Limited English Proficiency Populations Research Articles

Access to cancer center information for patients with limited English proficiency from NCI Cancer Center websites.

e23124 Background: Patients with Limited English Proficiency (LEP) can experience health disparities in cancer care and clinical trial participation. This study sought to assess the availability of information on interpreter services, clinical trials, and second opinions from National Cancer Institute – Designated Cancer Center (NCI-DCC) websites for patients with LEP. Methods: The public facing websites of all 65 adult NCI-DCCs were reviewed from January 1, 2023 to May 15, 2023 to assess availability of English and translated, non-English information on interpreter services, second opinion programs, and clinical trials. Data abstraction was conducted through predefined criteria for website inspection and search bars. Three authors independently abstracted websites for content, with constant comparison until consensus was achieved. Chi-square tests were used to ascertain any significant association between the proportion of LEP populations served by the centers ( > 5%) and their likelihood to provide translated information. Results: 92.3% of NCI-DCCs and their affiliated flagships hospitals provide information on interpreter services for patients with LEP. This information was translated into a non-English language approximately half of the time. All NCI-DCC center webpages provide information on clinical trials and 38.5% provide information regarding second opinions. There was no difference in the availability of translated information on interpreter services or second opinion programs based on percentage of LEP population. However, there was an association between higher LEP population and the provision of translated clinical trial pages. Conclusions: The majority of NCI-DCCs provide information on their webpages related to interpreter services and clinical trials. Half of these centers provide this information in a non-English language and there was an association between higher percentage of LEP populations in the NCI-DCC state and translated clinical trial pages. Future work should identify optimal methods to provide cancer related information to patients with LEP with the goal of improving clinical trial participation for LEP populations. [Table: see text]

Discharge Interventions for Limited English Proficiency Patients: A Scoping Review.

Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).

Hear Our Voice: Pediatric Communication Barriers From the Perspectives of Refugee Mothers With Limited English Proficiency

Adverse health outcomes are more common for health consumers with limited English proficiency (LEP). This study examines the consumer experience of refugee mothers with LEP when communicating with paediatric health services. A community-based participatory qualitative study engaging participants from refugee-like backgrounds. Focus groups and in-depth individual interviews (using professional interpreters) were conducted in community settings and analysed using Grounded Theory principles. Fifty ethnolinguistically diverse participants reported universal communication barriers; (i) "Negative health care experiences" (fear, helplessness, lack of safety, trust and dignity), (ii) "Ineffective health service communication and adverse outcomes", (iii) "Logistical access barriers" and (iv) self-sourced solutions". The "importance of professional interpreter utilisation" and subsequent "sense of empowerment" was unanimous. This study highlights gaps in current health interactions which negatively impact care, inclusion, and culturally safe engagement. Recommendations include orgainzational reform enhancing language services, increased cultural competency, long term support, and research with LEP populations.

Patient and Staff Perspectives on the Impacts and Challenges of Hospital-Based Harm Reduction

Harm reduction is associated with improved health outcomes among people who use substances. As overdose deaths persist, hospitals are recognizing the need for harm reduction services; however, little is known about the outcomes of hospital-based harm reduction for patients and staff. To evaluate patient and staff perspectives on the impact and challenges of a hospital-based harm reduction program offering safer use education and supplies at discharge. This qualitative study consisted of 40-minute semistructured interviews with hospitalized patients receiving harm reduction services and hospital staff at an urban, safety-net hospital in California from October 2022 to March 2023. Purposive sampling allowed inclusion of diverse patient racial and ethnic identities, substance use disorders (SUDs), and staff roles. Receipt of harm reduction education and/or supplies (eg, syringes, pipes, naloxone, and test strips) from an addiction consult team, or providing care for patients receiving these services. Interviews were analyzed using thematic analysis to identify key themes. A total of 40 participants completed interviews, including 20 patients (mean [SD] age, 43 [13] years; 1 American Indian or Alaska Native [5%], 1 Asian and Pacific Islander [5%], 6 Black [30%]; 6 Latine [30%]; and 6 White [30%]) and 20 staff (mean [SD] age 37 [8] years). Patients were diagnosed with a variety of SUDs (7 patients with opioid and stimulant use disorder [35%]; 7 patients with stimulant use disorder [35%]; 3 patients with opioid use disorder [15%]; and 3 patients with alcohol use disorder [15%]). A total of 3 themes were identified; respondents reported that harm reduction programs (1) expanded access to harm reduction education and supplies, particularly for ethnically and racially minoritized populations; (2) built trust by improving the patient care experience and increasing engagement; and (3) catalyzed culture change by helping destigmatize care for individuals who planned to continue using substances and increasing staff fulfillment. Black and Latine patients, those who primarily used stimulants, and those with limited English proficiency (LEP) reported learning new harm reduction strategies. Program challenges included hesitancy regarding regulations, limited SUD education among staff, remaining stigma, and the need for careful assessment of patient goals. In this qualitative study, patients and staff believed that integrating harm reduction services into hospital care increased access for populations unfamiliar with harm reduction, improved trust, and reduced stigma. These findings suggest that efforts to increase access to harm reduction services for Black, Latine, and LEP populations, including those who use stimulants, are especially needed.

