Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

Maria Esteli Garcia^{1

2

3}, Mia Williams⁴, Sunita Mutha^{4

5}, Lisa C Diamond⁶, Jane Jih^{4

7}, Margaret A Handley^{8

9

10}, Sarita Pathak¹¹, Leah S Karliner⁴

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA. maria.garcia@ucsf.edu.
² Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA. maria.garcia@ucsf.edu.
³ PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA. maria.garcia@ucsf.edu.
⁴ Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA.
⁵ Healthforce Center, University of California, San Francisco, CA, USA.
⁶ Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Asian American Research Center on Health, San Francisco, CA, USA.
⁸ Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA.
⁹ PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA.
¹⁰ Department of Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, San Francisco, CA, USA.
¹¹ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

PMID: 37620723
PMCID: PMC10651569
DOI: 10.1007/s11606-023-08354-6

Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

Maria Esteli Garcia et al. J Gen Intern Med. 2023 Nov.

. 2023 Nov;38(14):3099-3106.

doi: 10.1007/s11606-023-08354-6. Epub 2023 Aug 24.

Authors

Maria Esteli Garcia^{1

2

3}, Mia Williams⁴, Sunita Mutha^{4

5}, Lisa C Diamond⁶, Jane Jih^{4

7}, Margaret A Handley^{8

9

10}, Sarita Pathak¹¹, Leah S Karliner⁴

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA. maria.garcia@ucsf.edu.
² Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA. maria.garcia@ucsf.edu.
³ PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA. maria.garcia@ucsf.edu.
⁴ Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA.
⁵ Healthforce Center, University of California, San Francisco, CA, USA.
⁶ Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Asian American Research Center on Health, San Francisco, CA, USA.
⁸ Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA.
⁹ PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA.
¹⁰ Department of Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, San Francisco, CA, USA.
¹¹ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

PMID: 37620723
PMCID: PMC10651569
DOI: 10.1007/s11606-023-08354-6

Abstract

Background: Language concordance can increase access to care for patients with language barriers and improve patient health outcomes. However, systematically assessing and tracking physician non-English language skills remains uncommon in most health systems. This is a missed opportunity for health systems to maximize language-concordant care.

Objective: To determine barriers and facilitators to participation in non-English language proficiency assessment among primary care physicians.

Design: Qualitative, semi-structured interviews.

Participants: Eleven fully and partially bilingual primary care physicians from a large academic health system with a language certification program (using a clinician oral proficiency interview).

Approach: Interviews aimed to identify barriers and facilitators to participation in non-English language assessment. Two researchers independently and iteratively coded transcripts using a thematic analysis approach with constant comparison to identify themes.

Key results: Most participants were women (N= 9; 82%). Participants reported proficiency in Cantonese, Mandarin, Russian, and Spanish. All fully bilingual participants (n=5) had passed the language assessment; of the partially bilingual participants (n=6), four did not test, one passed with marginal proficiency, and one did not pass. Three themes emerged as barriers to assessment participation: (1) beliefs about the negative consequences (emotional and material) of not passing the test, (2) time constraints and competing demands, and (3) challenging test format and structure. Four themes emerged as facilitators to increase assessment adoption: (1) messaging consistent with professional ethos, (2) organizational culture that incentivizes certification, (3) personal empowerment about language proficiency, and (4) individuals championing certification.

Conclusions: To increase language assessment participation and thus ensure quality language-concordant care, health systems must address the identified barriers physicians experience and leverage potential facilitators. Findings can inform health system interventions to standardize the requirements and process, increase transparency, provide resources for preparation and remediation, utilize messaging focused on patient care quality and safety, and incentivize participation.

Keywords: doctor-patient communication; language concordance; provider non-English-language assessment.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

References

1. Bureau UC. Detailed Languages Spoken at Home and Ability to Speak English. The United States Census Bureau. Accessed December 15, 2020. https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html
1. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–788. doi: 10.1001/jama.1996.03530340047028. - DOI - PubMed
1. McFarland DC, Johnson Shen M, Holcombe RF. Predictors of Satisfaction With Doctor and Nurse Communication: A National Study. Health Commun. 2017;32(10):1217–1224. doi: 10.1080/10410236.2016.1215001. - DOI - PubMed
1. Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Aff Proj Hope. 2005;24(2):435–444. doi: 10.1377/hlthaff.24.2.435. - DOI - PubMed
1. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–754. doi: 10.1111/j.1475-6773.2006.00629.x. - DOI - PMC - PubMed

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Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

Affiliations

Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

Authors

Affiliations

Abstract

Conflict of interest statement

References

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Grants and funding

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Medical