Limited English Language Proficiency Research Articles

Ukrainian Forced Migrants in Edinburgh: How the Homes for Ukraine Scheme Worked

The article presents an in-deep analysis of the implementation the Homes for Ukraine Scheme (HFUS) for Ukrainian forced migrants fleeing the Russian-Ukrainian war in 2022. It is noteworthy that the HFUS does not provide for official refugee status in the UK but allows Ukrainians to seek asylum. The HFUS is unique, as it involves, in particular, the settlement of Ukrainian refugees in the same housing with their sponsors, which should contribute to the adaptation and assimilation of new residents in Scotland. Our interviews with Ukrainians and sponsors who hosted Ukrainians aimed to analyse the challenges faced by both groups involved in HFUS. The study aimed to explore the challenges faced by Ukrainians adapting to new conditions in Scotland, their self-identification in a new environment, and their future plans. The primary difficulties identified for Ukrainians in Scotland included limited English language proficiency, challenges in securing employment in their field, navigating unfamiliar systems, and instability hindering long-term planning. Conversely, Scots highlighted challenges related to the lack of clarity in the HFUS, in communication with local councils, and in understanding the consequences of using the scheme. Based on analysis of interviews and other open sources, the authors identified certain aspects that they believe should be considered in Scotland's migrant integration policy, in particular, the effectiveness of the HFUS and the work of state and volunteer organisations that assist Ukrainians and other forced migrants. Additionally, the authors suggest that the gathered data could inform policies for repatriating Ukrainian citizens once the conflict concludes.

Addressing the Requirements of EAP Students by Analyzing Their Demands in the Technological and Information Program

The aim of the research is to determine the specific requirements and needs of both students and lecturers in the EAP program for the Technology and Information Education Department in East Java Indonesia. A qualitative research design was adopted, utilizing closed-ended questionnaires to collect in-depth information. Contacts were made with Technology and Information students and EAP lecturers. The data collected through online forms focused on identifying needs, lacks, and wants. The data was then analyzed through coding and categorizing in a quantitative manner. The results indicate that both students and lecturers believe that the main areas of concern for prospective Technology and Information students are the need for English materials tailored to their specific field of study, as they have a limited English language proficiency. They expressed a desire for reading materials that align with their future careers. Lecturers identified the main need as English teaching materials aligned with EAP principles, and they also mentioned a lack of appropriate EAP resources and expressed a need for teaching materials focused on reading for students majoring in Technology and Information Education

Palliative and End-of-Life Family Caregiving in Rural Areas: A Scoping Review of Social Determinants of Health and Emotional Well-Being.

Introduction: Due to their remote location, rural-dwelling family caregivers (FCGs) experience geographic and psychosocial challenges when providing home-based palliative and end-of-life (PEOL) care for their care recipient. Limited research has evaluated the social and environmental factors that may compound FCG burden and contribute to adverse emotional health outcomes among rural-dwelling PEOL FCGs. Objective: To characterize the social determinants of health (SDOH) that affect the provision of PEOL care among rural-dwelling FCGs, along with symptoms of anxiety and depression. Methods: A scoping review was conducted using Arksey and O'Malley's Framework. Searches were conducted in PubMed, CINAHL, PsycINFO, and Cochrane, and 511 articles published between 2010 and 2023 were screened. Keywords included "rural," "PEOL care," and "FCG." Inclusion criteria included FCGs, ages ≥18 years; findings reported on SDOH, anxiety, and/or depressive symptoms; within a rural context; and U.S. based. Findings: In this review, 18 studies met eligibility and were included. Apart from six studies that specifically investigated Black and Latinx FCGs, most FCGs were middle-aged White female spouses. SDOH impacting PEOL care provision included: limited access to PEOL services due to remote distance and travel needs for services; low health literacy in medical terminology and patient symptom management; limited English-language proficiency; perceived clinician racial and ethnic discrimination; financial vulnerabilities affecting health care coverage; and underdeveloped infrastructure. These barriers negatively impacted decision making, communication with clinicians, and patient symptom management. FCGs reported emotional distress related to patients' symptom management and limited opportunities for respite. There was a limited investigation of emotional well-being and minimal interventions aimed toward improving rural-dwelling FCG emotional health. The presence of community support promoted hospice use and facilitated the provision of care. Conclusions: FCGs are vulnerable to adverse emotional health when providing home-based PEOL care. Research is needed to develop supportive interventions (e.g., digital health) for rural-dwelling FCGs.