An absence of translated consent forms limits oncologic clinical trial enrollment for limited English proficiency participants

ObjectivesA lack of diversity amongst participants in cancer clinical trials has raised scrutiny over the past decade. Patients with limited English proficiency (LEP) are further excluded. One modifiable reason for low LEP participation is a lack of non-English consent forms. MethodsWe queried the clinical trials registry database at an academic hospital serving a predominantly Spanish-speaking patient population. Clinical trials related to gynecology oncology were evaluated for the availability of fully translated Spanish consent forms, the racial and ethnic identification of enrolled patients, and the number of signed Spanish consents. Enrolment data was compared before and after 2019, when institutional financial support for document translation was withdrawn. ResultsSixteen gynecologic oncology clinical trials were opened between 2014 and 2022, with 10 trials enrolling 128 patients. Eight trials opened prior to 2019, all with fully translated consent forms. Seven of these trials enrolled 99 participants, 70% of whom identified as Hispanic and 60% who signed a Spanish consent. Eight trials opened after 2019 and one had a fully translated consent form. Three of the trials enrolled 29 participants, with 10% of subjects identifying as Hispanic and none signing a Spanish consent form. ConclusionsThere was a decrease in fully translated clinical trial consent forms for gynecologic oncology studies following the loss of subsidized translation services in our single institution with a predominantly LEP population. This correlated with a decrease in enrollment of Hispanic subjects. To increase enrollment of diverse participants, including those with LEP, simple actions such as fully translating consent forms would help maintain equity in research conduct and improve clinical outcomes through trial involvement.

Medicaid Expansions and Access to Substance Abuse Treatment Services Among Limited English Proficiency Populations.

Although the myriad of provisions under the Affordable Care Act (ACA) have generally increased coverage and financial access to the health systems, language barriers represent a serious challenge to access to care among Limited English Proficiency (LEP) populations. The aim of this study was to examine the effect of Medicaid expansions under the ACA on the availability of language services and Medicaid acceptance in substance abuse treatment (SAT) facilities. A quasi-experimental difference-in-differences design with multiple time periods was used to compare changes in the availability of language services and Medicaid as a payment source between Medicaid expansion and nonexpansion states. Facility-level observational data in the National Survey of Substance Abuse Treatment Services 2010-2019 was included. Availability of LEP services and Medicaid acceptance in the SAT facilities. The proportion of SAT facilities that provide LEP services increased from 40% in 2013 to 53% in 2019. The proportions by state are heterogeneous, ranging from approximately 20% to 70%. The ACA Medicaid expansions are not associated with changes in the availability of LEP services in the facilities. Moreover, Medicaid acceptance in the expansion states increased gradually following the expansion; however, the estimates are not statistically significant. The ACA Medicaid expansion had no impact on the availability of LEP services and the acceptance of Medicaid as a payment source in the SAT facilities.

