Measuring inequality in access to English across East Asia

In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes. To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016. We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents. Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency. Insurance coverage was a binary variable indicating any health insurance coverage during the past 12months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care. Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency. Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.

This study examines the role of social media in enhancing English language proficiency among bachelor’s degree students from one public university in Pahang, Malaysia. The objective of this study is to examine the role of social media in enhancing English language proficiency among students and to study the relationship between the role of social media and students’ English proficiency. This study investigates the impact of platforms like TikTok, Instagram, and Facebook on students’ skills in reading, writing, speaking, and listening, as these platforms are increasingly utilized for educational purposes. Using a correlational research design, data were collected from 196 students through a structured questionnaire. A probability sampling technique was used. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 29. The findings indicate that social media offers unique opportunities for immersive and interactive language learning by providing authentic contexts, user-generated content, and informal communication practices. The study underlines the potential of social media as a complementary tool to traditional language education, advocating for strategic frameworks that harness its benefits while addressing its limitations. These findings offer valuable insights for educators, policymakers, and researchers aiming to optimize social media as a resource for language learning in higher education. This study will help students and the public gain a better understanding of the true role of social media. It emphasizes that social media is not only for entertainment but can also be a valuable tool for learning and education.

This study explored the differences between high and low reading proficiency students in terms of language learning strategies in Taiwanese context. A total of 119 freshmen with various majors in one university in central Taiwan participated in the present study. With the use of the Strategy Inventory for Language Learning Questionnaire (SILL) and the administration of the reading section of the General English Proficiency Test (GEPT), the results indicated that high English reading proficiency students had a significantly higher average frequency in overall strategy use in four strategy categories than did low English reading proficiency counterparts. Specifically, high English proficiency students used 15 strategies significantly more frequently than low English proficiency counterparts. Such differences were discussed; meanwhile, suggestions for further research were provided at the end of the study.

The research investigates the findings of English language proficiency on business success in the Kurdistan region of Iraq, a region increasingly shaped by globalization. The data is collected through surveying 125 employees from five leading fast-moving consumer goods (FMCG) companies. The research explores the connection between English skills and key business outcomes, considering factors like revenue, marketing effectiveness, and overall growth. The findings show that over 90% of the employees who participated in the questionnaire perceive English proficiency as significantly beneficial to their work environment, promoting better communication and collaboration. While most of the communications with customers are done in Kurdish, the data revealed the prevalent incorporation of Business English terminology and code-switching within internal communication channels, suggesting a significant integration of English into the organization's professional environment. Further analysis also demonstrated that English proficiency contributed to the region’s increased international collaborations. These results align with existing literature on English as a lingua franca, emphasizing its role in international trade and communication. However, the research acknowledges the potential risk of local languages being overlooked, leading to a cultural homogenization. The study's finding that a majority of employees belong to younger generations suggests a workforce readily adaptable to technological advancements and evolving communication norms. Yet, the persistence of uncertainty regarding the value of English, even among some individuals in leadership positions, underscores the necessity of providing comprehensive training initiatives that clearly articulate the advantages of English proficiency for both organizational success and employee development. By examining these factors within a particular regional context, this research enhances our understanding of how English language skills shape business dynamics

The purpose of this study was to determine the current status of secondary teachers' implementation of the sheltered instruction operational protocol (SIOP) model and its effect on Hispanic English language learners' (ELL) English language proficiency and academic achievement. In addition, this study sought to determine whether teachers perceive the SIOP model as an effective tool for instruction of high school ELL students to increase English language content and English language proficiency. This study employed qualitative and quantitative methodologies. Data were collected from four sources: Hispanic ELLs' English language proficiency scores, students' English Language Arts scores, an oral interview with participating teachers and teacher observations. Each teacher was observed at four points during the school year with the SIOP instrument. Quantitative data on student achievement were collected employing a pre-experimental, one-group pretest-post-test design. Qualitative data were collected using a time-series design. Findings revealed that on the two student assessment measures there were increases in English proficiency and English language arts achievement among the Hispanic ELLs. On the assessment of English language proficiency, the students of the teacher with the highest level of SIOP implementation made the highest gains; the students of the teacher with the second highest SIOP implementation level made the second highest gains; and students of the teacher with the lowest level of SIOP implementation made the smallest gains. These findings suggest that the higher the level of SIOP implementation, the greater the student academic achievement gains. The gains in academic achievement attributed to the proper implementation of the SIOP model can have an extensive impact on English language learners who have not previously experienced academic success. Teacher participants perceived the SIOP model as effective for delivery of content through sheltered instruction lessons for high school ELLs. The teachers agreed that the SIOP model's components provided a consistent structure for planning and delivery of their sheltered lessons.

