Rethinking the Term “Limited English Proficiency” to Improve Language-Appropriate Healthcare for All

Abstract

The concept of limited English proficiency (LEP) presents significant challenges when applied to the healthcare needs of the diverse and growing multilingual population in the U.S. We expound on the following ways in which the concept of LEP is problematic: the ethnocentric notion of a "primary language," the ambiguous idea of "limited ability," and the deficit-oriented construct of "language assistance." We provide examples that illustrate the negative healthcare impact of LEP terminology, including the unaccounted-for complexities of health communication within the concept of "primary language," the "limited abilities" of health professionals whose language skills are often unassessed, and the ignored role of "language assistance" resources such as interpreters as essential collaborators. Finally, we propose rethinking LEP by (a) reframing patient language using the term non-English language preference and (b) assessing health professional non-English language skills. These actionable strategies have the potential to improve language-appropriate healthcare for diverse populations.

A language-matching model to improve equity and efficiency of COVID-19 contact tracing

“…Fifth, this intervention could be improved by accounting for fluidity in the language and communication preferences of Spanish speakers when collecting language data. The language preferences of an individual may not capture those of the individual’s household, especially if there are multigenerational family members involved, and individuals may prefer a different language for discussing health concepts than the one they report when being asked for their language preference or their fluency in English ( 17 ). Training staff to record language information that reflects a patient’s preferences in the health setting rather than a rigid assessment of the patient’s English proficiency would make it more feasible to provide language-concordant care and also allow for a more refined language algorithm in this context.…”

Socioecological and psycholinguistic approaches to multilingual health literacy.

“…Language-discordance often presents as an interpersonal phenomena, yet it also applies to how people and their environments interact, influencing communication through written mediums (Segalowitz & Kehayia, 2011). Models of health literacy have yet to fully consider multilingualism as a dynamic lifelong experience that affects how language is used, and consequently impacts how people process, comprehend, reason, and make decisions regarding their health (Ortega et al, 2021). Thus, for the multilingual person described in the opening paragraph, the challenges are to access and understand inherently complex health information in a second or third language (Yip, 2012).…”

Exploring the Impact of Language Concordance on Cancer Communication

“…Moreover, even patients who may not meet LEP definitions in everyday contexts may most effectively communicate about health issues in a language other than English. 3 Language discordance between clinicians and patients with LEP during a health care visit has been associated with decreased patient access to preventative services, satisfaction with care, understanding of goals of care, and adherence to treatments. 4-6…”

“…Moreover, even patients who may not meet LEP definitions in everyday contexts may most effectively communicate about health issues in a language other than English. 3 Language discordance between clinicians and patients with LEP during a health care visit has been associated with decreased patient access to preventative services, satisfaction with care, understanding of goals of care, and adherence to treatments. [4][5][6] In oncology, clinicians and patients often engage in sensitive, complex conversations that may include the communication of serious news, discussions about prognosis, and jargon-heavy medical information related to treatment options.…”