Assessing the translation capabilities of NCI-designated cancer websites with a focus on lung, breast, prostate and ovarian cancers.

e18514 Background: The world is becoming more and more dependent on the internet for garnering information. Medicine is no exception, with studies suggesting that 70% of patients will consult the internet to learn more about their health. Considering the diverse population served by the United States healthcare system, it is crucial that information can be accessed by Americans of Limited English Proficiency (LEP). This is especially true when it comes to cancer, a disease affecting hundreds of thousands of LEP Americans each year. National Cancer Institute (NCI)-designated cancer treatment centers represent the cutting-edge treatment facilities in oncology. Americans diagnosed with cancer often turn to the website of the nearest NCI-designated cancer center. Our study provides a snapshot of which NCI-designated cancer center websites provide translation capabilities for patient navigations including appointment scheduling, disease information and treatment for four of the most common types of cancer. Methods: Over the course of 2022, we performed a cross-sectional review of the language and translation services available to patients on each of the 71 NCI-designated cancer center websites with a focus on lung, breast, prostate and ovarian cancers. The primary outcomes included availability of translation services, method of translation (google translator vs. written text vs. telephonic) and number of languages offered. Results: Of the 71 NCI-designated cancer center websites, 15 (21.1%) provide information on prostate, lung, ovarian and breast cancer in languages other than English. Among these, 9 (60%) provide direct translation, 1 redirects the user to the NCI website for cancer information, and 5 offer only language lines. Furthermore, of the 9 cancer centers offering direct translation on their websites, only 6 had 2 or more languages. The most common translation language was Spanish (15/15) followed by Arabic and Chinese (11/15). The availability of translated cancer information on these websites did not correlate with the prevalence of LEP in each state. Analyzing previous NCI website interrogations shows that there has been no increase in the translation capabilities of NCI websites since 2019. Conclusions: One way to improve the quality of care in patients with Limited English Proficiency by improving access to care is to increase language concordant resources. NCI designated cancer center websites are sources of cancer related health knowledge. Our research exemplified that there are areas of opportunity to improve the reachability of these recourses to the LEP population. Increasing language concordant resources acknowledges and addresses one of the barriers to care that interferes with the quality of cancer care for LEP patients, promoting shared health care decision making for better health outcomes in a vulnerable population.

The Effect of Language Concordance on Health Care Relationship Trust Score.

Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes.This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who useprofessional or ad hoc interpreters. This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items. Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scoresthan the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.

Social Work with Interpreters: Using Practitioner Knowledge to Improve Practice

Abstract Interpreters are crucial to enabling individuals with limited English proficiency (LEP) to navigate the social welfare system, as they facilitate the development of relationships between this population and social workers. This article utilises primary data to analyse the interactive relationship between interpreters, social workers and service users with LEP with a view to better management of these three-way interactions and improved engagement with the LEP population, thus improving health and social care outcomes for this group. A social work education and workforce development review alongside online focus groups with professionals provided data to develop three broad categories: knowledge, values and skills. These categories house seven sub-themes, comprising trust/confidentiality, relationships, role knowledge, cultural knowledge, briefing and debriefing, values and attitude, and practical knowledge. Findings suggest that social workers saw interpreters as a barrier to their relationship with families rather than as a facilitator to communication. Enhancing practitioner knowledge, values and skills is essential to changing this narrative and improving relationships between professionals and in turn with the LEP population. By framing communication as a Human Rights issue, and prioritising language in social work education and workforce development, this is possible within existing legal and regulatory frameworks.

Enhancing patient-centered care for limited English proficiency patients through Tell Me More®: A student-driven initiative to explore the patient as a person and develop students’ communication skills

Tell Me More® (TMM) is a medical student-driven initiative to build rapport between patients, students, and the healthcare team through patient interviews and collaboratively created posters. Patients with limited English proficiency (LEP) often experience impaired communication with providers. TMM has the potential to address the loss of patient-centered dialogue in interpreter-mediated communications. In this exploratory pilot study, we aimed to include LEP patients in TMM by using medical interpreter phones (MIPs) at Long Island Jewish Medical Center, Northwell Health. Our objectives were to: (1) evaluate the feasibility of this approach, (2) compare TMM engagement between LEP and English-speaking (ES) patients, and (3) document the impact of this initiative on the medical student. Following the standardized TMM interview structure, the student used the MIP to interview LEP patients about who they are as people beyond their illnesses. This expanded social history was transcribed to bedside posters to enhance patient connection with the healthcare team. At the end of interviews, patients rated TMM’s impact on their hospital stay. Additionally, medical student reflections were recorded weekly. Our quantitative results from 12 LEP and 49 ES patients support significantly higher TMM participation for LEP compared to ES patients. Qualitative examination of student reflections suggests that TMM enriches medical education by promoting understanding of the LEP patient experience. Our results demonstrate that MIP-supported TMM is a feasible approach to enhance patient-centered care for LEP populations. Further research is needed to explore inclusion of LEP patients in patient-centered care initiatives such as TMM.

