Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Language and English Speaking Ability. US Census 2000 brief. Available at: http://www.census.gov/prod/2003pubs/c2kbr-29.pdf.

  2. Facione NC. Breast cancer screening in relation to access to health services. Oncol Nurs Forum. 1999;26:689–96.

    PubMed  CAS  Google Scholar 

  3. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40:52–9.

    Article  PubMed  Google Scholar 

  4. Flores G, Abreu M, Olivar MA, Kastner B. Access barriers to health care for Latino children. Arch Pediatr Adolesc Med. 1998;152:1119–25.

    PubMed  CAS  Google Scholar 

  5. Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81:885–91.

    PubMed  CAS  Google Scholar 

  6. Hu DJ, Covell RM. Health care usage by Hispanic outpatients as function of primary language. West J Med. 1986;144:490–3.

    PubMed  CAS  Google Scholar 

  7. Kirkman-Liff B, Mondragon D. Language of interview: relevance for research of southwest Hispanics. Am J Public Health. 1991;81:1399–1404.

    PubMed  CAS  Google Scholar 

  8. Derose KP, Baker DW. Limited English proficiency and Latino’s use of physician services. Med Care Res Rev. 2000;57:76–91.

    PubMed  CAS  Google Scholar 

  9. Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982–84. Am J Public Health. 1990;80(suppl):11–9.

    PubMed  Google Scholar 

  10. Weinick RM, Krauss NA. Racial/ethnic differences in children’s access to care. Am J Public Health. 2000;90:1771–4.

    PubMed  CAS  Google Scholar 

  11. Doty MM. Hispanic Patients’ Double Burden: Lack of Health Insurance and Limited English. New York, NY: The Commonwealth Fund; 2003.

    Google Scholar 

  12. Crane JA. Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997;15:1–7.

    Article  PubMed  CAS  Google Scholar 

  13. Lasater LM, Davidson AJ, Steiner JF, Mehler PS. Glycemic control in English- vs Spanish-speaking Hispanic patients with type 2 diabetes mellitus. Arch Intern Med. 2001;161:77–82.

    Article  PubMed  CAS  Google Scholar 

  14. Ghandi TK, Burstin HR, Cook EF, et al. Drug complications in outpatients. J Gen Intern Med. 2000;15:149–54.

    Article  Google Scholar 

  15. Shaw J, Hemming MP, Hobson JD, Nieman P, Naismith NW. Comprehension of therapy by non-English speaking hospital patients. Med J Aust. 1977;2:423–7.

    PubMed  CAS  Google Scholar 

  16. Baker DW, Hayes R, Fortier JP. Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care. 1998;36:1461–70.

    Article  PubMed  CAS  Google Scholar 

  17. Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14:82–7.

    Article  PubMed  CAS  Google Scholar 

  18. David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998;65:393–7.

    PubMed  CAS  Google Scholar 

  19. Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14:409–17.

    Article  PubMed  CAS  Google Scholar 

  20. Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38:789–808.

    Article  PubMed  Google Scholar 

  21. Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111:6–14.

    Article  PubMed  Google Scholar 

  22. Elderkin-Thompson V, Silver RC, Waitzkin H. When nurses double as interpreters: a study of Spanish-speaking patients in a U.S. primary care setting. Soc Sci Med. 2001;52:1343–58.

    Article  PubMed  CAS  Google Scholar 

  23. Launer J. Taking medical histories through interpreters: practice in a Nigerian outpatient department. BMJ. 1978;2:934–5.

    PubMed  CAS  Google Scholar 

  24. Marcos LR. Effects of interpreters on the evaluation of psychopathology in non-English-speaking patients. Am J Psychiatry. 1979;136:171–4.

    PubMed  CAS  Google Scholar 

  25. Rivadeneyra R, Elderkin-Thompson V, Silver RC, Waitzkin H. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000;108:470–4.

    Article  PubMed  CAS  Google Scholar 

  26. Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med. 2002;156:1108–13.

    PubMed  Google Scholar 

  27. Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18:44–52.

