Language needs and health literacy for post-partum mothers

Introduction: Limited English proficiency (LEP) and poor health literacy (HL) are barriers to effective patient-provider communication and impact health outcomes. During the current period of increased language diversity in the US, these are important considerations for health care providers. Starting in 2012, The Joint Commission requires that health systems provide qualified medical interpretation services to all patients in need of assistance. However, health systems are often unaware of the language needs and health literacy of their patients.

Methods: Language surveys and HL assessments were administered on weekdays over a 6 week period to all women 1-2 days postpartum at a large community-based academic medical center. A qualified medical interpreter was used for all Spanish-speaking mothers. For other languages a telephone interpretation service was used. Language services were available at the institution from on-site Spanish interpreters during daytime hours and a telephone interpretation service 24 hours a day 7 days a week. Of the 415 women approached, 391 (94%) completed the survey and 361 (92%) completed the HL assessment. Best language, preferred language for health care communication, and use of interpreters during the hospital stay were assessed. Women who preferred a language other than English were classified as LEP. The Newest Vital Sign was administered to mothers 18 and older whose preferred language was English or Spanish.

Results: We found 11.0% (95% CI 8.1%-14.5%) of postpartum women were LEP, 77% of whom preferred Spanish. A majority (76.7%) of LEP mothers reported using family members and 39.5% reported using unqualified staff members as interpreters during their hospital stay. Of the LEP mothers, 56% reported use of a qualified interpreter at least once: 17% using the on-site medical interpreter staff, 58% telephone interpretation service, and 25% using both. However, 58.1% of LEP mothers reported an unmet need for communication assistance at some point during their care. In addition, while adequate HL was found in 59.3% of the overall surveyed population, 69% of English Speaking and 100% of Spanish Speaking Hispanic mothers were found to have limited HL.

Conclusion: Qualified medical interpreters may be underused when providing care to LEP women of childbearing age. A better understanding of the barriers to their effective use is needed. The high prevalence of poor health literacy suggests written information may not be helpful at improving communication for some populations.