Understanding the Role of Caseworker-Cultural Mediators in Addressing Healthcare Inequities for Patients with Limited-English Proficiency: a Qualitative Study.

Patients with limited-English proficiency (LEP) face multiple barriers to equitable healthcare. Interventions that go beyond interpretation, such as the use of bicultural-bilingual patient navigators, hold promise for addressing multi-level barriers. However, data about how to operationalize the tasks that are key to such interventions across diverse LEP communities are lacking. Using our health system's bicultural-bilingual caseworker-cultural mediator (CCM) program serving Amharic-, Cambodian/Khmer-, Somali-, Spanish-, and Vietnamese-speaking patients, we sought to understand the key tasks that comprise the CCMs' role and how these tasks enable them to address barriers to healthcare for patients with LEP. Semi-structured interviews were conducted in 2019 with a purposive sample (n=23) of clinicians, CCMs, and patients with LEP or their family members from all language groups. Patients or family members receiving CCM services, CCMs, and clinicians who referred patients to the program. Content analysis consisting of a hybrid deductive-inductive qualitative approach. Seven CCM tasks were identified: advocacy, care coordination, navigation, interpretation, education, mediation, and emotional support. Additionally, four key impacts emerged that described the ways in which these tasks enabled the CCMs to facilitate equitable care: bridging the patient, family, community, clinical team, and healthcare system; impacting knowledge of cultural issues and of the healthcare system; troubleshooting cultural barriers and problem solving; and enhancing relationship building. We identified several tasks and impacts that enabled CCMs to address multi-level barriers to care experienced by patients with LEP and their families across diverse cultural and linguistic groups. Findings suggest opportunities for the generalizability of programs such as ours for multiple LEP populations. Additionally, interventions having a greater scope than interpretation and including relationships with communities may be more successful in addressing barriers to equitable care at the individual, system, and community levels.

32316 Five-year cancer-specific survival for melanoma in LEP: An analysis of the SEER database

Limited English Proficient (LEP) patients have been shown to have barriers to health care access. LEP is concentrated amongst Asian and Hispanic White populations. There is little known about cancer specific health outcomes for LEP melanoma patients. We hypothesized that there would be a statistically greater 5-year Cancer Specific Survival (CSS) in low LEP counties compared with high LEP counties. We performed a retrospective cross-sectional study on Asian and Hispanic White melanoma patients from the Surveillance, Epidemiology, and End Results database (SEER, 2018, 18 Reg.). 5-year CSS was compared between low LEP (0-12% LEP population) vs high LEP counties (≥12% LEP population) using a Kaplan-Meier analysis. A Cox proportional hazards regression was performed to investigate the effects of age of diagnosis, and county LEP status on 5-year CSS. A total of 8490 adult Asian and Hispanic White melanoma patients were identified, of whom 660 were in high LEP counties (7.8%). Mean age of diagnosis in high LEP counties (60.3 ± 17.7yo) was later than in low LEP counties (58.1 ± 16.9 yo, P = .002). 5-year melanoma CSS was marginally lower among patients in high LEP counties (P < .15). County LEP status did not confer a significant hazard (P = .334). 5-year melanoma CSS decreased with age of diagnosis (HR 1.01 per year, 95% CI [1.01-1.02]). Our results indicate that once diagnosed LEP does not affect a patient’s 5 year Cancer specific survival indicating the importance of melanoma screen in high LEP counties for early detection of melanoma. A limitation to this study is that it uses county level LEP data.

Speaking the language of identification: Building equity through communication with limited English proficiency populations.

Speaking the language of identification: Building equity through communication with limited English proficiency populations.

