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Breaking Language Barriers in Health Care

Tuesday, September 15, 2009

For someone with limited English, using typed medication directions instead of hand written directions can make a huge difference in understanding medical instructions.

Approximately 6 to 7 million Californians--20 percent--have limited English proficiency (LEP), meaning these individuals cannot speak English well or cannot speak English at all.

In San Francisco, Los Angeles, Monterey, and Imperial counties the numbers are even greater—25 percent to 33 percent of the population has limited English proficiency.

Language barriers often result in health care barriers. Research shows that language barriers contribute to inadequate patient evaluation and diagnosis, lack of appropriate and/or timely treatment, and other medical errors that compromise the safety of patients who have limited English skills and result in increased medical costs.

In California, all private and public health plans are required to provide language services if they have certain levels of enrollees who are not English proficient. Therefore, efficiently allocating language resources becomes a matter of economic imperative.

The California Program on Access to Care (CPAC), part of UC Berkeley’s School of Public Health, recently funded a study entitled California’s Limited English Proficient Population (LEP) and Strategies to Promote Health Care Access. The study’s authors, UC Berkeley researchers Mary Masland and Lonnie Snowden, identified California’s various limited English proficient groups by language and birth country. They then assessed health care difficulties and evaluated strategies to increase health care understanding for LEP groups.

The study found that using language resources effectively for education outreach and patient-doctor communication can make a real difference in health care outcomes for limited English proficient groups. For example, when the study looked at preventive care, it revealed large numbers of Asian language women forgoing cervical cancer screening. In contrast, nearly all Spanish language women were current with cervical screenings, driven in large part to previous research that called for public health outreach within Spanish-speaking communities and the expanded role of of Spanish-speaking clinics where screenings can be performed conveniently and affordably.

The study’s recommendations for making the most of language resources include:

• Using video interpretation pools so that the state’s relatively few professional health care interpreters can help patients with limited English skills who live in remote locations,
• Using typed instructions, which are easier for limited English proficient persons whose native language does not use a Roman alphabet,
• Having a bilingual nurse, ad-hoc staff, or family member review pharmacy and doctor instructions with the patient before leaving a doctor’s office,
• Ensuring written materials are compatible with the very low educational level of some limited English proficient groups, and
• Employing the appropriate media for health education outreach to limited English proficient populations--media such as phone, radio, video or TV, brochures or local newspapers are preferred since most LEP groups do not have access to the Internet.

According to research, the cost of providing effective language services may be recouped through reduced testing, shorter visits, and improved patient compliance. The recommendations from this study can help private and public health providers effectively use language resources to create a win-win situation for both patients and health care providers.”

The California Program on Access to Care is an applied policy research program administered by UC Berkeley School of Public Health in coordination with University of California Office of the President. CPAC works to expand health care access for the state’s most vulnerable populations, including immigrants, agriculture workers, the working poor, and other low-income groups.

For more information about this study and other CPAC-sponsored studies, visit:

Findings from the report:

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