A Survey of North Carolina Safety-Net Dental Clinics' Methods for Communicating with Patients of Limited English Proficiency (LEP)

e18533 Background: Prior studies have shown that when patients with cancer engage with social media, they have positive outcomes, including clinical trial participation, volunteerism and advocacy, and diminished levels of anxiety. However, active users of social media tend to be white, well-educated, and of higher socioeconomic status. Little is known about the use of technology and social media by underserved oncology populations, particularly patients with limited English proficiency (LEP). We sought to characterize current technology use by patients at Olive View—UCLA Medical Center (OVMC), a safety net hospital in Los Angeles County. Methods: We developed an anonymous online survey (Qualtrics, Provo, UT) comprised of 39 questions. The survey was administered, via touchscreen tablets from January 2020 through January 2021, to a convenience sample of patients seen in OVMC’s outpatient medical oncology clinic. The survey was available in English and Spanish, and we excluded patients who were not fluent in either language. Patients were categorized as having LEP versus English proficiency (EP) by self-assessment, on a 5-point Likert scale, of their comfort in speaking English. Differences between the LEP and EP groups were assessed using Pearson’s chi-squared test and Fisher’s exact test. Results: Of 113 patients who were offered the survey, 10 (9%) declined participation because of illiteracy in their primary language or inability to use a tablet. Reponses were recorded for 50 patients with LEP and 53 with EP. The LEP and EP groups, respectively, were similar in their representation of women (62% and 64%) and mean age (58 years and 51 years). High school completion rates were 32% for the LEP group and 70% for the EP group. A higher proportion of the LEP group identified as Hispanic/Latinx (84%) compared to the EP group (58%). The LEP group was less likely than the EP group to have internet access (63% vs. 98%, P< 0.01). However, among patients with internet access, social media use was similar in the LEP and EP groups (65% vs. 71%, P= 0.7). Facebook was the most used platform by the LEP (22%) and EP (32%) groups; other platforms (e.g., Twitter, Instagram) were used by very few respondents. The LEP group was less likely than the EP group to have activated the OVMC online patient portal (19% vs. 47%, P< 0.01) and less likely to perceive websites as helpful for learning about clinical trials (30% vs. 53%, P= 0.03). Conclusions: A notable proportion of safety net oncology patients at OVMC do not engage with tablet technology because of illiteracy or lack of comfort with touchscreens. Patients with LEP are less likely to have internet access, but those with access use social media about as often as patients with EP, and prefer Facebook over other platforms. For patients with LEP, engagement efforts, including clinical trial outreach, should continue to include non–internet-based resources in patients’ native languages.

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Computer use, language, and literacy in safety net clinic communication

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw062 ◽

2016 ◽

Vol 24 (1) ◽

pp. 106-112 ◽

Cited By ~ 7

Author(s):

Neda Ratanawongsa ◽

Jennifer L Barton ◽

Courtney R Lyles ◽

Michael Wu ◽

Edward H Yelin ◽

...

Keyword(s):

Health Literacy ◽

Computer Use ◽

Limited English Proficiency ◽

English Proficiency ◽

Interaction Analysis ◽

Safety Net ◽

Language And Literacy ◽

Limited Health Literacy ◽

Safety Net Clinic ◽

Analysis System

Objective: Patients with limited health literacy (LHL) and limited English proficiency (LEP) experience suboptimal communication and health outcomes. Electronic health record implementation in safety net clinics may affect communication with LHL and LEP patients. We investigated the associations between safety net clinician computer use and patient-provider communication for patients with LEP and LHL. Materials and Methods: We video-recorded encounters at 5 academically affiliated US public hospital clinics between English- and Spanish-speaking patients with chronic conditions and their primary and specialty care clinicians. We analyzed changes in communication behaviors (coded with the Roter Interaction Analysis System) with each additional point on a clinician computer use score, controlling for clinician type and visit length and stratified by English proficiency and health literacy status. Results: Greater clinician computer use was associated with more biomedical statements (+12.4, P = .03) and less positive affect (−0.6, P < .01) from LEP/LHL patients. In visits with patients with adequate English proficiency/health literacy, greater clinician computer use was associated with less positive patient affect (−0.9, P < .01), fewer clinician psychosocial statements (−3.5, P < .05), greater clinician verbal dominance (+0.09, P < .01), and lower ratings on quality of care and communication. Conclusion: Higher clinician computer use was associated with more biomedical focus with LEP/LHL patients, and clinician verbal dominance and lower ratings with patients with adequate English proficiency and health literacy. Discussion: Implementation research should explore interventions to enhance relationship-centered communication for diverse patient populations in the computer era.

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An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net (Preprint)

10.2196/preprints.18466 ◽

2020 ◽

Author(s):

Alejandra Casillas ◽

Anupama Gunshekar Cemballi ◽

Anshu Abhat ◽

Miya Lemberg ◽

Jennifer D Portz ◽

...

Keyword(s):

Health Systems ◽

Digital Literacy ◽

Limited English Proficiency ◽

English Proficiency ◽

Safety Net ◽

Security And Privacy ◽

Structured Interviews ◽

Patient Portals ◽

Privacy And Security ◽

Safety Net Providers

BACKGROUND Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. OBJECTIVE Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. METHODS We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. RESULTS Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. CONCLUSIONS Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

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An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net

Journal of Medical Internet Research ◽

10.2196/18466 ◽

2020 ◽

Vol 22 (7) ◽

pp. e18466 ◽

Cited By ~ 1

Author(s):

Alejandra Casillas ◽

Anupama Gunshekar Cemballi ◽

Anshu Abhat ◽

Miya Lemberg ◽

Jennifer D Portz ◽

...

Keyword(s):

Health Systems ◽

Digital Literacy ◽

Limited English Proficiency ◽

English Proficiency ◽

Safety Net ◽

Security And Privacy ◽

Structured Interviews ◽

Patient Portals ◽

Privacy And Security ◽

Safety Net Providers

Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

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Serving Children With Limited English Proficiency in the Schools

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.2503.156 ◽

1994 ◽

Vol 25 (3) ◽

pp. 156-164 ◽

Cited By ~ 29

Author(s):

Celeste A. Roseberry-McKibbin ◽

Glenn E. Eicholtz

Keyword(s):

Limited English Proficiency ◽

English Proficiency

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Assessment and Intervention for Children With Limited English Proficiency and Language Disorders

American Journal of Speech-Language Pathology ◽

10.1044/1058-0360.0303.77 ◽

1994 ◽

Vol 3 (3) ◽

pp. 77-88 ◽

Cited By ~ 25

Author(s):

Celeste Roseberry-McKibbin

Keyword(s):

Public Schools ◽

Limited English Proficiency ◽

English Proficiency ◽

Language Disorders ◽

Speech Language Pathologists ◽

Academic Difficulties ◽

Language Differences ◽

Language Impaired ◽

Number Of Children ◽

Assessment And Treatment

The number of children with limited English proficiency (LEP) in U.S. public schools is growing dramatically. Speech-language pathologists increasingly receive referrals from classroom teachers for children with limited English proficiency who are struggling in school. The speech-language pathologists are frequently asked to determine if the children have language disorders that may be causing or contributing to their academic difficulties. Most speech-language pathologists are monolingual English speakers who have had little or no coursework or training related to the needs of LEP children. This article discusses practical, clinically applicable ideas for assessment and treatment of LEP children who are language impaired, and gives suggestions for distinguishing language differences from language disorders in children with limited English proficiency.

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