Background English language proficiency is increasingly vital for higher education institutions due to globalization and the internationalization of academic programs. In Kosovo, public universities are experiencing similar pressures to adopt English as a medium of communication and instruction. Methods This study investigates how academic staff perceive their English language proficiency and its influence on their academic responsibilities and institutional roles. A mixed-method case study was conducted involving 336 academic staff members from all public universities in Kosovo. Data were collected through an online questionnaire distributed via email between October and December 2024. The survey included both closed- and open-ended questions assessing self-perceived language proficiency, usage in professional contexts, and attitudes toward English in higher education. Results Revealed that most lecturers rated their English proficiency as “good” or “very good,” and a majority acknowledged the importance of English for academic work, publication, and international collaboration. While English was not a formal job requirement for many, respondents agreed it facilitated research, access to academic resources, and professional networking. Key challenges included lack of formal training and limited institutional support. Open-ended responses emphasized the role of English in improving academic quality, access to international literature, and communication with foreign colleagues. English language proficiency plays a crucial role in the academic and professional development of university staff in Kosovo. Despite institutional gaps in formal language policies, the increasing demand for English in research, teaching, and international engagement signals the need for strategic support in language development. Conclusion In this study highlights the urgency of aligning institutional goals with language competence to ensure quality and competitiveness in the global academic arena.

This study focused on investigating the Constraints of English teaching proficiency on students’ mastery of English language skills in community secondary schools in Morogoro District Council. The study used case study research design and mixed research approach. The targeted populations in this study were ward education officers, School head masters, English teachers, and students from 5 rural community secondary schools in Morogoro district council. Sample size for this study was 130 respondents. Purposive sampling technique was applied in selecting Ward education officers and school head masters and simple random sampling technique was used in selection of students and English teachers. Collected data were analyzed using descriptive statistics and thematic analysis. The findings emphasize that low teaching proficiency is a significant factor contributing to poor student performance in community secondary schools. The overuse of code switching, although aimed at aiding comprehension, may negatively impact students’ English language development. Improving teachers’ proficiency is crucial for enhancing students’ communication skills and overall academic performance. The results emphasize the need for targeted professional development to address teaching deficiencies and support better educational outcomes. To address these challenges, educational institutions should invest in professional development programs that enhance teachers’ English proficiency and reduce code switching. Regular assessments of teaching effectiveness and the integration of language support tools will further improve instructional quality and boost students’ academic performance

Even in health systems with universal health coverage (UHC), disparities in access to time-sensitive stroke interventions may persist, leading to inequities in patient survival. I aimed to quantify regional disparities in access to endovascular thrombectomy (EVT) and 1-year mortality among patients with acute ischemic stroke (AIS) in South Korea and to assess associations with individual and regional healthcare factors. This retrospective cohort study analyzed the 2021 National Health Insurance Service claims data of 29,755 adults hospitalized with AIS across 250 administrative districts in South Korea. Districts were classified as having no EVT center, a low-volume EVT center (<24 annual cases), or a high-volume EVT center (≥24 annual cases per year). Multilevel logistic regression models were used to assess the association between individual- and regional-level factors with EVT receipt and 1-year mortality. Regional inequalities were further evaluated using Gini coefficients across the adjustment levels. Of the 29,755 patients, 22.5% resided in districts without EVT centers, 20.5% in low-volume districts, and 57.0% in high-volume districts. After adjusting for age, sex, comorbidities, and stroke severity, patients residing in high-volume districts were more likely to receive EVT (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.10–1.46) and had lower odds of 1-year mortality (aOR, 0.80; 95% CI, 0.73–0.89) than those residing in districts without EVT centers. Regional inequality in EVT access increased after adjustment for individual factors (Gini coefficient, 0.0948 to 0.1353), and mortality inequality also increased (0.0449 to 0.1184), indicating that crude comparisons underestimated the disparities. In a nationwide UHC system, regional disparities in EVT access and 1-year mortality were modest but persistent and associated with the availability of high-volume EVT centers. Expanding EVT capacity and strengthening prehospital–hospital networks in underserved regions may be associated with reduced inequities in stroke care and improve survival outcomes in patients with stroke.

