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OBJECTIVE:To determine the effect of limited English proficiency on medical comprehension in the presence and absence of language-concordant physicians. DESIGN, SETTING, AND PARTICIPANTS:A telephone survey of 1,200 Californians was conducted in 11 languages. The survey included 4 items on medical comprehension: problems understanding a medical situation, confusion about medication use, trouble understanding labels on medication, and bad reactions to medications. Respondents were also asked about English proficiency and whether their physicians spoke their native language. MEASUREMENTS AND MAIN RESULTS:We analyzed the relationship between English proficiency and medical comprehension using multivariate logistic regression. We also performed a stratified analysis to explore the effect of physician language concordance on comprehension. Forty-nine percent of the 1,200 respondents were defined as limited English proficient (LEP). Limited English-proficient respondents were more likely than English-proficient respondents to report problems understanding a medical situation (adjusted odds ratio [AOR] 3.2/confidence interval [CI] 2.1, 4.8), trouble understanding labels (AOR 1.5/CI 1.0, 2.3), and bad reactions (AOR 2.3/CI 1.3, 4.4). Among respondents with language-concordant physicians, LEP respondents were more likely to have problems understanding a medical situation (AOR 2.2/CI 1.2, 3.9). Among those with language-discordant physicians, LEP respondents were more likely to report problems understanding a medical situation (AOR 9.4/CI 3.7, 23.8), trouble understanding labels (AOR 4.2/CI 1.7, 10.3), and bad medication reactions (AOR 4.1/CI 1.2, 14.7).CONCLUSION: Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions. Access to language-concordant physicians substantially mitigates but does not eliminate language barriers. and patient recall. 32The current literature, however, has been limited by recruitment in patient care settings, relatively small sample sizes, and inclusion of few languages other than Spanish. The broader impact of language barriers on patient comprehension and the associated effects of access to language-concordant physicians remain unexplored. The goal of this study was to investigate the effects of language barriers in a linguistically diverse population-based sample, determine the extent to which limited English proficiency contributes to difficulty with medical comprehension, and explore the effects of languageconcordant physicians on comprehension.

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OBJECTIVE -Despite the importance of self-management support (SMS), few studies have compared SMS interventions, involved diverse populations, or entailed implementation in safety net settings. We examined the effects of two SMS strategies across outcomes corresponding to the Chronic Care Model. RESEARCH DESIGN AND METHODS-A total of 339 outpatients with poorly controlled diabetes from county-run clinics were enrolled in a three-arm trial. Participants, more than half of whom spoke limited English, were uninsured, and/or had less than a high school education, were randomly assigned to usual care, interactive weekly automated telephone selfmanagement support with nurse follow-up (ATSM), or monthly group medical visits with physician and health educator facilitation (GMV). We measured 1-year changes in structure RESULTS -Compared with the usual care group, the ATSM and GMV groups showed improvements in PACIC, with effect sizes of 0.48 and 0.50, respectively (P Ͻ 0.01). Only the ATSM group showed improvements in IPC (effect sizes 0.40 vs. usual care and 0.25 vs. GMV, P Ͻ 0.05). Both SMS arms showed improvements in self-management behavior versus the usual care arm (P Ͻ 0.05), with gains being greater for the ATSM group than for the GMV group (effect size 0.27, P ϭ 0.02). The ATSM group had fewer bed days per month than the usual care group (Ϫ1.7 days, P ϭ 0.05) and the GMV group (Ϫ2.3 days, P Ͻ 0.01) and less interference with daily activities than the usual care group (odds ratio 0.37, P ϭ 0.02). We observed no differences in A1C change.CONCLUSIONS -Patient-centered SMS improves certain aspects of diabetes care and positively influences self-management behavior. ATSM seems to be a more effective communication vehicle than GMV in improving behavior and quality of life.