Research report: Access to prescription medication labels in Spanish from community pharmacies

A mixed-methods observational study of 30 Spanish-preferred adults with limited English proficiency found that only 23% had ever received a Spanish prescription medication label from a U.S. community pharmacy, even though every participant preferred a Spanish label to an English one. The study, published in Frontiers in Health Services in 2026, also found that 80% of participants did not know they could request a Spanish label and 93% had never requested one. Interviews conducted from November 2021 through February 2022 identified low awareness, communication difficulties, inconsistent provision and fear of an unwelcoming response as recurring obstacles.

Researchers used a parallel convergent design that combined quantitative survey measures with a thematic analysis of open-ended interview responses. Adults were recruited through the electronic health record database of a large Midwestern academic medical center. Eligibility required a preference for Spanish, taking at least two prescription medications with refills during the preceding 30 days, and reporting that English was spoken less than “very well.” Adults who spoke English “very well” were excluded.

The study was designed as a pilot with a planned enrollment of 30, and its sample was too small for dependable inferential statistical analysis. The participants had a mean age of 51 years, with a standard deviation of 13 years, and 73% were women. All 30 were born outside the United States and had lived there for at least 10 years; Mexico was the most common country of birth, reported by 63%.

Most participants, 90%, completed primary and secondary education outside the United States, and formal education lasted an average of eight years. Every participant was classified as having low acculturation on the Brief Acculturation Scale for Hispanics. At the same time, 80% said they were confident or very confident completing medical forms in Spanish.

Participants were taking an average of 3.9 prescription medications, and 23% were taking more than five active prescriptions, a condition defined in the study as polypharmacy. Ninety percent had no more than three chronic medical conditions, with diabetes reported by 53%, high blood pressure by 33%, high cholesterol by 27%, pain by 27%, depression by 13%, and kidney or stomach problems by 10% each. Prescription coverage varied: 40% reported safety-net coverage, 23% government-sponsored coverage, 13% commercial insurance, and 23% no prescription coverage.

The primary quantitative outcome was whether a participant had ever received a Spanish prescription medication label from a U.S. community pharmacy. Seven of 30 participants, or 23%, reported ever receiving one, while 23, or 77%, had not. At the time of the study, five participants, 17%, said their current prescription label was in Spanish and 25, 83%, said it was in English.

Six participants, 20%, knew they could request a Spanish label, and two, 7%, had ever asked a community pharmacy for one. After researchers explained during the interview that a request was possible, 13 of the 23 participants who had never received one said they would ask for one, representing 57% of that group. Qualitative analysis produced four themes: uncertainty about whether the prescriber or pharmacist was responsible for requesting a Spanish label; barriers to access, including difficulty communicating with pharmacy personnel and fear of asking; concerns about receiving an English label; and workarounds for understanding English medication information.

Many participants with a Spanish label believed their prescriber had arranged it. Others were uncertain about which part of the health system should initiate the request. Some had not known that a Spanish label was available, and few recalled prescribers explaining how to access one at a pharmacy.

These accounts suggested that knowledge gaps at patient, prescriber and pharmacy levels contributed to low access, although the study did not establish causation. All participants denied seeing signage or other indications that language services were available at their pharmacy. Participants described not knowing whether staff members spoke Spanish and being unable to explain their needs.

Some were afraid or ashamed to ask because they expected personnel to become upset, refuse assistance or react with a lack of empathy. Two participants who had received Spanish labels described inconsistent provision, while one said a label had been promised but was not received. The mixed-method analysis treated anticipated or perceived language discrimination, stigma, low empathy and organizational health literacy as possible mechanisms behind the reported barriers rather than as proven causal factors.

English labels also created substantial uncertainty. Among the 25 participants whose current label was in English, 21, or 84%, said they were unsure what it stated. The other four said they took the medication based on memory, and none said they read the instructions.

Thirteen of the 25, 52%, described the English label as difficult or very difficult to read. Participants expressed uncertainty about medication names, dosing instructions, side effects and refill information. By comparison, all five participants with a current Spanish label described it as easy or very easy to read; four said they read the Spanish instructions and one relied on memory.

The study did not directly measure medication errors or clinical outcomes in these participants. To understand English labels, some participants asked a Spanish-speaking prescriber to explain the prescription or used an interpreter at a clinic. Others relied on a child, family member or friend to translate, or used memory and their limited reading of English.

A joint display integrating the survey and interview findings identified four potentially modifiable factors: gaps in patient knowledge, low organizational health literacy, anticipated or perceived language discrimination, and reliance on alternative resources. The researchers said future large cohort studies should examine the scope and mechanisms of the problem. They also proposed that pharmacies include language services in operating procedures, train staff, display bilingual signage, encourage prescribers to communicate language needs and make interpreters available in person or remotely during operating hours.

The findings require cautious interpretation because the research was a small, geographically restricted pilot drawn from patients at one academic medical center, and convenience recruitment was not designed to produce a representative national estimate. The investigators also noted that bilingual adults, who might still benefit from a Spanish label, were not included in the sample. Interviews took place more than three years before the article’s 2026 publication, so the results describe the sampled participants’ experiences during the study period rather than current access across all U.S. pharmacies.

Within those limits, the combination of universal preference for Spanish labels, low reported access and widespread uncertainty about English instructions demonstrates a substantial language-access gap within the population studied and a need for broader, nationally representative research.

Subject of Research: Access to Spanish prescription medication labels among adults with limited English proficiency

Article Title: Access to prescription medication labels in Spanish from community pharmacies

Article References: Gaines, N., Tran, T. T. P., Candelaria-Jimenez, A., & Manzor, B. (2026). Access to prescription medication labels in Spanish from community pharmacies. Frontiers in Health Services, 6, Article 1900946. https://doi.org/10.3389/frhs.2026.1900946

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1900946

Keywords: Spanish medication labels, limited English proficiency, community pharmacies, language access, health literacy, prescription safety, patient communication, mixed-methods research, Access, prescription, medication, labels