BackgroundThe unprecedented use of telemedicine during the COVID-19 pandemic provided an opportunity to examine its uptake among individuals with limited English proficiency (LEP).ObjectiveTo assess telemedicine use among nonelderly adults with LEP and the association between use of telehealth and emergency department (ED) and hospital visits.DesignCross-sectional study using the National Health Interview Survey (July 2020–December 2021)ParticipantsAdults (18–64 years), with LEP (N=1488) or English proficiency (EP) (N=25,873)Main MeasuresTelemedicine, ED visits, and hospital visits in the past 12 months. We used multivariate logistic regression to assess (1) the association of English proficiency on having telemedicine visits; and (2) the association of English proficiency and telemedicine visits on having ED and hospital visits.Key ResultsBetween July 2020 and December 2021, 22% of adults with LEP had a telemedicine visit compared to 35% of adults with EP. After controlling for predisposing, enabling, and need factors, adults with LEP had 20% lower odds of having a telemedicine visit than adults with EP (p=0.02). While English proficiency was not associated with ED or hospital visits during this time, adults with telemedicine visits had significantly greater odds of having any ED (aOR: 1.80, p<0.001) and hospital visits (aOR: 2.03, p<0.001) in the past 12 months.ConclusionsWhile telemedicine use increased overall during the COVID-19 pandemic, its use remained much less likely among adults with LEP. Interventions targeting structural barriers are needed to address disparities in access to telemedicine. More research is needed to understand the relationship between English proficiency, telemedicine visits, and downstream ED and hospital visits.

The Impact of Receiving Radiation Treatment on Financial Toxicity in Underserved Hispanic Cancer Patients with Limited English Proficiency

Health practitioners have to demonstrate that their English language proficiency meets certain standards. Being an important part of the healthcare team, nurses who work in multi-lingual context need to have necessary command in English to perform their duties effectively. Though Malaysia is a country full of diverse people, there is no specific English language test for Malaysian nurses now. This research aims to experiment a special test, the Occupational English Writing Test (OET) which is specifically designed for health practitioners, on the nurses of two nursing colleges in Kuantan, Pahang, Malaysia. Specifically the objectives of this research are to assess Malaysian nurses' performance in the OET and to evaluate its suitability and acceptability in Malaysian context. This study is a case study. The nurses chosen as samples for this research cover 53 nursing students from Kolej Kejururawatan, Kuantan and University College Shahputra, Kuantan. The researcher administers a questionnaire which comprises of three sample OET writing tests. She also interviews some samples individually. The result of this study shows that nurses' English proficiency is not satisfactory. The interviews obviously signify that nurses' lack of communication is a barrier to patient safety. Therefore the nurses need to demonstrate a good communication skill in working context. Thus their language proficiency needs to be tested and OET is suitable for this purpose because OET exemplifies the real difficulty of language performance of health practitioners in work-related context. From the research, it is also crystal clear that OET is very much acceptable for Malaysian nurses.

Purpose of ReviewSub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model.Recent FindingsA broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda.SummarySub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action.

If it were possible to automatically detect proficiency in languages using data from eye movements, new levels of customizing computer applications could possibly be achieved. An example in case is web searches where suggestions and results could be adjusted to the user's knowledge of the language. The objective of this study is to compare the reading habits of users with high and low English language proficiency, having in mind the possible automatic detection of the English proficiency level through reading. For this purpose, a study was conducted with two types of user, those with a high level of proficiency (Proficient Users), and those with low proficiency (Basic Users) in the English language. An eye-tracker was used to collect users' eye movements while reading a text in English. Results show that users with high proficiency engage in more careful reading. In contrast, low English proficiency users take more time to read, revisit sentences and paragraphs more often, have more and longer fixations and also a higher number of saccades. As expected, these users have more difficulties in understanding the text.

The potential of machine translation to enhance English language proficiency in university-level education has been the subject of much discussion. This paper presents empirical evidence that supports the notion that learners&amp;#39; English proficiency can improve or remain steady when machine translation is used. The study spanned a one-year period and involved administering objective tests to measure changes in English proficiency. Despite its potential, there is a dearth of empirical evidence on the effectiveness of machine translation in foreign language education. This paper fills this gap by presenting a positive case study of a specific class size. However, the paper acknowledges the need for further research to better understand the mechanisms through which machine translation contributes to improvements or stabilizations in English proficiency.

The acquisition of language as well as the acquisition of social consideration, or politeness, are two sets of separate skills. However, the lack of language knowledge by an English language learner can result in social mistakes that can be perceived as impolite by native speakers. The present study aimed to explore the relationship between English language proficiency and politeness in making requests at retail shops, specifically focusing on Saudi students in the United States. There were five participants in this study: two Saudi ESL students with low English proficiency; two Saudi Ph. D. students with advanced English proficiency, and an American waiter who speaks English as a native language. The study was conducted by using a qualitative research method in two phases. The first phase included observing all participants during interaction, and the second phase included interviewing a server at one of the restaurants where the students visited. The main findings revealed that there was no strong correlation between politeness and English language proficiency in making requests. However, there were some factors found in this study that contributed to politeness level, such as intonations and the use of politeness markers.