Limited English Proficiency and Insufficiently Disaggregated Data: Barriers to Health Care Equity for Southeast Asians?

Background/Purpose:

Despite the commonly held myth that Asian Americans are healthy, some Asian sub-groups have dangerous health disparities. Failure to disaggregate data about “Asians” means that health inequities go unnoticed and are not addressed by public policy. Anecdotal evidence identifies concerns about the implementation of Title VI of the Civil Rights Act, leaving Limited English Proficient (LEP) refugees at risk of serious health consequences given their inability to communicate with health providers. This study examined the following hypotheses in a state in New England: (1) Not all LEP Southeast Asians are provided with language assistance by health care providers as required by Title VI; (2) Due to lack of language assistance, LEP Southeast Asians experience significant barriers to accessing health care; and (3) Asian race and ethnicity data remains insufficiently disaggregated by health providers. 

Methods:

Cambodian, Vietnamese, and Lao community leaders were engaged with a CBPR approach to develop the study design and focus. We utilized a cross-sectional survey design, focus groups, and in-depth interviews and employed mixed methods including secondary literature review, legal research, semi-structured interviews of LEP community members and lay interpreters, focus groups with key informants, and Internet-based surveys of health providers.

Interview and focus group participants were recruited via purposive sampling. Participants included roughly equal numbers of males and females from three Southeast Asian middle-to-low socioeconomic communities. Three 8-person focus groups and interviews with 9 LEP individuals and 3 family/friends who served as lay interpreters were conducted to identify language-related barriers to health care. Digital recordings were transcribed verbatim. Holistic coding was employed to identify underlying themes.

Language access policy administrators from all 6 of the Accountable Care Organizations and all 15 Community Health Centers in the state and a purposive sample of 20 federally-funded hospitals serving the highest concentration of Asians were invited to complete a Qualtrics survey. Descriptive statistics examined whether data is disaggregated by ethnicity and policies and practices of providers regarding their provision of language assistance programs at no cost to LEP patients.

Findings:

Themes included not knowing of one’s right to an interpreter, inability to communicate with one’s health provider, misunderstands about medication, and concerns about LEP family members isolated and depressed in nursing homes. Regional differences existed in language access and perceived quality of the interpretation depending on the density of the Southeast Asian population. Interpreters provided to elders were often young US-born adults who did not speak Khmer, Vietnamese or Lao fluently and/or spoke with a different dialect. Barriers to implementing Title VI and disaggregating data reported by survey participants included resource constraints, particularly for minority language groups with small numbers in the catchment area.  

Conclusion/Implications:

Federally mandated health providers do not consistently provide adequate interpreters for or track data regarding Southeast Asians, creating barriers to their access to health care and resulting in social injustice. Their health problems go undetected and unaddressed because without disaggregated data, it is impossible to track the health status of Asian subgroups or to determine what factors might contribute to their health-related disparities.