Let’s Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care

Journal of General Internal Medicine (Impact Factor: 3.45). 05/2010; 25:189-193. DOI: 10.1007/s11606-009-1201-8


Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency
(LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients.
For example, studies suggest that teaching “Medical Spanish” or related courses may actually contribute to health care disparities
if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits
of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods
for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions
include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work
with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one’s
own limited non-English language skills.

KEY WORDScommunication barriers-doctor-patient relationships-medical education-health disparities

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Available from: Lisa C Diamond
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    • "A lack of shared mean - ing , or conceptual understanding , because of cultural , socio - economic , and gender differences may lead to misunderstandings of health - related perceptions . The negative consequences of miscommunication in health care settings are well investigated by academic scholars ( Diamond and Jacobs , 2010 ; Kale and Syed , 2010 ) although to date little research was found examining communication barriers of immigrant women during their maternity care in Canada . "
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    ABSTRACT: Background: many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. The negative consequences of miscommunication in health care settings are well documented although there has been little research on communication barriers facing immigrant women seeking maternity care in Canada. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. Methods: a focused ethnography was undertaken incorporating interviews with 31 participants recruited using purposive and snowball sampling. A community liaison and several gatekeepers within the community assisted with recruitment and interpretation where needed (n=1). All interviews were recorded and audio files were transcribed verbatim by a professional transcriptionist. The data was analysed drawing upon principles expounded by Roper and Shapira (2000) for the analysis of ethnographic data, because of (1) the relevance to ethnographic data, (2) the clarity and transparency of the approach, (3) the systematic approach to analysis, and (4) the compatibility of the approach with computer-assisted qualitative analysis software programs such as Atlas.ti (ATLAS.ti Scientific Software Development GmbH, Germany). This process included (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generation of themes, (5) generalising to generate constructs and theories, and (6) memoing including researcher reflections. Findings: four main themes were identified including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre-migration history and cultural factors which affect open communication, accessible health care and perhaps also maternal outcomes. Conclusion: this study provided insights regarding maternity health care communication. Communication challenges may be experienced by all parties, yet the onus remains for health care providers and for those within health care management and professional bodies to ensure that providers are equipped with the skills necessary to facilitate culturally appropriate care.
    Full-text · Article · Oct 2014 · Midwifery
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    • "(Karliner et al. 2007; Priebe et al. 2011; Flores et al. 2012). Yet, professional interpreters continue to be underused (Diamond and Jacobs 2010; Kale and Syed 2010; Phillips and Travaglia 2011; Schenker et al. 2011). Health professionals report cost concerns, organisational difficulties and a lack of confidence in the interpreter's competence for the situation as barriers to using professional interpreters (Burbano O'Leary, Federico, and Hampers 2003; Johnstone and Kanitsaki 2008; Bischoff and Hudelson 2010). "
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    ABSTRACT: Objective To explore the process of decision-making of older people with limited English proficiency (LEP) about using a professional interpreter during their health care after stroke.DesignA constructivist grounded theory approach was used. Up to two in-depth interviews were conducted with 13 older people with LEP from seven different language groups, and one older person who preferred to speak English, who had recently received health care after an acute stroke. Professional interpreters assisted with 19 of the 24 study interviews. Data were analysed and theoretical processes developed using a constant comparative method.ResultsProfessional interpreters were not a strong presence in the health care experience after stroke for participants. The use of professional interpreters was a complex decision for participants, influenced by their perception of the language and health care expertise of themselves and others, their perceived position to make the decision and whom they trusted. Getting by in English allowed participants to follow rules-based talk of health professionals, but did not enable them to understand detailed information or explanation, or to engage in the management of their condition in a meaningful way.Conclusion Health professionals have an opportunity and a mandate to demonstrate leadership in the interpreter decision by providing knowledge, opportunity and encouragement for people with LEP, to use an interpreter to engage in, and understand, their health care after stroke. Health professionals may need to advise when interpretation is needed for health care situations, when communication difficulties may not be anticipated by the person with LEP.
    Full-text · Article · Aug 2013 · Ethnicity and Health
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    • "Over the last several years, accrediting bodies such as the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) have developed cultural competency training standards and requirements [16-18]. Integral to this teaching is an emphasis on language barriers as a source of health disparities and how to overcome these barriers through skillful utilization of interpreter services [4,19]. However, little is known about how well medical schools prepare their students to care for LEP patients. "
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    ABSTRACT: Patients with limited English proficiency (LEP) represent a growing proportion of the US population and are at risk of receiving suboptimal care due to difficulty communicating with healthcare providers who do not speak their language. Medical school curricula are required to prepare students to care for all patients, including those with LEP, but little is known about how well they achieve this goal. We used data from a survey of medical students' cross-cultural preparedness, skills, and training to specifically explore their self-rated preparedness to care for LEP patients. We electronically surveyed students at one northeastern US medical school. We used bivariate analyses to identify factors associated with student self-rated preparedness to care for LEP patients including gender, training year, first language, race/ethnicity, percent LEP and minority patients seen, and skill with interpreters. We used multivariate logistic regression to examine the independent effect of each factor on LEP preparedness. In a secondary analysis, we explored the association between year in medical school and self-perceived skill level in working with an interpreter. Of 651 students, 416 completed questionnaires (63.9% response rate). Twenty percent of medical students reported being very well or well-prepared to care for LEP patients. Of these, 40% were in their fourth year of training. Skill level working with interpreters, prevalence of LEP patients seen, and training year were correlated (p < 0.001) with LEP preparedness. Using multivariate logistic regression, only student race/ethnicity and self-rated skill with interpreters remained statistically significant. Students in third and fourth years were more likely to feel skilled with interpreters (p < 0.001). Increasingly, medical students will need to be prepared to care for LEP patients. Our study supports two strategies to improve student preparedness: training students to work effectively with interpreters and increasing student diversity to better reflect the changing US demographics.
    Full-text · Article · Jun 2011 · BMC Medical Education
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