Linguistic Disparities in Diabetes Care Quality in California Community Health Centers Before and During the COVID-19 Pandemic.

Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (<140/90 mm Hg), and (3) hemoglobin A1c control (HbA1c <8%) for LEP versus non-LEP patients. LEP and non-LEP patients with diabetes had comparable blood pressure screening and control in 2019 and in 2020. LEP patients were less likely than non-LEP patients to have their HbA1c under control in 2019 (OR = 0.85, 95% CI = 0.77, 0.96, P = .006) and 2020 (OR = 0.83, 95% CI = 0.75, 0.92, P = .001). There were no differential changes in HbA1c control over time for LEP and non-LEP patients. Although LEP patients were less likely than non-LEP patients to have their HbA1c under control, CHCs maintained quality of care equally for LEP and non-LEP patients with diabetes during the early pandemic period.

Appropriate Use of Medical Interpreters in the Breast Imaging Clinic.

More than 25 million Americans have limited English-language proficiency (LEP) according to the U.S. Census Bureau. This population experiences challenges accessing health care and is least likely to receive preventive health care, including screening mammogram. In a setting where the breast radiologist does not speak the language of their patient, using certified medical interpreter services is fundamental. Medical interpreter use is associated with improved clinical care and patient satisfaction and can potentially increase adherence to screening mammograms and follow-up in patients with LEP. Title VI of the Civil Rights Act requires interpreter services for patients with LEP who are receiving federal financial assistance. Failure to provide interpretative services when necessary is considered discriminatory and illegal. The use of untrained medical interpreters, including ad hoc interpreters (eg, family, friends, or untrained staff), is associated with more medical errors, violation of confidentiality, and poor health outcomes. Types of medical interpretation services available to address language barriers include in-person interpretation, telephone and video remote interpretation, and qualified bilingual staff. Proper training and certification of medical interpreters is essential to prevent misinterpretations and ensure patient safety. When using an interpreter service, speak to and maintain eye contact with the patient, address the patient directly and seat the interpreter next to or slightly behind the patient, use visual aids whenever possible, and have the patient repeat the information to verify comprehension. Breast radiologists can address disparities in breast cancer screening and treatment by promoting effective communication.

Language Hurdles in Healthcare: Bridging the Gap

This article addresses the significant challenge posed by limited English language proficiency among the growing immigrant population in the United States, hindering effective communication in medical care. The inability to accurately convey symptoms and treatment information can lead to delayed diagnoses, prolonged treatment, increased healthcare costs, and potential complications. While in-person translator services are a common solution, logistical issues and resource constraints often impede their efficiency. The article explores the potential of digital translator services, with a focus on the benefits and limitations of tools like Google Translate. While studies show positive feedback from healthcare teams, concerns arise regarding the accuracy of translations, highlighting specific challenges in medical contexts and between certain language pairs. The need for innovative solutions to enhance the accuracy, affordability, and expediency of digital translation tools is emphasized, especially in the context of community-focused healthcare. The article underscores the pivotal role translation services play in modern medicine and the imperative for ongoing efforts to optimize their efficacy for improved patient care outcomes.

THE ROLE OF FORMAL RESOURCES ON ELDER MISTREATMENT HELP-SEEKING BEHAVIORS AMONG ASIAN OLDER ADULTS

Abstract Elder mistreatment is one of the most difficult topics to talk about among Asian older adult immigrants in the U.S. because they are unfamiliar and uncomfortable to disclose the issue due to their unique cultural values and limited English language proficiency. We recruited 494 community dwelling older adults from five cities who identified themselves of Asian ethnicity, and were 55 years old and older. Participants had various Asian ethnic and language backgrounds (e.g. Korean, Chinese, Filipino, and Vietnamese). Most of them were foreign-born (84.6%) with the mean age of 69.0 (SD = 8.47). Using the participant survey data, we focused on examining difference regarding elder mistreatment experience, perceptions, and help-seeking intentions between the Senior Community Service Employment Program (SCSEP) group and the non-SCSEP group that may or may not participate in paid workforce. The SCSEP is the federally paid workforce program for low-income older adults aged 55 or above aiming at fostering older adults’ community service and economic self-sufficiency. There was a significant difference in emotional mistreatment experiences between SCSEP and non-SCSEP participants. Furthermore, the two groups were significantly different in their likelihood of seeking help from Adult Protective Services (APS). Those who ever participated in the SCSEP were more likely to seek help from APS (X2 = 1, N = 284) = 4.674, p ≤ .05. Implications for future research and gerontology services are discussed to enhance Asian older adults’ awareness of elder mistreatment, and APS and other formal sources of help.

