Effects of limited English proficiency and physician language on health care comprehension

Abstract

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.

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

“…Language barriers play a significant role in poor health processes and outcomes, [4][5][6][7] including reduced accessing of preventive services 8,9 and cancer screening rates among LEP patients. [10][11][12][13] These obstacles to cancer screenings for LEP patients can be reduced with language assistance. Patient navigation is a promising intervention to eliminate language as a barrier to cancer screening for LEP patients.…”

Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

“…We used the literature and prior studies to determine the most parsimonious models given sample size considerations. 4,5 We conducted post hoc analyses to determine whether including household income or the number of medications attenuated the effect size or changed the direction of the association with each outcome measure. Table 1 reports weighted patient demographics and clinical characteristics for all survey respondents stratified by LEP status.…”

“…3 However, research on the use of refill functions of SMRs is scarce among patients whose primary language is not English. Patients with limited English proficiency and chronic conditions are at increased risk of medication nonadherence 4,5 and receive lower-quality care than patients who are proficient in English. [6][7][8] One study suggested that patient use of an online portal with refill function increased adherence to statin medications for those with diabetes receiving care in an integrated health system.…”

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

“…109 Having language-concordant clinicians with training in medical interpretation is ideal, 110 but organizations should at least offer access to certified medical interpreters to facilitate SDM. 43 A lack of professional medical interpretation services leads to errors in diagnosis and treatment, decreases patient satisfaction and continuity of care, and increases distrust.…”

“…43 A lack of professional medical interpretation services leads to errors in diagnosis and treatment, decreases patient satisfaction and continuity of care, and increases distrust. [109][110][111] Organizations should also avoid using patients' family members as interpreters, which can compromise patient privacy, introduce interpretation errors, and possibly harm family relationships. 43 This could be particularly problematic for LGBT patients who have not disclosed their sexual orientation or gender identity to family members and need additional privacy for successful SDM.…”