    Article  PubMed  Google Scholar 

  28. Lee LJ, Batal HA, Maselli JH, Kutner JS. Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. J Gen Intern Med. 2002;17:641–5.

    Article  PubMed  Google Scholar 

  29. Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16:468–74.

    Article  PubMed  CAS  Google Scholar 

  30. Fernandez A, Schillinger D, Grumbach K, et al. Physician language ability and cultural competence. J Gen Intern Med. 2004;19:167–74.

    Article  PubMed  Google Scholar 

  31. Perez-Stable EJ, Napoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. Dec. 1997;35:1212–19.

    Article  CAS  Google Scholar 

  32. Seijo R, Gomez J, Freidenberg J. Language as a communication barrier in medical care for Hispanic patients. Hispanic J Behav Sci. 1991;13:363–75.

    Article  Google Scholar 

  33. Bridging Language Barriers in Health Care. New California Media, Available at: http://news.ncmonline.com/news/view_article.html?article_id=ac9fc71c53dlafbd8d928601e9c79685.

  34. Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. June 18, 2002. Available at: http://www.usdoj.gov/crt/cor/lep/DOJFinLEPFRJun182002.htm.

  35. Insuring America’s Health: Principles and Recommendations. Institute of Medicine, Washington, DC: National Academy Press; 2004.

    Google Scholar 

  36. Smeldy B, Stith A, Nelson A. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: Institute of Medicine, National Academy of Press; 2002.

    Google Scholar 

  37. Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26:1119–28.

    Article  PubMed  CAS  Google Scholar 

  38. Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2:32–6; discussion 36–37.

    Article  PubMed  CAS  Google Scholar 

  39. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.

    Article  PubMed  CAS  Google Scholar 

  40. Weiss BD, Hart G, McGee DL, D’Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992;5:257–64.

    PubMed  CAS  Google Scholar 

  41. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114:1008–15.

    PubMed  CAS  Google Scholar 

  42. Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000;25:337–44.

    Article  PubMed  CAS  Google Scholar 

  43. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–72.

    Article  PubMed  CAS  Google Scholar 

  44. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998;13:791–8.

    Article  PubMed  CAS  Google Scholar 

  45. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475–82.

    Article  PubMed  Google Scholar 

  46. Schillinger D, Bindman AB, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004;52:315–23.

    Article  PubMed  Google Scholar 

  47. Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893–902.

    Article  PubMed  Google Scholar 

  48. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868–79.

    Article  PubMed  Google Scholar 

  49. Nguyen T, Vo PH, McPhee SJ, Jenkins CN. Promoting early detection of breast cancer among Vietnamese-American women. Results of a controlled trial. Cancer. 2001;91(suppl 1):267–73.

    Article  PubMed  CAS  Google Scholar 

  50. Jenkins CN, McPhee SJ, Bird JA, et al. Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women. Prev Med. 1999;28:395–406.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alicia Fernandez MD.

Additional information

The authors have no conflicts of interest to declare for this article or this research.

This paper had been presented at the UCSF Symposium on Multicultural Health: Linking Research, Education and Policy (January 2004), the Society for General Internal Medicine Conference (May 2004), the Commonwealth Fund Harvard University Fellowship in Minority Health Policy Annual Meeting (May 2004), the National Research Service Award Trainees Conference (June 2004), and the North American Primary Care Research Group Conference (October 2004).

This study was funded in part by grant (P30AG15272) under the Resource Centers for Minority Aging Research program by the National Institute on Aging, the National Institute of Nursing Research, and The National Center on Minority Health and Health Disparities, National Institutes of Health. Dr. Chen was funded by the Medicine as a Profession (MAP) program of the Open Society Institute. Dr. Alicia Fernandez was funded by NIH K-23 Award (18342-01). Dr. Kevin Grumbach received support from the National Center for Workforce Analysis, Bureau of Health Professionals (U79 HP00004).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilson, E., Hm Chen, A., Grumbach, K. et al. Effects of limited English proficiency and physician language on health care comprehension. J GEN INTERN MED 20, 800–806 (2005). https://doi.org/10.1111/j.1525-1497.2005.0174.x

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0174.x

Key Words

Navigation