Factors Associated with Poverty among Refugees in the United States

ABSTRACT In this paper, factors associated with poverty among refugees were explored using a nationally representative sample in the United States. Relying on the social exclusion theory,) a refugee integration framework was selected as a conceptual framework of the study. Poverty was calculated based on households’ income (income poverty) and deprivation in three domains of education, health, and housing (multidimensional poverty). Multivariate models of the study identified limited English language proficiency as the strongest predictor of both income and multidimensional poverty among refugees. The findings call for more attention to English language training among refugees in the United States.

Analysis of trends in nurse practitioner billing for emergency medical services: 2015–2018

Study objectiveDespite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality. MethodsMedicare provider utilization and payment data between 2015–2018 was used to explore NP billing as compared to five other clinician provider types for common emergency services acuity codes (CPT codes 99281–99285) to determine services billed for levels of severity of illness and trends over time. Number of services billed by clinician provider type related to state policies on NP practice authority, location, and population characteristics was explored. ResultsNPs who independently billed for ED CPT codes (99282–99285), increased during this time and decreased for acuity code 99281 (minor and self-limiting). Overall, NPs saw a greater increase than all other providers in both the highest severity CPT codes of 99284 and 99285.The analysis revealed that type of clinician, state practice authority policy, number of NPs, and percent of population 65 years and older (by zipcode) and population size are positive predictors for services billed. The negative predictors were rurality, states which accepted the Medicaid expansion, having a higher number of non-English speaking residents, and non-emergency medicine clinicians. ConclusionAs a proportion of the providers independently billing in the ED, NPs are increasingly managing higher acuity patients as evidenced by billing percentage of the highest acuity CPT codes (99284 and 99285). During the same time period, ED MDs decreased their billing in the same categories. Current employment of NPs in the ED may not be fulfilling its original vision to care for the lower acuity patients in order to allow MDs to care for the more acutely and critically ill patients, and to increase the services for underserved populations in rural areas, those over age 65, and those with limited English language proficiency. Future research should investigate ED policies resulting in NPs as opposed to MDs seeing patients with greater severity codes.

Disparities in Screening for Colorectal Cancer Based on Limited Language Proficiency.

This study analyzes the association between limited language proficiency and screening for colorectal cancer. This is a retrospective cohort study from the 2015 sample of the National Health Interview Survey database utilizing univariate and multivariate regression analysis. The study population includes subjects between 50 and 75years of age. The main outcome analyzed was rates of screening colonoscopies between limited English-language proficiency (LEP) subjects and those fluent in English. Secondary outcomes included analysis of baseline, socioeconomic, access to health care variables, and other modalities for colorectal cancer screening between the groups. Incidence of limited language proficiency was 4.8% (n = 1978, count = 4453599). They reported lower rates of screening colonoscopies (61% vs 34%, P < .001), less physician recommendation for a colonoscopy (87 vs 60%, P < .001), fewer polyps removed in the previous 3years (24% vs 9.1%; P < .001), and fewer fecal occult blood samples overall (P < .001). Additionally, Hispanic non-LEP subjects have higher rates of colonoscopies compared to those with language barriers (50% vs 33%, P < .001). On multivariate analysis, LEP was associated with a lower likelihood to have a screening colonoscopy (OR .67 95% CI .49-.91). A second regression model with "Spanish language" and "other language" variables included, associated Spanish speakers with a lower likelihood for a screening colonoscopy (OR .71 95% CI .52-.97) when controlling for baseline, socioeconomic, and access to health care covariates. Patients with limited English-language proficiency are associated with lower rates of screening for colorectal cancer, in particular the Spanish speaking subgroup.

