The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice

Although Spanish was the primary language of an estimated 11% of adults in the year 2000. the U,S. health care system is largely geared toward serving English speakers. A systematic review was conducted of studies published in biomedical journals from 1990 to 2000 examining language barriers in health care for Latino populations. Aspects of the problem examined were access to health care, quality of care, and health status/health outcomes. Five (55%) of the nine studies examining access to care found a significant adverse effect of language: three (33%) found mixed or weak evidence that language affected access. Six (86%) of the seven studies evaluating quality of care found a significant detrimental effect of language barriers. Two of the three studies examining health status or outcomes found language to be a risk factor for adverse outcomes. Evidence was mixed as to the level of importance attributable to language when access to care is considered: however. non-English-speaking status was a marker of a population at risk for decreased access. Solid evidence showed that language barriers can adversely affect quality of care. Health care practitioners are recommended to devise an effective strategy to bridge language barriers in their setting. National laws and policies are discussed, practical guidelines and resources for providing language access in health care are provided. This article is intended to supply basic knowledge for providers and institutions in devising effective strategies for bridging the language barrier. (C) 2002 by the American College of Nurse-Midwives.