Improving Language Access: A Personal and National Agenda

Carmona, Richard H.

doi:10.1007/s11606-007-0376-0

Cited by 10 publications

(8 citation statements)

References 2 publications

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“…As discussed in a recent editorial by former US Surgeon General, Dr. Richard Carmona, communication barriers faced by non-English speaking patients leads to disparities in access to preventive services and an increased reliance on emergency services [8]. Even one year after the enactment of state legislation that mandates the right to a medical interpreter, we found that utilization among ED patients with limited English remained low.…”

Section: Discussionmentioning

confidence: 76%

Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation

Ginde

Clark

Camargo

2008

J Immigrant Minority Health

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Background Since 2001, Massachusetts state law dictates that emergency department (ED) patients with limited English proficiency have the right to a professional interpreter. Methods one year later, for two 24-h periods, we interviewed adult patients presenting to four Boston EDs. We assessed language barriers and compared this need with the observed use and type of interpreter during the ED visit. Results We interviewed 530 patients (70% of eligible) and estimated that an interpreter was needed for 60 (11%; 95% confidence interval, 7–12%) patients. The primary interpreter for these clinical encounters was a physician (30%), friend or family member age ≥18 years (22%), hospital interpreter services (15%), younger family member (11%), or other hospital staff (17%). Conclusions We found that 11% of ED patients had significant language barriers, but use of professional medical interpreters remained low. One year after passage of legislation mandating access, use of professional medical interpreters remained inadequate.

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Section: Discussionmentioning

confidence: 76%

Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation

Ginde

Clark

Camargo

2008

J Immigrant Minority Health

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“…Language and culture in this context become intertwined with how patients communicate individual preferences for care and how providers communicate with patients in addressing their needs. Both are influenced by personal beliefs, experiences, and even biases about expectations and decisions for care [46]. Additional patient level barriers need to be addressed, including limited time with providers, difficulty in scheduling appointments, and long wait times in the clinics.…”

Section: Discussionmentioning

confidence: 99%

Pathways to Depression Care: Help-Seeking Experiences of Low-Income Latinos with Diabetes and Depression

Hansen

Cabassa

2012

J Immigrant Minority Health

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This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression.

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“…7 As our former Surgeon General, Richard Carmona, attests in his foreword to this Supplement, we push LEP immigrants to the fringes of our society. 8 The net effect is that many immigrant groups form communities of their own, in which they are able to go about their daily lives in their native languages...until they get sick.…”

Section: N 2003 the Institute Of Medicine Issued A Groundbreakingmentioning

confidence: 99%

Reducing Language Barriers and Racial/Ethnic Disparities in Health Care: An Investment in Our Future

2007

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I n 2003, the Institute of Medicine issued a groundbreakingreport that shone a spotlight on the problem of racial and ethnic disparities in health care in the United States. 1 It is now well recognized that minority Americans tend to receive less care, and lower-quality care, than the majority (white) population. The reasons behind this phenomenon are complex and opaque. There is no single explanation, and in many cases, we do not have an explanation. However, for millions of minority Americans, most of them foreign-born, one explanation is readily apparent: they do not speak, read, or write English, and health care in this country, with few exceptions, is delivered in English.Two articles in this JGIM Supplement attest to the role of language barriers in explaining racial/ethnic disparities in health care. Cheng and colleagues examined the use of basic, evidence-based health care services for prevention and chronic disease management among Latinos and whites in the United States. 2 They found that whites were more likely than Latinos as a whole to receive all recommended services for which they were eligible. However, when grouped by language use, Latinos who spoke English at home were not significantly less likely than whites to receive recommended services, whereas those who spoke Spanish at home were, even after accounting for education, insurance coverage, usual source of care, and a host of other potential explanatory factors. Thus, the bulk of the racial/ethnic disparity between whites and Latinos, in this case, is actually a "language" disparity, between English-speakers and Spanish-speakers.The study by Sentell et al. produced similar findings. 3 They examined access to mental health care in California, the state with the highest proportion of limited English-proficient (LEP) persons in the country. 4 They found that among individuals stating a need for mental health services, Latinos were less likely than whites to have received them. However, Englishspeaking Latinos were similar to whites in their access to mental health care, whereas non-English-speaking Latinos had a markedly lower likelihood of receiving services (even when they had mental health insurance coverage). Again, the disparity here is not so much a racial/ethnic one per se, as one related to English proficiency.The findings of these studies indicate not only that language plays a large role in explaining racial/ethnic disparities, but that comparing groups by race/ethnicity alone may substantially underestimate the degree of inequity between the haves and the have-nots. For instance, in the study by Sentell et al., Latinos as a whole were about one-third less likely to receive needed mental health services when compared to the overall California population (28% vs 45%). But Latinos who spoke no English were 85% less likely to receive services compared to the general, English-speaking population (8% vs 51%). 3 In the same vein, examining groups by English proficiency can reveal "hidden" disparities. Sentell and colleagues found that Asian...

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Improving Language Access: A Personal and National Agenda

Cited by 10 publications

References 2 publications

Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation

Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation

Pathways to Depression Care: Help-Seeking Experiences of Low-Income Latinos with Diabetes and Depression

Reducing Language Barriers and Racial/Ethnic Disparities in Health Care: An Investment in Our Future

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