Enhancing Medical Communication and Care Through Professional Medical Interpreters

The quality of care provided to patients with limited English-language proficiency (LEP) is significantly affected by the appropriate use of interpreters.1,2 No formal curriculum on the use of professional medical interpreters (PMIs) exists in medical school or residency programs. Herein, I outline communication through PMIs who assist patients with LEP. These patients have a limited ability at speaking, reading, writing, or understanding the English language. Medical institutions should focus on emphasizing the importance of early education on the use of PMIs and integrating these in various teaching curricula.

The Effect of English Language Proficiency and Glossary Provision on Personality Measurement

Research on English language learners suggests that language proficiency can affect the validity of standardized test scores. This study examined whether the provision of a glossary as a test accommodation during personality test completion influences the measurement of personality. Using an experimental research design, participants recruited from Amazon Mechanical Turk and Prime Panels (n = 206) were first categorized as having limited or high English language proficiency and then randomly assigned to a glossary condition. The results indicate that providing a within-text glossary does not impact the construct validity and reliability of personality measures. The results also suggest that participants who received glossaries found them useful. However, those who were not provided with one disagreed that they would benefit from the provision of a glossary.

Embodied mathematical practices in (re)designing board games in a linguistically diverse classroom

ABSTRACT In this article, we discuss embodied mathematical practices in the context of learners’ board game (re)design activities. By focusing on redesigning a board game as a pedagogical approach, rather than designing one from scratch, we intended to limit the vast creative design possibilities and engage learners more deeply with the discipline of mathematics. We conducted a design-based research project in a culturally and linguistically diverse Canadian school. Our video analysis identified embodied discourses wherein a student with limited English language proficiency came to be a designer of a board game, while meaningfully engaging in mathematics learning. Our findings demonstrate how the conversations between a newly arrived immigrant student and the teacher in the process of redesigning an existing board game helped the student fully participate in the classroom practice, maximizing the available cultural and linguistic resources.

Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care.

Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study

BackgroundImmigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The “Healthy Immigrant Effect” or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country.MethodsAn exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees.ResultsA thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues.ConclusionsThe study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.

Students’ perceptions of the inclusion of the English Word Power programme at one university in South Africa

Background: South Africa has incorporated Computer-Assisted Language Learning (CALL) into many university classrooms in order to help address ubiquitous concerns related to the limited English language proficiency of first-year university students. In the context of this study, the research site used the CALL application called the English Word Power (EWP programme). Research to establish students’ perceptions of the CALL application is somewhat limited, although students’ perceptions of a learning environment can be more useful in explaining their behaviour. Therefore, teachers’ understanding of the students’ perceptions towards a new learning programme is likely to assist them in tailoring the content according to the needs of the learners.Objectives: The objective of this study was to explore the students’ perceptions of the use of the EWP, a computer-based programme used for improving English language proficiency. The researchers endeavoured to gain an understanding of the students’ perceptions of the strengths and frustrations of the EWP programme. Specifically, the focus was on what the students perceived as their preferred mode of learning and what their views were regarding the contribution of the EWP programme in improving their language skills.Method: The study was qualitative in nature and a case study design was adopted. A purposive sample of 60 students from an Information and Communication Technology’s (ICT) Foundation programme was used to collect data. Focus group interviews were conducted with 60 purposefully selected students and content analysis was used to process data.Results: The study yielded mixed results, as some students were happy with some of the components of the EWP programme whilst others were frustrated with some components. Specifically, some students reported experiencing frustration with the irrelevant nature of the EWP content. On the contrary, the study revealed that students were satisfied with the EWP programme’s accessibility, which facilitated their learning opportunities. Some students reported that their language proficiency concerning spelling and vocabulary had improved. The findings further revealed that the students preferred face-to-face learning to the EWP programme learning environment.Conclusion: The implication of the findings is that students need a language learning programme that is relevant to their field of study. They also require a programme that allows for student–student and lecturer–student interaction.

Experiences of Hispanic Families with Social Services in the Racially Segregated Southeast: Views from Administrators and Workers in North Carolina.

