The most recent U.S. Census Bureau data, released in 2015, found that languages other than English are spoken in millions of households across America. Although Spanish continues to dominate, the total number of languages is 350, including less widely spoken languages like Pennsylvania Dutch, Romanian and Cherokee.
Census Bureau statistician Erik Vickstrom said, “While most of the U.S. population speaks only English at home or a handful of other languages like Spanish or Vietnamese, the American Community Survey reveals the wide-ranging language diversity of the United States.”
If your hospital or health system serves patients with limited English proficiency (LEP), you need to speak their language—in more ways than one.
What Defines Limited English Proficiency?
The Journal of the American Osteopathic Association uses the term “limited English proficiency,” to describe individuals for whom English is a second language and who also have a “limited ability to read, speak, write, or understand English.” While many of these individuals are foreign-born, others are born in the United States, but live in isolated, ethnic communities where their native language is widely spoken.
And such isolation doesn’t only occur in remote communities. According to the Census Bureau’s American Community Survey, some of the largest metro areas in the country also have large populations that speak a language other than English at home:
- 38 percent in New York City
- 26 percent in Washington D.C.
- 17 percent in Atlanta
- 51 percent in Miami
- 29 percent in Chicago
- 12 percent in Detroit
- 37 percent in Houston
- 26 percent in Phoenix
- 54 percent in Los Angeles
- 40 percent in San Francisco
Of course, not everyone who speaks a different language at home qualifies as LEP. Often, a household may include individuals who report good or very good understanding of English, as well as those who report poor or no understanding of English.
Still, estimates put the number of individuals in the U.S. with LEP numbers at nearly 20 million—and healthcare providers cannot simply rely on an English-speaking family member to communicate on behalf of these patients.
As FierceHealthcare notes, “… this approach leads to numerous risks, such as family members who do not entirely understand medical terminology inadvertently causing a medical error.” In order to serve LEP patients, healthcare providers must address language barriers to understand these patients’ medical histories and, in turn, to help patients understand their own preventive care needs, diagnoses or treatment plans.
Translation Alone Doesn’t Improve Communications
Using population-level demographic data in combination with individual assessments of patients’ English proficiency and their preferences for both spoken and written language communications can help hospitals and health systems identify specific language needs and health literacy of community members.
This can guide decisions on having documents translated, including vital documents for informed consent, availability of language assistance services, intake forms, as well as other less vital—but still important—informational or educational materials.
But as healthcare providers know all too well, handing over a pamphlet or providing a care plan does not automatically result in an engaged patient—even if provided in a patient’s preferred language.
The five psychographic segments appear across all demographic and socioeconomic groups.
Psychographic segmentation allows hospitals and other health systems to address patients in a more meaningful way. Rather than approaching patients based on broad similarities—mutual languages or cultures, common barriers to care based on geography or income or shared diagnoses—healthcare providers can use psychographics to better understand what makes individuals tick. This is because psychographics pertain to people’s attitudes, values, lifestyles and personalities, and are key to understanding their motivations and priorities.
For example, the c2b Consumer Classifier uses 12 simple questions to classify healthcare consumers into one of five psychographic segments: Balance Seekers, Willful Endurers, Priority Jugglers, Self Achievers and Direction Takers. Each segment reflects the attitudes, priorities and communication preferences of members. The five psychographic segments appear across all demographic and socioeconomic groups, though in different distributions:
In turn, this allows healthcare providers to align messaging to patients’ needs and expectations to better motivate patients to engage in healthy behaviors or manage chronic conditions more proactively. When used in conjunction with appropriate language services, it could be just what the doctor ordered for communicating with limited English proficiency patients and native English-speaking patients alike.