Category Archives: Barriers to care: language and literacy

Sep 27 2013
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Professional Interpreters are Costly, But Crucial

Lisa Ross DeCamp, MD, MSPH, is an alumna of the Robert Wood Johnson Foundation Clinical Scholars program. She is an assistant professor of pediatrics at Johns Hopkins University School of Medicine and a researcher with the Center for Child and Community Health Research.

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Good communication is critical for development of an effective partnership between patient and provider.  However, for the more than 25 million people in the United States who report speaking English less than very well and are classified as having limited English proficiency (LEP), access to the most basic aspect of communication—a common language with the provider—may be limited.

It is easy to imagine how language barriers may compromise the quality and safety of health care. Research consistently demonstrates that physicians falter in many aspects of communication, compromising health care quality and lowering patient satisfaction even when they speak the same language.  Quality and satisfaction gaps stemming from poor communication are only magnified when a language barrier is present. Health care safety requires understanding instructions, again an impossible task if the patient and provider do not share a common language. 

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Jul 18 2013
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Human Capital News Roundup: Interpreters at pediatric appointments, air pollution’s effect on life expectancy, fast food restaurants near schools, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

The majority of pediatricians use bilingual family members instead of professional interpreters to communicate with patients with limited understanding of English, according to a study led by RWJF Clinical Scholars alumna Lisa DeCamp, MD. Family members may make errors or withhold sensitive or painful information, DeCamp told Reuters. Two other Clinical Scholars alumnae, who were not involved in the study, also spoke to Reuters about the findings: Lisa Diamond, MD, MPH, and Darcy Thompson, MD, MPH.

Nearly 500 million people living north of the Huai River in Northern China will lose an estimated 2.5 billion life years—or five years each, on average—because of air pollution from widespread coal burning, the Washington Post reports. The data come from a new study co-authored by RWJF Scholars in Health Policy Research alumni Michael Greenstone, PhD, and Avraham Ebenstein, PhD. Greenstone tells the Washington Post he was “surprised by the magnitude of the effect.”

A study led by RWJF Health & Society Scholars alumna Magdalena Cerdá, PhD, MPH, finds New York City saw a sevenfold increase in opioid overdoses from 1990 to 2006, Pain Medicine News reports. The trend has largely been driven by White individuals who live in areas with “high income inequality but lower than average rates of poverty.”

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Dec 17 2012
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The Role of Caregivers in Supporting Patients Living with Chronic Illness

Andrea Wallace, PhD, RN, is an assistant professor at the University of Iowa College of Nursing and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

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Patients live in communities that offer support and include influences that are outside the walls of clinical settings. While this is not a new revelation, I have often had to remind myself and the students I teach that, as health care providers, we witness only a very small part of patients’ lives, generally at a time when they are most removed from their experience of daily living.

"I cringe to think of how many of my adult patients I’ve asked to adopt a complex medication schedule for their diabetes, all the while suspecting they may have limited literacy skills"

We must remain continually aware of patients’ personal and financial resources when planning care. But it was not until recently that I became incredibly taken with the idea that, for many patients living with chronic illness, it’s those who help patients care for themselves—the daughter picking up medications, the neighbor driving to appointments, the spouse doing shopping – who may make the difference between successfully and unsuccessfully coping with what can be incredibly complex self-management regimens.

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