Paso a Paso: Espanol Para Profesionales De Salud/Step by Step: Spanish for Health Professionals by D. E. Bender, S. Gutter, and I. Stern. Albuquerque, NM: University of New Mexico Press; 2002. 104 pages, paperback (includes CD), $18.95.

Language differences may be one of the strongest factors influencing the racial and ethnic disparities in healthcare services and outcomes in the United States. Linguistically diverse people with limited English proficiency typically experience inadequate access to care, lower quality of care, and poorer health status. Today more than 1 in 10 people in the United States speak Spanish.1 As of July 2003, an estimated 40 million Latinos live in the United States (13.7% of the nation's total population), making people of Spanish origin the nation's largest ethnic minority group.1 In many parts of the country, most healthcare providers, who only speak English, often work with clients who only speak Spanish. Practitioners who cannot communicate, to some extent in another language, may not be able to fulfill their clients' needs. For novice Spanish speakers who want to quickly increase their communication skills and health-related vocabulary, the Paso a Paso/Step by Step handbook and accompanying CD is an effective resource for group learning.

This book is organized using specific pasos, "steps," each designed to be a chapter, with a total of 6 chapters. With this in mind, the authors state that learners could work through the material in 6 weeks. The chapter topics, like a visit with the healthcare professional, focus on welcome/reception and information, financial counseling and paying for health services, clinical interview, pregnancy and delivery, ambulatory surgery, and infectious diseases. Each chapter contains 7 activities dedicated to increased Spanish learning and practice. The activities include work before the group meets that takes the form of listening, conversations to start the group's meeting, more practice to build on the conversation, new words and expressions, learning for the next week, activities for fun that reinforce what was learned during the group meeting, and, in the community events, encourages learners to participate in Latino activities. For those who want to increase their Spanish vocabulary beyond what was introduced in the 7 activities, an eighth activity, vocabulary expansion, is also included. The accompanying CD includes healthcare-related dialogues that typically occur in administrative and clinical settings. Each dialogue requires a greeting and a few simple sentences to contextualize the conversation.

This book emphasizes communicative language learning, a speaking and learning process, rather than grammar and language structure lessons. Recognizing that learners may need English assistance at first, the authors structure each section of pasos using a bilingual approach, introducing Spanish followed by English and then, transition to a Spanish-focused approach. This methodology helps learners quickly advance by encouraging them to think and speak Spanish rather than relying on English translations.

For healthcare professionals seeking to advance their Spanish speaking and listening skills, this well-developed and organized text is an excellent resource to consult.

Overall, the authors, Deborah Bender, Suzanne Gutter, and Irwin Stern, have assembled a concise and relevant handbook that represents the critical components of any Spanish conversation in a healthcare setting. Practitioners will find this work to be a convenient and comprehensive reference that would be difficult to find in a single publication.

Cynthia M. Goody, PhD, RD, LD

Assistant Professor, Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, Ohio

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