UCSF Study Finds English Proficiency A Major Hurdle In Patient Comprehension

The UCSF study, which appears in the online version of the Journalof General Internal Medicine on August 1, is the first multilingual,population-based study to focus on the impact of English proficiencyand physician language on medical comprehension.

"Looking at a broad population of respondents with variousnative languages, we found English proficiency is an independent riskfactor for difficulty in understanding medical situations and reportingproblems with medications," said lead author Elisabeth Wilson, MD, MPH,research fellow and clinical instructor of medicine at UCSF.

According to the study, respondents who were limited in theirEnglish proficiency were significantly more likely to report problemsunderstanding a medical situation, experience confusion about how touse medication, have trouble understanding labels on medications, andsuffer a bad reaction to medication due to problems understandinginstructions.

Researchers conducted a telephone survey with 1200 Californiansin 11 different languages -- Russian, Spanish, Cambodian, Vietnamese,Farsi, Armenian, Chinese (Cantonese and Mandarin), Korean, Tagalog(Philippines) and Mien (Hmong). Of the respondents, 49 percent weredefined as being limited English-proficient (LEP). Respondents weredefined as LEP if they responded "not well" or "not at all" to thequestion, "How well do you understand English?" The comprehensivesurvey included 48 questions ranging from health care access tosatisfaction to comprehension.

Data also revealed more than two-thirds (69 percent) of LEPrespondents reported that their physicians spoke their native language,yet they were still significantly more likely to report problemsunderstanding a medical situation than English-proficient respondents.

Overall, LEP respondents who had access to a languageconcordant physician had a much improved understanding of their medicalsituation. Fifty-seven percent of LEP respondents with a languagediscordant physician reported comprehension problems compared with only44 percent of those with language concordant physicians.

"This study highlights the difficulties persons with limitedEnglish skills face when navigating the complex U.S. health caresystem," Wilson said. "Our health care systems should do more toimprove cultural and linguistic competence between patient andphysician."

In addition to poorer comprehension, LEP respondents weresignificantly more likely than English proficient respondents to beelderly, female, less educated, uninsured and have lower income. "Inpast studies, these factors also have shown to increase the risk forhealth disparities in population groups," added Wilson. "Thecombination of these factors and limited English proficiency helpexplain the high prevalence of comprehension problems in this country."

The study was funded by the California Endowment and a grant underthe Resource Centers for Minority Aging Research Program by theNational Institute on Aging.