Language Barriers in Healthcare: Results of the KFF Survey on Racism, Discrimination and Health | KFF - Latest Global News

Language Barriers in Healthcare: Results of the KFF Survey on Racism, Discrimination and Health | KFF

There are approximately 26 million people in the United States with limited English proficiency (LEP), meaning they speak English less than very well, accounting for approximately 8% of people ages five and older. Most U.S. adults with LEP speak Spanish (62%), followed by Chinese (7%), Vietnamese (3%), Arabic (2%), and Tagalog (2%), with the remainder speaking a variety of languages ​​from the Regions speaks worldwide. Hispanics make up nearly two-thirds (62%) of the LEP population, while over one-fifth (22%) of individuals with LEP are Asian. The remainder of individuals with LEP are white (11%), black (4%), or from other racial and ethnic backgrounds. Adults with LEP are also more likely to have low incomes—nearly one in five people with LEP have a family income less than 200% of the federal poverty level, compared to one in 10 people who are English proficient. This brief examines the health care experiences of adults with LEP in the United States, drawing on results from the KFF Racism, Discrimination, and Health Survey. For more information about U.S. immigrants with LEP, see this brief. The data identifies persistent barriers and disparities that adults with LEP face in accessing health care and suggests that access to providers who speak their preferred language helps reduce these barriers and improve certain health care experiences .

Health and health care experiences among adults with LEP

Adults with LEP report poorer health and greater barriers to accessing health care compared to adults with English proficiency. Adults with LEP are more likely to report their physical health as “fair” or “poor” than adults with English proficiency (34% vs. 19%). Despite this difference in health status, adults with LEP report lower levels of care utilization and greater barriers to accessing health care compared to their English-speaking peers. Adults with LEP are less likely to report having had a doctor’s visit in the past three years than adults with English proficiency (86% vs. 95%). Additionally, consistent with other analyses, adults with LEP are more likely than those with English proficiency to report being uninsured (33% vs. 7%). They are also less likely to say they have another source of usual care other than the emergency room (74% vs. 88%). Notably, four in ten adults with LEP (39%) report that their usual source of care is a neighborhood clinic or health center, highlighting the importance of community health centers in providing linguistically appropriate and culturally competent care.

Approximately half of adults with LEP report encountering at least one language barrier in healthcare in the past three years. This includes about a third of LEP adults who say there was a time in the past three years when difficulty speaking or reading English caused them to fill out forms for a health care provider (34%) or communicate with them a doctor’s office staff (33%; three in ten say they have difficulty understanding a healthcare provider’s instructions (30%), and about a quarter say language barriers make it difficult to fill a prescription, understand, how to use it (27%) or to make an appointment to see a doctor (25%).

Adults with LEP are slightly less likely to report positive, respectful interactions with health care providers than those who are proficient in English. Overall, most adults say they have had mostly positive interactions with health care providers in the last three years, with the majority, regardless of their English proficiency, saying their providers explained things in a way they could understand and spent enough time with them , understood and respected their cultural beliefs, and included them in decision-making at least most of the time. However, compared to those with English proficiency, adults with LEP are less likely to report some of these experiences, including having a provider explain things in a way they can understand (81% vs. 89%) and taking enough time during visits (68% vs. 76%), and involving them in decision-making about their care (63% vs. 82%).

Adults with LEP feel less comfortable asking questions of their health care providers than those who are proficient in English. While most adults, regardless of English proficiency, say they have felt at least “somewhat” comfortable asking doctors and other health care providers questions about their health or treatment in the past three years, about half (54% ) of adults with LEP feel “very comfortable,” which is lower than the two-thirds (66%) of English-speaking adults who say the same.

Approximately one in five adults with LEP report a negative experience with a provider, one in eight report being treated unfairly or disrespectfully, and approximately half report exhibiting alert behavior during medical visits. Among adults with LEP, one in five report having at least one of several negative experiences with a health care provider in the past three years, including having a provider ignore a direct request or question (11%) or making assumptions about them, without asking (8). %), suggesting that they are personally responsible for a health problem (8%) or that they refuse to prescribe needed pain medication (8%). Additionally, one in eight (13%) adults with LEP report having been treated unfairly or disrespectfully by a health care provider or their staff because of their race, ethnic background, or another reason in the past three years. Because of these experiences, approximately half (48%) of adults with LEP report feeling like they have to pay close attention to their appearance in order to be treated fairly (44%) and/or to be prepared for possible insults from a provider or his employees (18% at least some of the time during doctor’s visits. Adults with LEP do not report these experiences significantly more often than those who have English language skills.

Importance of linguistically concordant care

Nearly four in 10 adults with LEP report that fewer than half of their most recent medical visits were with a provider who spoke their preferred language. While six in ten (63%) adults with LEP say at least half of their medical visits in the past three years were with a doctor or health care provider who spoke their preferred language, only 28% say this was the case for all of them. Nearly four in 10 (37%) say fewer than half of their visits were with a provider who speaks the language, including 15% who said they had no health care visits with a provider in the last three years spoke their preferred language. Additionally, four in 10 adults with LEP reported that fewer than half of their health care visits in the past year were with a provider of the same racial and ethnic background.

Adults with LEP who visit providers who speak their preferred language more often are less likely to report experiencing language barriers to health care. Overall, four in ten LEP adults who report that at least half of their medical visits in the past three years were with a provider who speaks their preferred language report at least one language barrier, compared to six in ten among those who reported less than these had half of their health visits with a language-concordant provider. For example, 45% of LEP adults who reported that fewer than half of their medical visits were with a provider who spoke their preferred language reported difficulty communicating with doctor’s office staff, compared to 26% of those who spoke their preferred language , half or more of whom had health visits with a language-concordant provider.

Adults with LEP who visit a provider who speaks their preferred language more often are more likely to report feeling comfortable asking questions about their health and treatment than those who visit a provider who speaks their preferred language less often . Six in ten (61%) LEP adults who had at least half of their visits with providers who spoke their preferred language said they were very comfortable asking questions, compared to four in ten (43% ) of those who had fewer visits with a concordant language provider.

Adults with LEP who make more visits to language-concordant providers are more likely to say that their providers typically respect their cultural values ​​and beliefs and ask them about social factors such as access to work, food, and housing. Among adults with LEP, those who had at least half of their health care visits with a health care provider who spoke their preferred language were more likely to report that their health care provider understood and respected their cultural values ​​and beliefs most or every time than those who who had fewer visits with language concordant providers (87% vs. 76%). While few LEP adults overall say their provider has asked them about their job, housing situation, or access to food or transportation during recent health visits, those who have had at least half of their visits with language-concordant providers are more likely , than those who had fewer visits. For such providers, this is at least the case in most cases (29% versus 15%).

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