Is Language a Barrier to the Use of Preventive Services?

Objective: To isolate the effect of spoken language from financial barriers to care, we examined the relation of language to use of preventive services in a system with universal access.

Design: Cross-sectional survey.

Setting: Household population of women living in Ontario, Canada, in 1990.

Participants: Subjects were 22,448 women completing the 1990 Ontario Health Survey, a population-based random sample of households.

Measurements And Main Results: We defined language as the language spoken in the home and assessed self-reported receipt of breast examination, mammogram and Pap testing. We used logistic regression to calculate odds ratios for each service adjusting for potential sources of confounding: socio-economic characteristics, contact with the health care system, and measures reflecting culture. Ten percent of the women spoke a non-English language at home (4% French, 6% other). After adjustment, compared with English speakers, French-speaking women were significantly less likely to receive breast exams or mammography, and other language speakers were less likely to receive Pap testing.

Conclusions: Women whose main spoken language was not English were less likely to receive important preventive services. Improving communication with patients with limited English may enhance participation in screening programs.