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

Authors

  • Elisabeth Wilson MD, MPH,

    1. Department of Family and Community Medicine, University of California, San Francisco, Calif, USA
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  • Alice Hm Chen MD, MPH,

    1. Division of General Internal Medicine, University of California, San Francisco, Calif, USA
    2. Asian & Pacific Islander American Health Forum, USA
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  • Kevin Grumbach MD,

    1. Department of Family and Community Medicine, University of California, San Francisco, Calif, USA
    2. Primary Care Research Center, San Francisco General Hospital, San Francisco, Calif, USA.
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  • Frances Wang MS,

    1. Division of General Internal Medicine, University of California, San Francisco, Calif, USA
    2. Primary Care Research Center, San Francisco General Hospital, San Francisco, Calif, USA.
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  • Alicia Fernandez MD

    1. Division of General Internal Medicine, University of California, San Francisco, Calif, USA
    2. Primary Care Research Center, San Francisco General Hospital, San Francisco, Calif, USA.
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  • 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).

Address correspondence and requests for reprints to Dr. Fernandez: Building 10, Ward 13, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110 (e-mail: aliciaf@itsa.ucsf.edu).

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.

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