Effects of Limited English Proficiency and Physician Language on Health Care Comprehension

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2005 Aug 25

PMID 16117746

Citations 245

Authors

Elisabeth Wilson

Alice H M Chen

Kevin Grumbach

Frances Wang

Alicia Fernandez

Affiliations

Soon will be listed here.

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.

Citing Articles

Reporting on knowledge, attitudes, and behaviours of pharmacists regarding the active offer of French language health services in Ontario: A quantitative survey study.

Timony P, Leone A, Caron C, Giguere P, Thabet P, Gauthier A Can Pharm J (Ott). 2025; :17151635241308874.

PMID: 39885954 PMC: 11775929. DOI: 10.1177/17151635241308874.

Use of Antihyperglycemic Medications Among US People with Limited English Proficiency.

Muller F, Holman H, Bhangu N, Kottutt J, Azhary H, Alshaarawy O J Gen Intern Med. 2025; .

PMID: 39875767 DOI: 10.1007/s11606-025-09385-x.

Communicating Effectively With Limited English Proficiency Patients: Incorporating Training on Working With Medical Interpreters in the Undergraduate Medical Curriculum.

Wrench A, Fine L, Griffin D Cureus. 2025; 16(12):e75207.

PMID: 39759726 PMC: 11700432. DOI: 10.7759/cureus.75207.

Unraveling the link between language barriers and cancer risk.

Toraih E, Hussein M, Malik M, Malik A, Kandil E, Fawzy M Cancer Causes Control. 2024; .

PMID: 39658741 DOI: 10.1007/s10552-024-01946-5.

Language Justice as Health Equity in Palliative Care: A Scoping Review.

Bigger S, Obregon D, Keinath C, Doyon K J Pain Symptom Manage. 2024; 69(3):269-288.

PMID: 39643251 PMC: 11802314. DOI: 10.1016/j.jpainsymman.2024.11.012.

References

Fiscella K, Franks P, Doescher M, Saver B . Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2001; 40(1):52-9. DOI: 10.1097/00005650-200201000-00007. View

Heisler M, Vijan S, Anderson R, Ubel P, Bernstein S, Hofer T . 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(11):893-902. PMC: 1494939. DOI: 10.1046/j.1525-1497.2003.21132.x. View

Marcos L . Effects of interpreters on the evaluation of psychopathology in non-English-speaking patients. Am J Psychiatry. 1979; 136(2):171-4. DOI: 10.1176/ajp.136.2.171. View

McDonald H, Garg A, Haynes R . Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002; 288(22):2868-79. DOI: 10.1001/jama.288.22.2868. View

Shaw J, Hemming M, HOBSON J, Nieman P, Naismith N . Comprehension of therapy by non-English speaking hospital patients. Med J Aust. 1977; 2(13):423-7. DOI: 10.5694/j.1326-5377.1977.tb114593.x. View

Crane J . Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997; 15(1):1-7. DOI: 10.1016/s0736-4679(96)00261-2. View

Flores G, Laws M, Mayo S, Zuckerman B, Abreu M, Medina L . Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003; 111(1):6-14. DOI: 10.1542/peds.111.1.6. View

Lasater L, Davidson A, Steiner J, Mehler P . Glycemic control in English- vs Spanish-speaking Hispanic patients with type 2 diabetes mellitus. Arch Intern Med. 2001; 161(1):77-82. DOI: 10.1001/archinte.161.1.77. View

Morales L, Cunningham W, Brown J, Liu H, Hays R . Are Latinos less satisfied with communication by health care providers?. J Gen Intern Med. 1999; 14(7):409-17. PMC: 1496614. DOI: 10.1046/j.1525-1497.1999.06198.x. View

10.

Jenkins C, McPhee S, Bird J, Pham G, Nguyen B, Nguyen T . Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women. Prev Med. 1999; 28(4):395-406. DOI: 10.1006/pmed.1998.0444. View

11.

Weiss B, Hart G, McGee D, DEstelle 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(3):257-64. View

12.

Prince D, Nelson M . Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995; 2(1):32-6; discussion 36-7. DOI: 10.1111/j.1553-2712.1995.tb03076.x. View

13.

Baker D, Parker R, Williams M, Clark W . Health literacy and the risk of hospital admission. J Gen Intern Med. 1998; 13(12):791-8. PMC: 1497036. DOI: 10.1046/j.1525-1497.1998.00242.x. View

14.

Weech-Maldonado R, Morales L, Elliott M, Spritzer K, Marshall G, Hays R . Race/ethnicity, language, and patients' assessments of care in Medicaid managed care. Health Serv Res. 2003; 38(3):789-808. PMC: 1360917. DOI: 10.1111/1475-6773.00147. View

15.

Flores G, Abreu M, Olivar M, Kastner B . Access barriers to health care for Latino children. Arch Pediatr Adolesc Med. 1998; 152(11):1119-25. DOI: 10.1001/archpedi.152.11.1119. View

16.

Lee L, Batal H, Maselli J, Kutner J . Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. J Gen Intern Med. 2002; 17(8):641-5. PMC: 1495083. DOI: 10.1046/j.1525-1497.2002.10742.x. View

17.

Hu D, Covell R . Health care usage by Hispanic outpatients as function of primary language. West J Med. 1986; 144(4):490-3. PMC: 1306688. View

18.

Fernandez A, Schillinger D, Grumbach K, Rosenthal A, Stewart A, Wang F . Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004; 19(2):167-74. PMC: 1492135. DOI: 10.1111/j.1525-1497.2004.30266.x. View

19.

David R, 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(5-6):393-7. View

20.

Schillinger D, Bindman A, Wang F, Stewart A, Piette J . Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004; 52(3):315-23. DOI: 10.1016/S0738-3991(03)00107-1. View