Language Barriers In Health Care Research Articles

Large language models leverage external knowledge to extend clinical insight beyond language boundaries.

Large Language Models (LLMs) such as ChatGPT and Med-PaLM have excelled in various medical question-answering tasks. However, these English-centric models encounter challenges in non-English clinical settings, primarily due to limited clinical knowledge in respective languages, a consequence of imbalanced training corpora. We systematically evaluate LLMs in the Chinese medical context and develop a novel in-context learning framework to enhance their performance. The latest China National Medical Licensing Examination (CNMLE-2022) served as the benchmark. We collected 53 medical books and 381149 medical questions to construct the medical knowledge base and question bank. The proposed Knowledge and Few-shot Enhancement In-context Learning (KFE) framework leverages the in-context learning ability of LLMs to integrate diverse external clinical knowledge sources. We evaluated KFE with ChatGPT (GPT-3.5), GPT-4, Baichuan2-7B, Baichuan2-13B, and QWEN-72B in CNMLE-2022 and further investigated the effectiveness of different pathways for incorporating LLMs with medical knowledge from 7 distinct perspectives. Directly applying ChatGPT failed to qualify for the CNMLE-2022 at a score of 51. Cooperated with the KFE framework, the LLMs with varying sizes yielded consistent and significant improvements. The ChatGPT's performance surged to 70.04 and GPT-4 achieved the highest score of 82.59. This surpasses the qualification threshold (60) and exceeds the average human score of 68.70, affirming the effectiveness and robustness of the framework. It also enabled a smaller Baichuan2-13B to pass the examination, showcasing the great potential in low-resource settings. This study shed light on the optimal practices to enhance the capabilities of LLMs in non-English medical scenarios. By synergizing medical knowledge through in-context learning, LLMs can extend clinical insight beyond language barriers in healthcare, significantly reducing language-related disparities of LLM applications and ensuring global benefit in this field.

The Association of Patient-Provider Language Concordance with Healthcare Comprehension Among Mexican-origin Latino/as in Oregon

Objective: To understand the local Mexican-origin Latino community’s preference for bilingual health care providers and understand the relationship between language concordant care and comprehension of a healthcare visit. Background: Language barriers in healthcare negatively impact quality of care. Language concordant care (where a health care provider speaks the patient’s language) has been shown to result in better patient comprehension than using interpreters/translators. Study Design: This is a cross sectional study in collaboration with the General Consulate of Mexico. We developed a 20-item survey that includes questions about socio-demographics, an acculturation scale, and questions regarding language concordant care experience and preferences. Participants were aged 18 or older who had a healthcare visit within the past 12 months. We used descriptive and multivariable statistics to describe our sample and test the association of language concordant care and comprehension of the healthcare visit. Results We recruited 505 participants who all completed the survey in Spanish. Overall, 93.5% reported preference for a language concordant provider and 32.9% reported receipt of such care. Of those who reported a concordant provider visit, 87% reported a regular source of care compared to 50% among those with a discordant provider (p<0.001). In multivariable analyses, patients with a concordant provider had higher odds of understanding everything their provider said (aOR = 10.53 (95% CI: 6.60-16.81). Conclusion There is a gap between the preference for language concordant providers and the receipt of this type of health care for Oregon Latinos. Increasing access to language concordant care can contribute to improving health care quality, equity, and outcomes for Latinos in Oregon.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol

IntroductionIn many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order...

Quality and safety issue: language barriers in healthcare, a qualitative study of non-Arab healthcare practitioners caring for Arabic patients in the UAE

ObjectivesTo identify language-related communication barriers that expatriate (non-Arabic) healthcare practitioners in the UAE encounter in their daily practice.DesignQualitative study utilising semi-structured in-depth interviews. The interviews were conducted in English language.SettingDifferent...

209 The experiences of native Irish speaking older adults in navigating healthcare services in Ireland: a generic qualitative inquiry

