How to Build Trust Among Patients with Language Barriers

Members of the LEP community face different barriers to receiving accessible and equitable health care. Unfortunately, LEP patients are 53% more likely to experience an adverse health outcome, 22.4% more likely to experience an event that results in significant injury or fatality, 24% more likely to have unplanned readmission within 72 hours of discharge, and LEP patient hospital stays are 50% longer than English speaking patients with comparable conditions. The citations for these statistics can be found here at the Kaiser Family Foundation Medicaid Enrollment & Spending Growth: FY 2020 & 2021. This write-up is intended to provide insight into gaining trust among limited English proficiency (LEP) members of the healthcare experience.

Understand Barriers for LEP Members

The following Health Factors and respective Social Determinants of Health have been adapted from the University of Wisconsin Population Health Institution, 2018. After assessing these trends, consider the impact of a language barrier or low health literacy on health outcomes.

  • Health Behaviors
    • Tobacco Use
    • Diet and Exercise
    • Alcohol Use
    • Unsafe Sex
  • Clinical Care
    • Access to Care- consider whether your existing resources are accessible to members of your LEP community
    • Quality of Care
  • Social and Economic
    • Education
    • Employment and Income- consider whether your LEP community is earning a livable wage
    • Family and Social Support- consider whether your LEP community has familial support along their healthcare journey and support to maintain medical progress
    • Community Safety- consider whether your LEP community is in a high crime area of your city
  • Physical Environment
    • Environmental Quality
    • Built Environment- consider whether your community is a food desert (grocery store vs. convenience store)

Community Engagement Strategies

Bilingual community healthcare professionals offer a visualization of resources offered to LEP members of your community and can be a stepping stone to building relationships with your LEP patients. When your healthcare staff is culturally competent, they can better understand the cultural dynamics of the LEP patient population and engage local leaders to develop training for other healthcare workers and the LEP community. In the same vein, collaborating and partnering with community leaders and organizations can increase resource visibility, increase trust with your LEP community, and encourage them to participate in healthcare events held by your facility. To better access the LEP patients in your city, your facility should perform surveys and health risk assessments to identify which Social Determinants of Health impact your LEP community the most, determine the LEP community’s healthcare priorities, and identify health literacy dynamics of the population.

When you layer the bolded ideas above, health outcomes are improved, health costs are reduced, and community engagement with the LEP patient population increases.

Access vs. Equitable Access

Offering the minimum required resources to your LEP community as a healthcare facility is offering “access.” Conversely, offering resources such as community engagement programs, language access evaluations, language-specific care and discharge instructions, and care coordination solutions provides equitable and more effective access to care for your LEP patient population.

Population Health Data Profile- Using Data to Understand Your Community and Get Them Resources

Note- These trends may look very different depending on your facility’s location.

  • Determine the median age of your LEP patient population
  • Determine the percentage of insured and uninsured compared to the English proficient population
  • Determine the percentage of your LEP patient population that lives at or below the federal poverty line
  • Determine the percentage of LEP adults who live in a multi-generational household

Trust-Building Strategies for LEP Members

Tips for Building Trust

  1. Know the health priorities of your community
  2. Assess your organization’s current engagement with the community and its current effectiveness
  3. Identify and closely partner with community stakeholders and bilingual/bicultural community healthcare workers
  4. Authentic engagement takes time; manage expectations of implementation