By Rachel Showstack, Marycarmen Cervantes, and Rommy Vargas-Bezubbikoff
Alce su Voz’s mission, vision, and programs have all emerged over the past five years from community conversations. Now, we are beginning to learn how to facilitate community conversations to evaluate the impact of our activities. In March and June 2025, two groups of Spanish-speaking Wichitans, including both new and seasoned Alce su Voz program participants, gathered to collaboratively illustrate the impact of our healthcare language access initiative. Through these interactive activities, called “ripple effects mapping,” we learned about the direct and indirect impacts of our work on the improvement of healthcare language access for Spanish speakers in Wichita, and we also learned about areas where more work was needed. Dr. Showstack facilitated a ripple effects mapping session focused on community engagement activities at the Child Advocacy Center of Sedgwick County in March and another one focused on interpreter professional development at the Evergreen Community Center and Library in June.
Starting with timelines of our activities (like listening sessions, workshops, and trainings) drawn on large sheets of butcher paper, groups of five to seven participants discussed the impact of each activity and mapped out those impacts on the timelines. The participants noted that some of the impacts gave rise to additional impacts; for example, our language access workshops resulted in increased community awareness of the patients’ right to qualified professional interpreting services, which, in turn, empowered individuals to demand equitable language access services in hospitals and clinics, and even to inform health care professionals of their obligation to provide those services. Since Alce su Voz began its work, healthcare agencies in Wichita have begun to develop language access policies and procedures, and some clinics are beginning to shift their intake practices and to ask patients about language preference more consistently. When qualified interpreting services were indeed provided, our participants said that they enjoyed greater privacy in their health care encounters because they did not have to depend on family members to interpret for them. Other activities, such as Alce su Voz’s blog campaign, white paper, and clinician professional development videos, drew the attention of health care leaders and provided educational resources for healthcare professionals.
Despite the consensus that Spanish-speaking individuals had gained an awareness about their rights, many of the people in the room during the first ripple effects mapping activity had questions about Section 1557 of the Affordable Care Act, one of the most extensive federal rules protecting patients against discrimination in health care contexts. Extending protections implemented under the Title VI of the Civil Rights Act, Section 1557 “prohibits discrimination based on race, color, national origin, sex, age, or disability in covered health programs and activities.”1 It includes specific requirements to ensure that “meaningful access” to health care is provided for individuals who generally communicate in a language other than English and whose ability to communicate in English is limited. The requirements specify to whom language access services must be provided, that the services must be free of charge to the patient, and that they must be qualified. In 2024, the U.S. Department of Health and Human Services implemented a new rule that outlines more specific stipulations for what health care institutions must do to ensure that they are providing meaningful access to their services without discriminating. The ripple effects mapping activity showed Alce su Voz that we have more work to do to educate Kansans about Section 1557 at a time when the Affordable Care Act itself might be in danger.
In addition to identifying unexpected opportunities for improvement, we also recognized unintended positive impacts of our activities. Marycarmen Cervantes, an interpreter who participated in the first ripple effect mapping activity, commented that our programs can positively impact the mental health of the community members who engage in our activities. She explained that knowing that there are community leaders and scholars who care about achieving equitable access to health care for people who speak languages other than English makes them feel valued and seen as human beings; she added that seeing students who are interested in learning about Indigenous languages gives Indigenous individuals living in the United States a sense that their roots and language are valued and that they can be themselves without the feeling that they have to suppress who they are.
After the second ripple effects mapping activity, Alce su Voz’s Director of Interpreter Engagement and Education Rommy Vargas concluded that “the knowledge, confidence, and advocacy skills developed since the initial workshops have transpired through families, neighborhoods, and professional networks.” In this way, Alce su Voz’s community and interpreter engagement events have impacted a much broader set of individuals than those who participated directly in the activities. Vargas-Bezzubikoff also noted “the ripple effects mapping reminded participants and organizers alike that systems change often begins with a story.” Personal stories allow our team to identify the issues that are important to those served by our work; the same stories can help a lawmaker to understand the impact of policies on vulnerable individuals.
Ripple effects mapping is a form of project evaluation that can be used in community-driven approaches to improving community health and well-being. In community-driven approaches to health equity, members of the community that a program is designed to impact collaborate on the project instead of just serving as participants. In one of these approaches, called community-based participatory research (CBPR), community engagement spans throughout every phase of an initiative, from identifying a problem that affects the community, to designing an innovative solution to that problem, to evaluating its impact on the community, and finally educating others about the findings. CBPR and other community-engaged research approaches differ from traditional approaches to health research that are sometimes described as “extractive” or even “exploitative.”
Traditionally, researchers from both public health and linguistics have relied on collecting data from communities, such as health outcomes or recordings of language use, which they analyze to draw conclusions about the communities. Research findings are usually published in primarily in scholarly journals that are not readily available to the public, and academics scholars generally get much more credit from their institutions and professional communities for scholarly journal publications than for public scholarship like this blog post. However, it is the work that we do with the communities we serve that makes a direct impact on peoples’ lives, and Alce su Voz is committed to engaging Kansas Latine and Indigenous communities throughout our programs. At a time when these communities are under threat, there is an increased need to continue the work that we are doing to improve health care access for individuals with non-English language preference.
We extend our heartfelt gratitude to Dr. Evelyn Vásquez and the Unidas por Salud team from Southern California for the inspiration to follow in their footsteps and conduct ripple effects mapping activities with our community program participants.
Alce su voz is a community-engaged program at Wichita State University whose mission is to improve health equity for speakers of Spanish and Indigenous languages in the United States, with a focus on Kansas and the Midwest. For more information or to get involved, please send an email to alcesuvoz@wichita.edu. You can also join our email list and follow us on Facebook, Instagram, LinkedIn, and YouTube.
- Office of Civil Rights of the U.S. Department of Health and Human Services. (Dec. 4, 2024). Language Access Provisions of the Final Rule Implementing Section 1557 of the Affordable Care Act. ↩︎