COVID-19 is a rapidly evolving situation. When working in different community settings, follow CDC guidance External Web Site Icon to help prevent the spread of COVID-19. Visit www.cdc.gov/coronavirus External Web Site Icon for the latest public health information.

Health Equity: Use of Interpreter Services or Bilingual Providers

Tabs

What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of one study (search period 1965 - 2001).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to promoting health equity.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 730 KB].

The systematic review included one study.

  • Clients who reported that an interpreter was needed but not used were more likely to be discharged without a follow-up appointment than clients who were able to communicate directly with their physicians in a common language.
  • Clients who communicated through an interpreter were more likely to be discharged without a follow-up appointment than those who were able to communicate directly with their physicians in a common language.
  • People in the intervention groups were no more likely to adhere to appointments than were controls.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Do interventions improve satisfaction with care, reduce ethnic differentials in utilization and treatment, and improve health status?
  • What are intervention effects on knowledge, attitudes, use of services, receipt of treatments, and changes in health outcomes?
  • What are the unintended consequences of, and potential barriers to these interventions?
  • What are the additional effects of language on existing provider–client communication patterns?
  • Do the client benefits of engaging in culturally competent healthcare systems carry over to other social institutions (e.g., education, employment)?

In 1964, the Civil Rights Act, Title VI, mandated provisions for the language needs of clients. Healthcare organizations cite cost as an important factor that limits their ability to provide trained interpreters. Very little research has been done on the effectiveness and cost-effectiveness of providing linguistically competent healthcare services in the United States or on ways to reduce the costs of providing such services.

  • Do trained interpreters compare favorably with family or ad hoc staff interpreters in improving outcomes of satisfaction, appropriate utilization, and health status?
  • What are the relative contributions of improvements in linguistic competence and cultural sensitivity skills to reducing miscommunication and the resulting medical errors?
  • Are linguistically and culturally appropriate health education materials more effective than standard materials in improving health outcomes?

Healthcare providers and provider organizations are concerned about the burden placed on resources by implementing interventions to improve the cultural competence of healthcare systems, particularly in the absence of proven effectiveness.

  • What role should communities play in collaborating with area healthcare organizations to communicate the needs of ethnically diverse populations? At what levels (e.g., management, provider, staff) in a healthcare organization does investment in linguistic and cultural competencies create the greatest improvement in health or other outcomes?

Study Characteristics

  • The study was conducted in an urban hospital emergency department serving predominantly Latino clients (74%).
  • Subjects were predominantly female (64%), between 18 and 60 years of age (92%), and uninsured (68%).
  • Most interpreters (88%) were family members or hospital staff serving as ad hoc interpreters; 12% of interpreters were professionally trained.

Publications