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Top 3 Threats to Health Literacy for the Limited English Population

One-third of US adults lack the skills needed to understand their doctor and follow medical instructions – that’s the finding of a recent assessment by the United States Department of Education. Some of this can be attributed to the significant knowledge gap that exists between medical providers and their patients. Unlike the average layman, doctors spend 11-15 years after high school being inundated with medical terminology.

For those with limited English proficiency, however, another set of barriers looms. This group is overrepresented in the USDE’s findings, and the Joint Commission has identified three main causes, which they have labeled the “triple threat” to effective doctor/patient communication.

Threat One: Language

First, a healthcare provider must communicate effectively with the patient, as a person who cannot understand their doctor’s instructions can hardly be expected to follow them. If a patient speaks no English, the need for an interpreter will likely be recognized.

More problematic is the patient with some knowledge of English who overestimates their proficiency, accepting instructions in English which they do not fully understand. Don’t fall victim to the “smile and nod” that can occur in diverse language scenarios.

Conversely, medical staff may overestimate their own bilingual abilities, believing they speak the patient’s language well enough to provide clear direction. An American-Brazilian research project measuring vocabulary confirmed that foreign speakers of a language knew, on average, between 11,000 and 22,000 words; as opposed to native speakers, who knew between 22,000 and 32,000 words.


Threat Two: Culture

Secondly, according to many interpreters interviewed by CyraCom, a person’s culture can significantly impact communication with their healthcare professional. How comfortable are they discussing medical issues with a stranger?  Could views on gender roles impact the interaction?

Serbian culture, for example, holds doctors in high regard, to the point where asking a doctor questions is viewed as offensive or disrespectful. In Indian culture, women depend primarily on their husbands to handle personal information for them; whereas in Assyrian culture, the elderly are reliant on their adult children, looking to them to handle major decisions.

Any number of cultural factors may affect the way a patient receives care and adheres to medical direction, making it essential that healthcare providers understand the prevalent cultures in their area.


Threat Three: Health literacy

Health literacy is defined as “the ability to obtain, process, and understand health information and use that information to make appropriate decisions about one’s health and medical care.” According to the most recent National Assessment of Adult Literacy conducted by the USDE, 90 million Americans lack health literacy, particularly those with limited proficiency in English.

It is one thing to be able to speak and understand English in daily conversation; it is quite another to know enough about medicine and its terminology to process a doctor’s verbal and written directives, and to understand your options when a medical decision needs to be made.

Cultural beliefs that run counter to Western medicine can also impact health literacy. For example, a common belief in Vietnamese culture is that health depends on harmony between hot and cold poles which govern bodily functions.

Between the knowledge gap inherent in medicine and the factors above, it’s clear that misunderstandings and mistakes can easily occur. However, they must be prevented whenever possible, as the consequences to patients and providers alike are significant. They include:

  • Worse overall health status
  • Trouble accessing appropriate and timely care
  • Struggle with self-management of their health
  • Failure to follow physician instructions
  • Improper taking of medications
  • Higher healthcare costs

Fortunately, modernization and advancing technology continue to provide innovation. In addition to the traditional on-staff interpreters used by many larger facilities to address their most common language needs, providers great and small now have near-instant access to over-the-phone interpretation, video remote interpretation, and document translation services, ensuring that all patients receive the information they need in a clear and understandable way.

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