OBJECTIVE: To determine the effect of limited English proficiency on medical comprehension in the presence and absence of language-concordant
physicians.
DESIGN, SETTING, AND PARTICIPANTS: A telephone survey of 1,200 Californians was conducted in 11 languages. The survey included 4 items on medical comprehension:
problems understanding a medical situation, confusion about medication use, trouble understanding labels on medication, and
bad reactions to medications. Respondents were also asked about English proficiency and whether their physicians spoke their
native language.
MEASUREMENTS AND MAIN RESULTS: We analyzed the relationship between English proficiency and medical comprehension using multivariate logistic regression.
We also performed a stratified analysis to explore the effect of physician language concordance on comprehension. Forty-nine
percent of the 1,200 respondents were defined as limited English proficient (LEP). Limited English-proficient respondents
were more likely than English-proficient respondents to report problems understanding a medical situation (adjusted odds ratio
[AOR] 3.2/confidence interval [CI] 2.1, 4.8), trouble understanding labels (AOR 1.5/CI 1.0, 2.3), and bad reactions (AOR 2.3/CI
1.3, 4.4). Among respondents with language-concordant physicians, LEP respondents were more likely to have problems understanding
a medical situation (AOR 2.2/CI 1.2, 3.9). Among those with language-discordant physicians, LEP respondents were more likely
to report problems understanding a medical situation (AOR 9.4/CI 3.7, 23.8), trouble understanding labels (AOR 4.2/CI 1.7,
10.3), and bad medication reactions (AOR 4.1/CI 1.2, 14.7).
CONCLUSION: Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions.
Access to language-concordant physicians substantially mitigates but does not eliminate language barriers.
Key Words language - comprehension - ethnic groups - access to health care - Latinos - immigrants - communication
The authors have no conflicts of interest to declare for this article or this research.
This paper had been presented at the UCSF Symposium on Multicultural Health: Linking Research, Education and Policy (January
2004), the Society for General Internal Medicine Conference (May 2004), the Commonwealth Fund Harvard University Fellowship
in Minority Health Policy Annual Meeting (May 2004), the National Research Service Award Trainees Conference (June 2004),
and the North American Primary Care Research Group Conference (October 2004).
This study was funded in part by grant (P30AG15272) under the Resource Centers for Minority Aging Research program by the
National Institute on Aging, the National Institute of Nursing Research, and The National Center on Minority Health and Health
Disparities, National Institutes of Health. Dr. Chen was funded by the Medicine as a Profession (MAP) program of the Open
Society Institute. Dr. Alicia Fernandez was funded by NIH K-23 Award (18342-01). Dr. Kevin Grumbach received support from
the National Center for Workforce Analysis, Bureau of Health Professionals (U79 HP00004).