ASHEVILLE — It would be nearly impossible for Tamara Litova to go to the doctor if she didn't have an interpreter.

The 70-year-old has tried to learn English, but it has been difficult. Instead, she relies on other people to interpret what her doctors are telling her into her native Russian.

Litova is able to get an interpreter at the Buncombe County Health Center and at local medical practices, but she said there have been times when she was forced to visit a doctor without one.

“It was very difficult for me being in that situation,” Litova said through an interpreter. “I didn't receive the full information that I needed.”

For people who don't speak English, the language barrier can be a major factor in receiving, or not receiving, health care, contributing to differences in health that are seen among some minority populations in the United States.

North Carolina has struggled to comply with Title VI of the Civil Rights Act requiring facilities receiving federal money, including physicians' offices, hospitals, and local health and social services departments, to provide access to meaningful communication for people who do not speak English.

The state is under a voluntary compliance agreement with the federal government to ensure these services are being provided after visits to county health departments found they were out of compliance.

While the state has improved access to these services, there are still some areas, especially in more rural settings, where providers could do better, said Arelys Chevalier, director of the interpreter access project at the Center for New North Carolinians at UNC Greensboro.

Chevalier is heading up an effort to certify interpreters, which she hopes will increase the use of services in the state. North Carolina would become one of the first states in the country to have statewide credentialing for health care interpreters if it adopts the test and certification that Chevalier is proposing.

“People will truly have a better chance of meaningful access to health services,” she said. “If you have meaningful access to health services, it may have more positive outcomes on your health.”