Abstract Background Research on the impact of language barriers in healthcare is well-developed. However, limited evidence includes the patient perspective. Furthermore, there is an absence of qualitative literature on the healthcare experiences of native Irish speaking older adults, despite the population’s recent and predicted growth. This study aims to provide insight into the healthcare experiences of native Irish speaking older adults, who dwell in Gaeltacht areas, and to explore their perspectives on what promotes or hinders their access to healthcare services in Ireland. Methods Participants were recruited through poster and radio advertisement. Convenience sampling was used. The researcher conducted semi-structured interviews in the Irish language with seven participants. Interviews were conducted in a health unit, audio recorded and transcribed. Data was coded using Nvivo software and analysed thematically through the Irish language. Quotations were presented in both Irish and English to illustrate findings. Results Participants reported their experiences of Irish healthcare services, and preferences for healthcare interactions. Shared communications preferences included using pidgin Irish, English, or interpreters. Participants preferred if healthcare providers were proficient in both Irish and English, and valued a long-standing therapeutic relationship with healthcare providers. In addition, participants commented that communicative difficulties they experienced must be exacerbated for monoglot Irish speakers. Conclusion Native Irish speaking older adults’ healthcare experiences aren’t ‘black and white’. Each participant had individual preferences for communication during healthcare interactions, speaking from both negative and positive experiences. To cater for the native Irish speaking older adult population in Gaeltacht areas, a consensus among participants was that healthcare providers working in these areas should be fluent in Irish and English, and have a long-term contract. This study highlights the need for language concordant care to be available for native Irish speaking older adults living in rural Gaeltacht areas, and further emphasises the importance of language concordant care for minority language speaking populations.

Patient perceptions of the readability and helpfulness of bilingual clinical forms: a survey study

BackgroundPatients with limited English proficiency (LEP) are rarely provided with translated clinical materials. Typically, healthcare clinics cite high costs of translation and lack of professional translators as barriers to this service. The purpose of the current study was to investigate the perceptions of LEP dental patients regarding the readability, understanding, and helpfulness of translated clinical forms produced by dental student doctor translators.MethodsWe used a survey design and convenience sampling to recruit LEP patients from a dental school clinic. Participants completed a 9-question (8 Likert-type items and 1 open-ended item) paper survey about translated forms. The bilingual survey was a combination of English and 8 other languages (Arabic, Dari, Pashto, Russian, Spanish, Ukrainian, Urdu, or Vietnamese) and assessed the type of form received; self-reported literacy; design, readability, and helpfulness of the form; overall understanding of the form; understanding of medical and dental terms; helpfulness for patient-provider communication; and comfort level with dental care after receiving the form. Demographic characteristics of participants were collected from the clinic’s electronic health record. Survey responses were analyzed descriptively, and Spearman’s correlation was used to examine the relationship between outcomes.ResultsNinety-seven LEP patients (61.9% [60] female, 78.4% [70] Spanish speakers) completed 140 surveys for various translated forms in Dari, Pashto, Spanish, Urdu, or Vietnamese. Participants positively rated translated clinical forms: range, 50.4% (70) for design of the form to 80.0% (112) for comfort level with dental care after receiving the form. For the open-ended item, participants indicated the translations were good, and no improvements were needed. They also thought providing the form was evidence of good customer service. When examining relationships between outcomes, positive correlations were found between self-reported literacy and readability (Spearman r = .57, P < .001), overall understanding and understanding of medical and dental terms (Spearman r = .58, P < .001), and type of form and helpfulness for patient-provider communication (Spearman r = .26, P = .005).ConclusionsStudy results suggested the translated clinical forms were perceived as helpful and beneficial by LEP dental patients. Similar approaches should be considered to reduce language barriers in healthcare.

Promoting physician-patient language concordance in undergraduate medical education: a peer assisted learning approach

BackgroundVerbal communication plays an important role in the patient-physician relationship. Research shows that language concordance, when a healthcare professional communicates fluently in the patient’s preferred language, contributes to patient satisfaction and improves healthcare outcomes. Yet, many medical schools worldwide, including most institutions in the Arab world, use English as the language of instruction. As a result, students lack confidence and feel unprepared to communicate effectively with the local population. This manuscript describes the development, implementation and early perceptions of an Arabic language program for medical students in the United Arab Emirates.MethodsIn 2020, the learning communities at Khalifa University College of Medicine and Health Sciences launched a pilot program implementing a Peer Assisted Learning (PAL) framework to teach Arabic medical terminology and language to both native and non-native Arabic speaking medical students. A web-based survey was administered to the first two cohorts of students to assess satisfaction with the classes and the program’s impact on students’ communication skills during clinical encounters.ResultsEarly perceptions of the program were very positive, with 43/48 students (89.6%) reporting that they used the information during home visits and clinical rotations, and 42 students (87.5%) admitting that the classes made them feel more comfortable in communicating with the Arabic speaking local patient population.ConclusionThis paper explores a new educational approach to address the challenge of language barriers in healthcare. A feasible, low cost program using peer assisted learning can improve students’ comfort in communicating with patients in the local language.

