are unable to read, and 21 percent of adults in the U.S. read below a 5th grade level. Nineteen percent of high school graduates cannot read. An estimated 14 percent of adults in the United States have “below-basic” levels of prose literacy - this is defined as the ability to use printed and written information to function in society. Twelve percent of adults are also estimated to have below-basic “document literacy,” meaning they can’t read and understand drug or food labels. Researcher Dr. Erin Marcus says, “There’s also a growing body of research on health literacy, the ability to comprehend and use medical information.” Patients with reading problems may avoid doctors’ offices and clinics because they are intimidated by paperwork. Emergency rooms, however, may be more user-friendly because someone asks the questions and fills out the forms for the patient (NJM, 2010). Barry Weiss, a professor of family and community medicine at the University of Arizona, advocates routine screening for illiteracy as a new vital sign. Many doctors oppose such an idea as opening a “Pandora’s box” of social and other problems that they have not been trained to address. In the meantime, doctors may believe that they have explained medication usage clearly and might have no idea that an illiterate patient is unable to read the prescription label. “These days, I think twice whenever I explain anything to a patient or jot down instructions on a pad of paper,” said one doctor (NJM, 2010). Resource utilization There is evidence of an underuse of professional interpreters and an overreliance on untrained interpreters in health care settings - even in practices with a high number of LEP patients. This results in an increase in the number of errors, misunderstandings, and poor treatment adherence. Factors identified as barriers for the use of professional interpreters include excessive time spent waiting, awkward communication, poor interpreter availability, failure of staff to identify LEP patients needing interpreters, a perception of additional time for encounter, and perception of increased cost for professional interpretation. However there is evidence to show that the use of professional interpreter services is cost-effective over the long term, and improves the quality of client/patient-therapist communication, as well as health care access and delivery. ● Recruitment should include hiring of bilingual mid-level practitioners. ● Dual-role bilingual staff with training and language proficiency can be rewarded for their additional interpretation roles. ● Interpreter services may be sought from agencies by contract, or by using community resources such as hospitals, colleges and community groups. ● Written translated materials can be obtained and made available. The type of interpreting service to be provided should be considered for the local community and the LEP group served. Although traditional face-to-face professional interpreting is used in most health care settings, and is superior to non-professional interpreting, these resources (as discussed) may often not be provided. Other methods of interpreting have been studied. These include telephone interpreting and video conferencing, and computer technology. Overall, studies have demonstrated that patients are satisfied with language-proficient health providers.
And the other way, which is much harder to spot and which can’t be remedied by an interpreter, is real, actual illiteracy, the condition in which a patient cannot read or write, and has grown to adulthood concealing that fact in a number of ways. In cases of language mismatch, it’s important to keep in mind that the U.S. Census Bureau (2014) reports that over 20 percent of the U.S. population has limited English proficiency and speaks a language other than English at home. Yet, given those formidable numbers (which are much higher in places like California, Texas and Florida), many patients who need interpreters have no access to them. According to one NJM study, no interpreter was used in 46 percent of emergency department cases involving patients with limited English proficiency. Only 23 percent of U.S. teaching hospitals provide any language training; and those that do provide it make the training optional (NJM, 2014). Language barriers can have serious effects. According to the researchers, patients with language use-and-understanding problems are less likely than others to have a regular medical care provider, receive fewer preventive services, and have an increased risk of non-adherence to medication. The use of available health services may also be affected by the availability of trained interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half - 48 percent report that they always or usually had one (NJM, 2014). The U.S. Office for Civil Rights issued a memorandum in 1998 stating that denial or delay of medical care because of language barriers constitutes illegal discrimination under Title VI of the Civil Rights Act (OCR, 2001). It is not difficult to notice if a patient cannot speak or understand the doctor’s language; patients will find a way to indicate a language barrier. The second language issue, illiteracy, may not be as readily apparent. Patients may be ashamed to admit they cannot read or write. Researchers in the NJM study reported that patient illiteracy was often discovered in instances of non-adherence to prescription dosages and failure to keep return appointments. “Blindness to illiteracy” is common, says the National Assessment of Adult Literacy (2016). The survey conducted by the National Center for Education Statistics reported that 32 million (14 percent of the population) adults in the U.S. Strategies to address language barriers Providing language services Hundreds of languages are spoken across urban and rural settings in the U.S. The Institute of Medicine National Academy of Sciences (2016) reported that more than 50 percent of health providers surveyed believed that patients did not adhere to treatment because of cultural issues. More than 50 percent of health providers have received no language or cultural competency training. Addressing language needs should include the designation of responsibility (leadership), conducting an analysis of local need, and identifying community resources. This should be followed by implementing the services, training staff, notifying patients of services as well as evaluating and reviewing the quality of services. Some guidelines offered by the Commonwealth Fund (2015) to address local needs for language services include: ● Language access planning: an employee or team member can be designated to develop a language plan to meet client or patient needs. ● Language needs can be determined at first point of contact with the receptionist, for example, using flash cards that state “I speak (specific language),” to identify patient language preference.
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Book Code: MMD0724
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