A 65-year-old Hispanic male has just been diagnosed with type II diabetes mellitus. He and his daughter are speaking with the nurse in an exam room about his new diagnosis, his medication regimen, and some dietary modifications that he needs to implement. The patient uses a walker to move around, but his daughter says he prefers a cane at home. He speaks in Spanish to his daughter, but she speaks English and Spanish. He seems to follow along well and at the end of the visit, he states that he would like to get better. Given this scenario, which of the following is most likely to be a barrier for this patient’s adherence to the nurse’s instructions?