Lifting the voices of Spanish-speaking Kansans: a community-engaged approach to health equity

Abstract An important component of social justice research is centering the voices of those individuals whose lives the research is intended to improve, not as subjects from whom researchers collect data but as active participants in a process of understanding and addressing issues of concern to the community. This ideal of community engagement slows the pace of dissemination of traditional social science or sociolinguistic scholarship but also allows scholars and community members to collaborate to identify and implement meaningful solutions to community problems. We describe a process of engagement of Spanish-speaking patients, interpreters, and healthcare providers in developing a health equity agenda for Spanish speakers in Kansas, grounded in a community-based participatory approach called Patient-Centered Outcomes Research. Stakeholders were engaged through sharing and amplifying their testimonios, stories that tied personal experiences of encountering language barriers in healthcare with calls to action, and they contributed to decisions about what to do with the stories and how to respond to the problems they identified. The result of our engagement process is the formation of a community-based team that has amplified the voices of Spanish-speaking patients and families to reach a range of audiences and responded to a number of evolving community needs. We provide recommendations for language researchers interested in pursuing community-engaged work and explore the possibilities for aligning such work with the expectations of academic institutions.

"It's the First Barrier" - Lack of Common Language a Major Obstacle When Accessing/Providing Healthcare Services Across Europe.

International migration is shaping and changing urban areas as well as impacting on healthcare access and provision in Europe. To investigate how residents of superdiverse neighborhoods put together their healthcare, we conducted qualitative interviews with 76 healthcare providers and 160 residents in four European cities - Bremen, Germany; Birmingham, UK; Lisbon, Portugal and Uppsala, Sweden, between September 2015 and April 2017. A common theme arising from the data was language and communication obstacles, with both healthcare providers and users experiencing language difficulties, despite all four countries having interpretation policies or guidelines to address language barriers in healthcare. Official interpreter services were seen to be unreliable and sometimes of poor quality, leading to a reliance on informal interpretation. Some coping strategies used by both service providers and users led to successful communication despite the lack of a common language. Where communication failed, this led to feelings of dissatisfaction and frustration among both users and providers. Language difficulties came up across all participating countries even though this was not prompted by interview questions, which highlights the widespread nature of language barriers and communication barriers and the need to address them in order to promote equal accessibility to good quality healthcare.

Implications of Language Barriers for Healthcare: A Systematic Review.

ObjectivesLanguage barriers pose challenges in terms of achieving high levels of satisfaction among medical professionals and patients, providing high- quality healthcare and maintaining patient safety. To address these challenges, many larger healthcare institutions offer interpreter services to improve healthcare access, patient satisfaction, and communication. However, these services increase the cost and duration of treatment. The purpose of this review is to investigate the impact of language barriers on healthcare and to suggest solutions to address the challenges.MethodsWe identified published studies on the implications of language barriers in healthcare using two databases: PubMed and Medline. We included 14 studies that met the selection criteria. These studies were conducted in various countries, both developed and developing, though most came from the US. The 14 studies included 300 918 total participants, with participation in each study ranging from 21 to 22 353 people.ResultsWe found that language barriers in healthcare lead to miscommunication between the medical professional and patient, reducing both parties’ satisfaction and decreasing the quality of healthcare delivery and patient safety. In addition, the review found that interpreter services contribute indirectly to increased cost and the length of treatment visits. One study reported the implementation of online translation tools such as Google Translate and MediBabble in hospitals, which increased the satisfaction of both medical providers and patients (to 92%) and improved the quality of healthcare delivery and patient safety. Language barriers are responsible for reducing the satisfaction of medical providers and patients, as well as the quality of healthcare delivery and patient safety. Many healthcare institutions use interpreter services that increase the cost and length of treatment visits.ConclusionsThe results of our review suggest that implementing online translation tools such as Google Translate and MediBabble may improve the quality of healthcare and the level of satisfaction among both medical providers and patients.

Strategies for overcoming language barriers in healthcare.

Language barriers between nurses and patients increasingly affect nursing practice, regardless of where care is delivered. In the United States, a language other than English is now spoken at home in one of five households, the highest level since just after World War I.1 Patients with limited Engli

Strategies for overcoming language barriers in healthcare.

Strategies for overcoming language barriers in healthcare.

Migrace a porod: sociální aspekty prolínání dvou životních změn ve výzkumu perinatálního zdraví žen

When the experiences of migration and becoming a mother intersect, the context and conditions of this have implications for the health of the women and their children. This article presents an overview of social-science research on health and pregnancy among migrant women and on the perinatal and postpartum care they receive. Research on 124 studies on this subject revealed that there are three main themes associated with maternal health in this context: (1) How women are defined and categorised as migrants: This is often based on a single indicator, country of origin or birth. This creates a simplified and homogenising category that then also serves as the basis for the use of more complex categories. (2) The significance of social support for families, especially with respect to informal care, and the fundamental role of language and language barriers in health care. The relationship between migrant women and health-care providers is impacted by cultural differences, which leave women in a vulnerable position. (3) Macro-sociological and epidemiological factors. These are discussed mainly from the perspective of the 'epidemiological paradox', which the authors here deem a rhetorical trick because it conceals the variableness of the findings obtained from perinatal health indicators.

