecuador (National Assembly of Ecuador,
2021) and the Regulations for the Application of the Intercultural Approach in
Health Facilities (Ministry of Public Health, 2017), which guarantee the right
of indigenous peoples to receive care in their mother tongue. The lack of
effective implementation of these legal mandates reflects a gap between
institutional discourse and daily practice, which deserves to be urgently
addressed through coordinated actions between the Ministry of Health,
universities and local governments.
From the results and reflections of this research, several lines of
study emerge that could strengthen the approach to this problem. In the first
place, it would be pertinent to conduct qualitative research with Kichwa-speaking patients, in order to understand from their
experience how they perceive the quality of care, what emotions the language
barrier generates and what strategies they use to communicate in health services.
This approach would contribute to broaden the view from a user-centered
intercultural perspective.
Second, longitudinal studies are suggested to evaluate the impact of Kichwa language training programs for health personnel,
observing changes in the quality of care, patient understanding and therapeutic
adherence. This type of research would allow establishing evidence on the
effectiveness of the interventions and justify their scalability in other areas
of the country.
A third relevant line of research consists of designing and validating
visual and auditory educational materials in Kichwa,
applied in clinical contexts, and evaluating their acceptance, usefulness and
results. These materials could include infographics, explanatory audios,
posters, medical consultation guides, among others, always validated with
community participation.
It would be necessary to deepen comparative studies between different
health centers with indigenous populations, in order to identify good
practices, replicable models and specific challenges according to the region or
nationality. This would make it possible to build a broader framework on the
communicative situation in intercultural health in the country.
Finally, the results of this research coincide with the existing
literature in demonstrating that the lack of proficiency in the Kichwa language significantly limits the quality of care in
rural indigenous contexts. At the same time, a favorable scenario is identified
to implement improvement strategies, which should not only focus on language as
an instrument, but also on the integral respect for the patient's cultural
identity, from an ethical, technical and legal point of view.
Conclusions
The findings obtained throughout this study allow us to affirm that
effective communication in primary health care contexts with indigenous
populations is deeply conditioned by linguistic factors. Empirical evidence
shows that the absence of functional knowledge of the Kichwa
language among health personnel constitutes a critical barrier that directly
affects the quality, safety and equity of the service provided. This reality
reinforces the thesis that health communication cannot be understood only as a
technical process of information transfer, but as a culturally and socially
situated practice, where language is a central element to ensure mutual
understanding and respect for the patient's identity.
From the conceptual framework of intercultural health and the
constitutional principles that protect the right to receive care in the mother
tongue, the situation detected in the San Juan de Llullundongo
Health Center is evidence of non-compliance with the regulations in force in
Ecuador. Despite the fact that Kichwa has been
recognized as an official language of intercultural relations, its use in
clinical spaces continues to be marginal, which configures a form of structural
exclusion that reproduces historical inequalities.
The research showed that most health personnel do not have the minimum
linguistic competencies necessary to establish adequate interaction with Kichwa-speaking patients. This limitation is more evident
in key moments of the care process, such as the explanation of diagnoses, the
indication of treatments and the promotion of preventive practices. However, a
favorable attitude towards the implementation of linguistic support resources
and bilingual materials was also identified, which represents a concrete
opportunity for institutional intervention.
The critical interpretation of the results leads to the conclusion that
the training of health personnel should incorporate the intercultural approach
in a cross-cutting manner, not as a complementary content, but as an essential
professional competence. The promotion of the Kichwa
language in the clinical setting should not be understood only as a functional
communication tool, but as an act of cultural justice and as an effective
strategy to improve therapeutic adherence, patient satisfaction and clinical
outcomes.
The development of this research opens new possibilities for the design
and implementation of training strategies and didactic materials that
facilitate intercultural dialogue in health services. It also provides evidence
to support public policies aimed at linguistic equity in health care. Finally,
this study experience invites us to rethink the model of care from a plural
logic, where the patient's language ceases to be a barrier and becomes a bridge
for mutual recognition, dignity and quality in health care.
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National Assembly of Ecuador (2021). Constitution
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