Redesigning the Health System / Increasing Access to Culturally and Linguistically Appropriate Services

Indicator: Percent of adults who report not speaking English well and had a difficult time understanding their provider, California

Indicator Description: Indicators are from UCLA’s California Health Interview Survey (CHIS) Public Use File (PUF) and the AskCHIS exploratory dashboard. This variable is based on a question that asks if adult patients had a hard time understanding their doctor (AJ8V3, AskCHIS Variable: Difficulty understanding doctor). Adults 18+ who speak a language other than English at home and that report not speaking English well were asked “The last time you saw a doctor, did you have a hard time understanding the doctor?”. Prior to 2018, the survey asked this question of all adults who visited a doctor in the past 1-2 years.

Data Limitations: The survey is administered in English, Spanish, Chinese, Korean, Tagalog, and Vietnamese, and therefore the measure is not adequately informed by people who do not speak English well and are also not proficient in the languages offered. Does not include those living in group quarters or people experiencing homelessness (PEH). The indicator is a downstream measure that is not directly tied to upstream improvements in health systems. The measure is unable to differentiate between difficulty understanding what a doctor said due to limited English proficiency (LEP) and other potentially relevant factors (educational attainment, use of jargon or technical language by the doctor, inadequate time spent with the doctor, etc.).

Indicator Source: UCLA’s Center for Health Policy Research CHIS is an annual, population-based, omnibus health survey of California’s residential population (adults, teens, and children). It is the largest telephone survey in California and the largest state health survey in the country. Note that this indicator uses weighted data.

Data Sharing Agreement: Researchers can access a variety of publicly available CHIS data files and web tools. These CHIS data products include downloadable data sets and easy-to-read documents. In addition, local county health departments can request data files specific to their county. Researchers can also apply to analyze confidential CHIS data, data sensitive variables, and/or geo-coded data through the CHIS Data Access Center (DAC). Access to confidential CHIS data requires a research application, review, and approval.

Indicator Calculation Methodology: Percent of the adult population who speak a language other than English at home, do not speak English well, and report having a difficult time understanding their provider (answered “Yes” to the question “The last time you saw a doctor, did you have a hard time understanding the doctor?”). Note that this indicator uses weighted data. https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/chis-design-and-methods

Data Collection Methodology: Statewide web and telephone survey using a geographically stratified sample design. Estimates are weighted to Dept. of Finance demographic data (adjusted for group quarters population). More information is available at https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/chis-design-and-methods

Program URL Link: https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis

Reporting Cycle: Annually (June)

1. Let’s Get Healthy California Task Force. (2012, December). Let’s Get Healthy California Task Force Final Report. Let’s Get Healthy California Task Force. https://letsgethealthy.ca.gov/wp-content/uploads/2019/02/Lets-Get-Healthy-California-Task-Force-Final-Report.pdf

2. Betancourt, J. R., Green, A. R., Carrillo, J. E., Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302. https://doi.org/10.1093/phr/118.4.293

3. Schiaffino, M. K., Ruiz, M., Yakuta, M., Contreras, A., Akhavan, S., Price, B., & Weech-Maldonado, R. (2020). Culturally and linguistically appropriate hospital services reduce Medicare length of stay. Ethnicity & Disease, 30(4), 603-610. https://doi.org/10.18865%2Fed.30.4.603

4. Hampers, L. C. & McNulty E. (2002). Professional interpreters and bilingual physicians in a pediatric emergency department: Effect on resource utilization. Arch Pediatr Adolesc Med., 156(11), 1108–1113. https://doi.org/10.1001/archpedi.156.11.1108

5. Yeo, S. (2004). Language barriers and access to care. Annual Review of Nursing Research, 22(1), 59-73. https://doi.org/10.1891/0739-6686.22.1.59

6. U. S. Census Bureau. (n.d.). Detailed household language by household limited English speaking status in California (Detailed Table B16002). U.S. Department of Commerce. Retrieved December 6, 2023, from https://data.census.gov/.

7. Shommu, N. S., Ahmen, S., Rumana, N., Barron, G. R. S., McBrien, K. A., & Turin, T. C. (2016). What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. International Journal for Equity in Health, 15, 6. https://doi.org/10.1186/s12939-016-0298-8

8. Geiger, H. J. (2001). Racial stereotyping and medicine: the need for cultural competence. CMAJ, 164(12), 1699-1700.

9. Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res, 22, 438. https://doi.org/10.1186/s12913-022-07829-2