Utilization of a Text and Translation Application for Communication With a Foreign Deaf Family

Effective communication with patients is essential to quality care. Obviously, language barriers significantly impact this and can increase the risk of poor patient outcomes. Smartphones and mobile health technology are valuable resources that are beginning to break down language barriers in health care. We present a case of a challenging language barrier where successful perioperative communication was achieved using mobile technology. Although quite beneficial, use of technology that is not validated exposes providers to unnecessary medicolegal risk. We hope to highlight the need for validation of such technology to ensure that these tools are an effective way to accurately communicate with patients in the perioperative setting.

The “Battle” of Managing Language Barriers in Health Care

Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging. Reports of parent perspectives on navigating language discordance in health care are limited. We analyzed portions of 48 interviews focused on language barriers from 2 qualitative interview studies of the pediatric health care experiences of LEP Latina mothers in 2 urban US cities. We found mothers experienced frustration with health care and reported suboptimal accommodation for language barriers. Six themes emerged relevant to health care across settings: the "battle" of managing language barriers, preference for bilingual providers, negative bias toward interpreted encounters, "getting by" with limited language skills, fear of being a burden, and stigma and discrimination experienced by LEP families. Parents' insights highlight reasons why effective language accommodation in health care remains challenging. Partnering with families to address the management of language barriers is needed to improve health care quality and safety for LEP patients and families.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language.

BackgroundMiscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language.Methods/DesignEighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation.DiscussionUnderstanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Changes in research on language barriers in health care since 2003: A cross-sectional review study

BackgroundUnderstanding how to mitigate language barriers is becoming increasingly important for health care providers around the world. Language barriers adversely affect patients in their access to health services; comprehension and adherence; quality of care; and patient and provider satisfaction. In 2003, the United States (US) government made a major change in national policy guidance that significantly affected limited English proficient patients’ ability to access language services. ObjectiveThe objectives of this paper are to describe the state of the language barriers literature inside and outside the US since 2003 and to compare the research that was conducted before and after a national policy change occurred in the US. We hypothesize that language barrier research would increase inside and outside the US but that the increase in research would be larger inside the US in response to this national policy change. MethodsWe reviewed the research literature on language barriers in health care and conducted a cross sectional analysis by tabulating frequencies for geographic location, language group, methodology, research focus and specialty and compared the literature before and after 2003. ResultsOur sample included 136 studies prior to 2003 and 426 studies from 2003 to 2010. In the 2003–2010 time period there was a new interest in studying the providers’ perspective instead of or in addition to the patients’ perspective. The methods remained similar between periods with greater than 60% of studies being descriptive and 12% being interventions. ConclusionsThere was an increase in research on language barriers inside and outside the US and we believe this was larger due to the change in the national policy. We suggest that researchers worldwide should move away from simply documenting the existence of language barriers and should begin to focus their research on documenting how language concordant care influences patient outcomes, providing evidence for interventions that mitigate language barriers, and evaluating the cost effectiveness of providing language concordant care to patients with language barriers. We think this is possible if funding agencies around the world begin to request proposals for these types of research studies. Together, we can begin document meaningful ways to provide high quality health care to patients with language barriers.

Exploring the Determinants of Language Barriers in Health Care (LBHC): Toward a Research Agenda for the Language Sciences

There is growing interest in language barriers in health care (LBHC) – interest, that is, in how the quality of health care service delivery might be compromised when patients and health care providers do not share the same first language. This article discusses LBHC as an emerging research area that provides valuable opportunities for researchers in various branches of the language sciences – including, among others, applied linguistics, theoretical linguistics, psycholinguistics, second language acquisition – to conduct basic research and to make contributions to the socially important area of medical communication. This article also proposes a research agenda aimed at attracting general language researchers to the study of LBHC, an agenda that is theory driven, programmatic, problem-solving oriented, and interdisciplinary in scope. In proposing this agenda, selected examples have been reviewed from the current literature that can serve as illustrative models for how future research into LBHC can proceed.

Language Barriers, Physician-Patient Language Concordance, and Glycemic Control Among Insured Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE)

BACKGROUNDA significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown.OBJECTIVETo assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician.DESIGNCross-sectional, observational study using data from the 2005–2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%).KEY RESULTSThe unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53–1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04–2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03–3.80).CONCLUSIONSLanguage barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.

Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care.

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.