Facilitating Communication in a Pediatric Surgery Center: Implementation of an Interactive Communication Board

Increasing linguistic diversity has important implications for providers serving limited English proficiency (LEP) populations. LEP patients have decreased understanding, increased risk for adverse events, and lower healthcare satisfaction. Limited interpreting methods affect nurses' ability to provide efficient, culturally competent care. An interactive communication board was implemented to evaluate the perceived effectiveness of LEP patient communication and increase nurse satisfaction with communication in a pediatric ambulatory surgery center. A pre-post survey design evaluated the implementation of an interactive communication board. After a 3-month implementation period, post-surveys assessed nurse satisfaction, perception of time required to interpret nursing tasks, and feasibility of the tool. Nurses reported a 64% increase (2.27 ± 0.88 pre; 3.57 ± 0.76 post; p = 0.0007) in satisfaction with the interpretation process and a 43% increase (2.07 ± 0.70 pre; 3.50 ± 0.76 post; p = 0.0001) in their self-perceived ability to communicate with LEP populations post-intervention. Communication boards and similar tools can improve nurse satisfaction and streamline the interpretation process in peri-operative periods. Similar tools could be implemented in other healthcare settings to increase communication efficiency between nurses and LEP populations. Further projects must be conducted to evaluate the experience and efficacy of this tool from the patient/caregiver perspective.

Abstract PO-022: Community-driven recommendations for a culturally and contextually tailored HPV campaign for Arab and Mexican communities in Brooklyn

Abstract Purpose. Uneven language access in policy implementation perpetuates health disparity for limited English proficient populations. This study engages Arab and Mexican communities in Brooklyn to identify individual, community, and health system-level determinants of HPV vaccine uptake and hesitancy and inform a multilevel and culturally tailored HPV campaign. Methods. Guided by an integrated framework of community-based participatory research and social marketing for behavior change, we are conducting semi-structured interviews with community stakeholders (target n=18; health care providers, community and faith-based leaders) and community members (target n=80; parents/caregivers and adolescents) from the Arab and Mexican American communities in Brooklyn to examine challenges and facilitators to HPV vaccination and garner recommendations for a HPV campaign. Results. To date, we interviewed 14 community stakeholders (9 Arab, 5 Mexican) and 14 parents (11 Arab, 3 Mexican); data collection is ongoing. Preliminary content analysis revealed an overall consensus that in-language HPV-related materials are lacking and translated education is needed in both communities. Both Arab and Mexican parents reported limited knowledge of HPV, including the vaccination status of their adolescents. Recommendations for a HPV campaign were organized around the 4 P's of the social marketing mix (Price, Product, Place, Promotion). For Price, the 2 communities shared restrictive norms about premarital sex, particularly for girls, and the perception that girls only should receive the HPV vaccine. For Product, they agreed that the HPV campaign should be available in-language and emphasize cancer prevention not sexually transmitted illness. Arab parents, in particular, preferred messaging that emphasizes risk reduction for their daughters after they get married and become sexually active. For Place, most participants cited doctors as ideal sources of information. They recommended different campaign dissemination strategies for parents and adolescents: virtual (e.g., Facebook) or in-person interactive workshops conducted in community-based organizations (CBOs) for parents, and social media (e.g., TikTok) for adolescents. For Promotion, all participants agreed that bilingual brochures should be available in doctors' offices and CBOs. Arab parents expressed interest in opportunities for interactive workshops to ask questions and Mexican parents suggested supplementing school-based PTA meetings with opportunities for HPV education. Social media was again mentioned by all as the ideal platform to reach adolescents. Conclusion. Preliminary findings identified low levels of knowledge on HPV and a lack of in-language education reaching these communities. To bridge these gaps and improve reach and vaccination rates, our participatory social marketing approach underscores the need for a multilevel in-language HPV campaign for Arab and Mexican communities that aligns with their cultural norms and leverages existing community assets such as CBOs, healthcare providers, and schools. Citation Format: Perla Chebli, Sonia Sifuentes, Victoria Foster, Yousra Yusuf, Abiha Kazmi, Sally Idris, Chau Trinh-Shevrin, Simona Kwon. Community-driven recommendations for a culturally and contextually tailored HPV campaign for Arab and Mexican communities in Brooklyn [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-022.

Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters.

Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care

A Survey of Nurses' Perspectives on Delirium Screening in Older Adult Medical Inpatients With Limited English Proficiency.

The Confusion Assessment Method (CAM) is commonly used to detect delirium but its utility in patients with limited English proficiency (LEP) is not well-established. In the current study, internal medicine nurses at an acute care hospital in Canada were surveyed on the use of the CAM in older adults with LEP. Nurses' perspectives were explored with a focus on barriers to administration. Fifty participants were enrolled (response rate = 47.6%). Twenty-eight (56%) participants stated they could not confidently and accurately assess delirium in patients with LEP. Twenty-nine (58%) participants believed the CAM is not an effective delirium screening tool in the LEP population. Barriers to screening included: challenges with interpretation services, dependence on family members, and fear that the assessment itself may worsen confusion. Our study is the first to describe specific barriers to administering the CAM in patients with LEP. Strategies are required to address these barriers and optimize delirium screening for patients with LEP. [Journal of Gerontological Nursing, 47(4), 29-34.].

COVID-19 information gaps among disadvantaged communities: The case of the deaf and limited English proficiency communities in Zimbabwe

Worldwide public health authorities are taking action to contain Covid-19. While the bulk of research on the pandemic focuses on understanding the spread and seeking a cure for the virus from a virology perspective, research of the same magnitude should also focus on the risks of the pandemic for society, particularly among disadvantaged groups. This study adopted a community-centred approach to information and health rights and utilised the case study approach to investigate the quality and access to Covid-19 information, care and treatment by the Limited English Proficiency (LEP) and the Deaf communities in Zimbabwe. More than 60% of Covid-19 messages communicated in Zimbabwe’s mainstream media do not cater for the needs of these disadvantaged groups. Brochures, videos and infographics, for instance, appear in English, yet there is a significant LEP population in Zimbabwe. As regards the Deaf community, videos, conversations and interviews with health specialists, which rarely appear in mainstream public media, include Zimbabwean Sign Language interpretation. In this case, the choice of language and medium used to communicate vital Covid-19 messages in mainstream public media may pose language barriers to effective and equitable health information for these vulnerable groups. What this reality hints at is that public communication that does not discriminate is a necessity to allow all members of the community to fight the spread of Covid-19 and hence, reduce its potential risks.

Culturally and Linguistically Appropriate Hospital Services Reduce Medicare Length of Stay.

Almost 40% of the 63 million Americans who speak a language other than English have limited English proficiency (LEP). This communication barrier can result in poor quality care and potentially adverse health outcomes. Of particular interest is that the greatest proportion of LEP adults are aged >65 years and will face barriers and delays in accessing high-quality care. Age cohort variation of LEP burden has not been widely addressed. Culturally and linguistically appropriate hospital care delivery can mitigate these barriers. In order to test whether culturally competent services reduced length-of-stay (LOS), we linked organizational cultural competence surveys across two-states (CA+FL) for comparison across Medicare acute care LOS. Using the 2013 American Hospital Association Database, and Hospital Compare Data from CMS (N=184), we compared hospital structure with culturally and linguistically appropriate services related to improved care delivery for LEP populations and aging LEP populations. We utilized Kruskal-Wallis to test group differences and a negative binomial regression to model median LOS. All analyses were conducted using SAS 9.4 (Cary, NC). Median LOS across all hospitals was 4.7 days (mean 5.7, standard deviation 6.3). Most hospitals were not-for-profit (46.7%), small (<150 beds, 54.4%), Joint Commission accredited (67.9%), and in urban areas. We found shorter median LOS when hospital units identified cultural or language needs at admission (Wald χ23.82, P=.0506). Hospitals' identification of these needs at discharge had no impact on LOS. Hospitals that accommodated patient cultural or ethnic dietary needs also reported lower median LOS (Wald χ2 12.93, P=.0003). Structurally, public hospitals, accredited hospitals, and hospitals that reported system membership were predictive of a lower median LOS. Our findings demonstrate that patient outcomes are responsive to culturally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of culturally and linguistically appropriate care for a rapidly growing population of diverse older adults.