Interventions Between Providers and Patients with Limited English Proficiency to Improve Health-Related Outcomes

Context Substantial ethnic and linguistic diversity of the population in the United States may contribute to significant communication barriers between patients and their healthcare providers, and result in negative healthcare outcomes

Objective To conduct a systematic review of published communication interventions which improved patient care or health outcomes for patients with limited English proficiency.

Study Design This study was a systematic review of randomized controlled trials to identify RCTs demonstrating successful interventions that used communication interventions to impact patient outcomes.

Setting or Dataset We retrieved studies from Embase, Wiley, Cochrane, and MEDLINE published until February 2022. Additional relevant studies were used from references listed in systematic reviews found in our search.

Population Studied Included studies were required to be an RCT, had published results that reported intervention effects in a distinct-language discordant population, or in which ≥ 80% of the study population reported limited English proficiency.

Intervention/Instrument Multiple interventions utilized, as specified in each study.

Outcome Measures We constructed a framework to organize interventions used by outcome. (e.g., diagnosis of a condition; biological markers; knowledge; attitude; quality of life and change in symptoms; individual or group behavior, skills; healthcare process and system outcomes).

Results Eighty-four studies fit inclusion criteria. Almost all included studies utilized interventions were efficacious compared to usual care. Studies utilizing interventions with one-on-one interaction tended to have significant outcomes. Additionally, studies with more than one intervention tended to use a mix of counseling and education. Overwhelmingly, however, the studies did not measure either changes in healthcare system processes nor implemented outcomes of effective interventions at the clinical setting’s point-of-care.

Conclusions Utilized interventions need to address healthcare system processes and/or implement effective interventions at the clinical settings’ point-of-care. There remains a gap in extant research on “clinician-facing” or “supply-side” outcomes. There is a need to focus on implementation into practice and study the results of putting effective communication interventions into systematic practice at the point of care, for both patient and process outcomes.