North Carolina—as a state in the racially segregated Southeast—offers a unique context to understand access to social services for Hispanic families and children. Theories of administrative burden posit that Hispanic families likely face high learning, compliance, and psychological costs. Hispanic families face challenges that compound these costs: limited English language and literacy proficiency, complex household composition, and citizenship status of family members and other household members. With new survey results and qualitative data on social service administrators and front-line workers, we examine how these costs may affect access to programs for Hispanic families who reside in a state with a history of racial divisions that have shaped local policy implementation. Some workers noted transportation barriers and complex application processes as limiting access. While we expected to find that Hispanic families may be disadvantaged by decentralized service delivery in a manner that is similar to the experiences of African American families, workers instead note significant resources that help facilitate Hispanic families’ access to programs. Workers view national anti-immigrant policies and rhetoric, rather than state and local policy rules or resource constraints, as limiting their capacity to serve Hispanic families.

English Language Proficiency and Immigrant Families Annual Earnings and Medical Care Spending in the USA

This study reports on the role of English language proficiency (ELP) in immigrants' health and economic integration in the USA. Bayesian Markov Chain Monte Carlo (MCMC) estimation of a mixed bivariate ordered probit specification of annual earnings and medical care spending is conducted using a representative sample of immigrant families' data from the 2015-2017 US National Health Interview Surveys (NHIS). The results reveal that annually, limited ELP has an increasingly negative impact on immigrants' propensity to earn income (-$44.83, -$50.66 and -$56.97), while simultaneously positively impacting at a decreasing rate their propensity to spend on medical care ($8.09, $6.09 and $4.32). Furthermore, a positive and significant 7.2% correlation coefficient is found between annual earnings and medical care spending propensities, suggesting that the income effect of higher earnings from increased ELP outweighs the substitution effect leading to higher health consciousness and preventive care spending. Thus, policies aimed at raising immigrants' families ELP in the USA would not only contribute to their effective socio-economic integration, but also strengthen the US workforce and economy in the long run.

Public Housing With Services for Older Adults With Developmental Disabilities: Differences in Efficacy Among Asian and White Communities

This study examined the efficacy of a culturally responsive housing with services model for Asian-American older adults and persons with developmental disabilities separately, and with both for an interaction effect. Study participants, including 278 Whites and 75 Asian Americans, lived in 10 properties of public housing with services in Portland, OR. All Asian-American participants (except four) were immigrants from China, Korea, and Vietnam, and were well connected through community-based health and social services that were delivered onsite and at a nearby center by staff members who were also immigrants from these three countries. Asian-American participants were older, very poor, with limited English proficiency, but, reported stronger family connection and satisfaction with the living environment, which reflected in lower health care needs and utilization, and better quality of life. Participants with developmental disabilities comprised 27 individuals who reported greater health care needs, service utilization, and food insecurity. Asian-American participants with developmental disabilities reported stronger family connections. Regression analyses found level of health care needs was consistently the strongest predictor, followed by food insecurity and family connection, in predicting perceived quality of life. Findings offer insight into a culturally responsive housing services model where minority culture is no longer a risk factor and limited English language proficiency is no longer a cause of isolation.

Vaccination Rates Among Patients Age 65 Years and Older Who Require Interpreter Services in the State of Minnesota.

In the United States, the growing population of older adults with limited English language proficiency (LEP) faces profound health care disparities. Previous research on vaccination of older adults has been based on self-reported data, without clinical verification. We compared pneumococcal vaccination rates between a patient group with LEP and a group of English speakers in an older community-dwelling population. A population-nested matched cohort of participants age 65years and older was identified in Minnesota. Patients with LEP were identified through an electronic alert within the electronic health record, designed to determine the need for an interpreter. Patients were matched 1 to 1 for age, sex, and Charlson comorbidity index. We used conditional logistic regression for the final analysis. In total, 24,052 patients were identified as older patients (mean [SD] age, 74 [7] years). Of them, 617 patients (2.6%) had LEP. The most common primary languages were Somali (24%), Vietnamese (15%), and Spanish (13%). We found lower rates of vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) in the LEP group compared with English speakers [62% vs 77%; odds ratio (OR) (95% CI) 2.07 (1.61-2.66); P < 0.001]. Results were similar for 23-valent pneumococcal polysaccharide vaccine (PPSV23) [60% vs 75%; OR (95% CI) 1.97 91.54-2.51); P < 0.001]. These data are suggestive that older adults who required a language interpreter during health care encounters were less likely to be vaccinated with PCV13 and PPSV23 than older adults who did not require an interpreter. Effectiveness studies are needed to determine which interventions can help improve vaccination rates in the LEP population of elderly patients.