title: Changes in research on language barriers in health care since 2003: A cross-sectional review study.
abstract: BACKGROUND
  Understanding how to mitigate language barriers is becoming increasingly important for health care providers around the world. Language barriers adversely affect patients in their access to health services; comprehension and adherence; quality of care; and patient and provider satisfaction. In 2003, the United States (US) government made a major change in national policy guidance that significantly affected limited English proficient patients' ability to access language services.
  
  
  OBJECTIVE
  The objectives of this paper are to describe the state of the language barriers literature inside and outside the US since 2003 and to compare the research that was conducted before and after a national policy change occurred in the US. We hypothesize that language barrier research would increase inside and outside the US but that the increase in research would be larger inside the US in response to this national policy change.
  
  
  METHODS
  We reviewed the research literature on language barriers in health care and conducted a cross sectional analysis by tabulating frequencies for geographic location, language group, methodology, research focus and specialty and compared the literature before and after 2003.
  
  
  RESULTS
  Our sample included 136 studies prior to 2003 and 426 studies from 2003 to 2010. In the 2003-2010 time period there was a new interest in studying the providers' perspective instead of or in addition to the patients' perspective. The methods remained similar between periods with greater than 60% of studies being descriptive and 12% being interventions.
  
  
  CONCLUSIONS
  There was an increase in research on language barriers inside and outside the US and we believe this was larger due to the change in the national policy. We suggest that researchers worldwide should move away from simply documenting the existence of language barriers and should begin to focus their research on documenting how language concordant care influences patient outcomes, providing evidence for interventions that mitigate language barriers, and evaluating the cost effectiveness of providing language concordant care to patients with language barriers. We think this is possible if funding agencies around the world begin to request proposals for these types of research studies. Together, we can begin document meaningful ways to provide high quality health care to patients with language barriers.
authors: Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. Electronic address: rschwei@medicine.wisc.edu.
authors: Rebecca J
authors: RJ
authors: Schwei
authors: White Memorial Medical Center, Los Angeles, CA, USA.
authors: Sam
authors: S
authors: Del Pozo
authors: School of Leadership Studies, Royal Roads University, Victoria, BC, Canada.
authors: Niels
authors: N
authors: Agger-Gupta
authors: Alvarado-Little Consulting, Albany, NY, USA.
authors: Wilma
authors: W
authors: Alvarado-Little
authors: Rutgers University School of Nursing, Newark, NJ, USA.
authors: Ann
authors: A
authors: Bagchi
authors: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
authors: Alice Hm
authors: AH
authors: Chen
authors: Department of Psychiatry & Behavioral Sciences & Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Healthcare Policy and Research, Weil Cornell Medical College, New York, NY, USA.
authors: Lisa
authors: L
authors: Diamond
authors: Department of Psychiatry & Behavioral Sciences & Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Francesca
authors: F
authors: Gany
authors: Asian Americans Advancing Justice-Los Angeles, Los Angeles, CA, USA.
authors: Doreena
authors: D
authors: Wong
authors: Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA; Deparment of Population Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Elizabeth A
authors: EA
authors: Jacobs
mesh_terms: D003144:Communication Barriers; D003430:Cross-Sectional Studies; D006302:Health Services Research / Q000639:trends*
keywords: Cross sectional review; Language barriers; Limited English proficiency; Policy change