Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use

J Gen Intern Med. 2007 Nov;22 Suppl 2(Suppl 2):324-30. doi: 10.1007/s11606-007-0340-z.


Background: Provider-patient language discordance is related to worse quality care for limited English proficient (LEP) patients who speak Spanish. However, little is known about language barriers among LEP Asian-American patients.

Objective: We examined the effects of language discordance on the degree of health education and the quality of interpersonal care that patients received, and examined its effect on patient satisfaction. We also evaluated how the presence/absence of a clinic interpreter affected these outcomes.

Design: Cross-sectional survey, response rate 74%.

Participants: A total of 2,746 Chinese and Vietnamese patients receiving care at 11 health centers in 8 cities.

Measurements: Provider-patient language concordance, health education received, quality of interpersonal care, patient ratings of providers, and the presence/absence of a clinic interpreter. Regression analyses were used to adjust for potential confounding.

Results: Patients with language-discordant providers reported receiving less health education (beta = 0.17, p < 0.05) compared to those with language-concordant providers. This effect was mitigated with the use of a clinic interpreter. Patients with language-discordant providers also reported worse interpersonal care (beta = 0.28, p < 0.05), and were more likely to give low ratings to their providers (odds ratio [OR] = 1.61; CI = 0.97-2.67). Using a clinic interpreter did not mitigate these effects and in fact exacerbated disparities in patients' perceptions of their providers.

Conclusion: Language barriers are associated with less health education, worse interpersonal care, and lower patient satisfaction. Having access to a clinic interpreter can facilitate the transmission of health education. However, in terms of patients' ratings of their providers and the quality of interpersonal care, having an interpreter present does not serve as a substitute for language concordance between patient and provider.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Asian Americans / statistics & numerical data*
  • Communication Barriers*
  • Community Health Services / statistics & numerical data*
  • Cross-Sectional Studies
  • Cultural Competency*
  • Female
  • Focus Groups
  • Health Care Surveys
  • Humans
  • Language
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data
  • Pilot Projects
  • Professional-Patient Relations
  • Quality of Health Care / statistics & numerical data*
  • United States