Caring for patients with limited English proficiency (LEP) is a complex process that challenges clinicians in any setting. Being able to effectively communicate is crucial to ensuring the patient’s well-being and safety. But when this process is hindered by a patient or family’s language barrier, quality of care and patient outcomes could be compromised. Even with the assistance of an interpreter, how can we ensure that LEP patients and families truly understand their education? How much health knowledge and health literacy do they need in order to effectively synthesize and apply everything they learned during an encounter? There are a number of factors to consider.
Health literacy is often referred to as “a hidden epidemic.” That’s because it can be challenging to gauge whether a patient truly understands — and most important, can act upon — the health information given to them. This is especially so in patients with LEP. Engaging interpreters seems like the most logical solution to address language and knowledge gaps, but it may not be enough. Next time you are speaking with an LEP family through an interpreter, try to:
- Take note of how the patient or family is answering your questions: Are they one-word answers or are they full sentences? If they give one-word answers or try to dismiss the conversation altogether, it could be a sign that they don’t understand the information being given to them.
- Have the patient or family explain things “in their own words:” When clinicians do most of the talking during an encounter, they miss the opportunity to get a sense of the patient and family’s ability to understand information, especially when they don’t speak English. Through an interpreter, ask the patient and family to explain what you told them in their own words. For example, you may say, “I just want to make sure that I explained things clearly. Can you tell me how to give Ana’s medication in the morning?” This technique is called the Teach-Back Method and has been proven to improve patient outcomes.
Some clinicians feel they can better treat LEP patients and families if they improve their knowledge of medical terminology in another language. This is not always the solution. More often than not, LEP patients and families do not possess a sophisticated level of medical terminology or health literacy in their native language. Instead, try to:
- Use plain language: Plain language (often known as everyday “living room language”) is “communication your audience can understand the first time they read or hear it.” Avoid using medical jargon and explain things in easy to understand terms, like how you would explain it to your mom, dad or grandparents. You can also use analogies to explain complex concepts.
- Chunk and check: When communicating with LEP families through an interpreter, break complex concepts into small, digestible chunks. Research shows that most people can remember three important points at a time. Speak slowly and encourage the interpreter to do so as well. Even the most sophisticated, educated LEP family might find the prospect of understanding a lot of complex medical information in a foreign hospital overwhelming.
Enough English to be at risk
Many clinicians ask, “If the patient or family speaks enough English to get by, do they still need an interpreter?” The answer is yes! LEP patients and families “make do” the best they can in English-only health systems. They often rely on instinct, friends, relatives and chance encounters to navigate complex interactions and appointments. However, “making do” can be burdensome and costly, as LEP patients and families often do not capture the complete meaning of what is happening. Remember:
- Language ability is not static: Language is fluid from moment-to-moment. It may be easier to understand words in English when the situation is simple and less stressful than when things are complicated and very stressful. At times, it may seem as though the family members nod their heads saying “yes, I understand,” when in fact they only captured 50 percent of what was explained to them.
- There’s nothing wrong with repetition: Having an interpreter present with patients and families who speak “some English” means the information will be repeated twice — they hear it from both the clinician and the interpreter in their own language. This is not a bad thing. Saying something once in a patient’s native language does not guarantee understanding. Interruptions, sudden noises, or misunderstanding a word can happen right at the crucial time when key information is delivered. Therefore, repeating critical information increases the likelihood that LEP patients and families will retain and act upon the most important pieces of their health care.
Overall, language barriers present many challenges. But using the right strategies to elicit conversation and promote health literacy can ensure high quality, safe care for all LEP patients and families.
- Agency for Healthcare Research and Quality’s Health Literacy Universal Precautions Toolkit, 2nd Edition, Use the Teach-Back Method
- Centers for Disease Control and Prevention, Simply Put: A Guide for Creating Easy-to-Understand Material
- Plain Language Medical Dictionary
Need assistance with health literacy or creating plain language patient education materials for your patients or families? Boston Children’s Patient and Family Education team can help. Email firstname.lastname@example.org for more information.
About the bloggers: Eva Gomez, MSN, RN-BC, CPN is a professional development specialist in Boston Children’s Clinical Education and Informatics department. Kristin Barton, MA, CHES, is the Boston Children’s Health Literacy/Patient & Family Education project manager.