Culturally Competent Care for LEP Patients
Providing language assistance services overcomes barriers to communication, improves outcomes
Mario Muchacho, DDS | Beatrice de Salles
Although the connection between oral health and overall health may be underestimated, research has shown that an individual's oral health can be a major determinant of his or her overall health. For example, a recent study found that six out of ten of the systemic diseases investigated were directly related to oral health outcomes.1 Such findings highlight the crucial role of good oral healthcare in preventing and managing many serious health conditions, including diabetes,2 cardiovascular disease,3 and others.
Beyond the connection between oral and general health, the connection between oral and mental health is another area of growing concern. The social and emotional implications of poor oral health are well-known by dentists. Poor oral health can lead to decreased self-esteem, social anxiety, and depression. However, conversely, mental health issues can negatively affect a person's oral health. For example, those who are suffering from anxiety or depression may struggle to maintain good oral hygiene habits and visit the dentist regularly.4
Patients with Limited English Proficiency
Factors that contribute to dental anxiety and discourage patients from visiting the dentist include language barriers, which can hinder patients with limited English proficiency (LEP) from receiving the care that they need. Research has shown that LEP patients have poorer health outcomes than patients who speak English proficiently and that their adverse events are often a consequence of some failure in communication.5 This situation puts these patients at risk of not having their oral healthcare needs met, and their overall health could also be impaired.
Dental practices have the legal and ethical obligation to guarantee equal access to care for every patient, regardless of his or her language abilities. The Patient Protection and Affordable Care Act prohibits discrimination based on national origin and establishes that failure to provide meaningful access to care to LEP patients is a form of discrimination. Interestingly, although there is extensive legislation advocating for equal access to healthcare, the need for the use of language professionals is not always explicitly stated.
Language Services in Dental Care
In order to provide the most culturally sensitive care possible, it is crucial for healthcare professionals to work with language professionals. Effective communication between dental patients and practitioners is vital to facilitate proper diagnosis, effective treatment, and optimal outcomes. Without the assistance of a language professional, LEP patients may feel uneasy and overwhelmed, which could have a negative impact on patient safety, their ability to understand and adhere to instructions, and the overall quality of care.
Language assistance services, as defined by the Patient Protection and Affordable Care Act, include oral language assistance, such as interpretation provided in-person or remotely by a qualified interpreter or by qualified bilingual or multilingual staff, and written translation, performed by a qualified translator, of written materials in paper or electronic form into languages other than English.
Because the United States continues to become more diverse and the number of LEP patients keeps growing, language services in healthcare have become more of a necessity than a commodity, and their impact on patient satisfaction is undeniable.
Empower Patients Through Oral Health Literacy
The American Dental Association defines oral health literacy as the degree to which individuals can obtain, process, and understand the basic health information and services needed to make appropriate oral health decisions. This becomes more relevant every day as patients demand greater access to health information to take a more active role in their healthcare decisions.
In some cases, it is possible that a patient may sign an informed consent form without fully understanding its content and may even feel obligated to do so,6 which is unacceptable from both a legal and ethical standpoint. The informed consent document provides patients with information regarding the benefits and risks of the treatment they will receive, so they need to be able to fully understand it in order to make informed decisions.
Professional translators can help to bridge any gaps in communication by not only translating materials into a patient's native language but also adapting the tone and terminology to his or her literacy level. Another way to help improve health outcomes for LEP patients is to work with medical interpreters whose combination of skills, training, and experience enable them to educate practitioners and patients about different cultures and behaviors.7
Although some authors may claim that automatic translation tools such as Google Translate present possible solutions for overcoming language barriers in healthcare,8 the use of such tools may not be the most ethical choice. Machine translation can produce acceptable results in many cases; however, it still struggles with the nuances, context, and cultural differences between languages. Alternatively, human translators and interpreters can comprehend source and target languages in all of their complexity and consider cultural, historical, and social contexts that machines cannot.
Delivering Culturally Competent Care
Dental healthcare professionals have the opportunity to broaden their cultural competence by understanding the impact of language barriers on patients' health, particularly in multicultural locations, and taking actions to help patients overcome these barriers. If healthcare is to be truly equitable and inclusive, we must acknowledge the unique communication needs of LEP patients. Dental schools can contribute by teaching students, faculty, and staff about patients' legal rights to effective communication and the advantages of collaborating with language professionals to achieve positive health outcomes in populations of linguistically diverse patients. Such efforts will result in a more inclusive and patient-centered approach to dental care, benefiting both patients and professionals alike.
About the Authors
Mario Muchacho, DDS, is a licensed dentist and translator who is dedicated to improving communication in healthcare.
Beatrice de Salles is a multilingual translator and interpreter for the United Nations and a certified member of the American Translators Association.
References
1. Hung M, Moffat R, Gill G, et al. Oral health as a gateway to overall health and well‐being: surveillance of the geriatric population in the United States. Spec Care Dentist. 2019;39(4):354-361.
2. Wu CZ, Yuan YH, Liu HH, et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020;20:204.
3. Kotronia E, Brown H, Papacosta AO, et al. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Sci Rep. 2021;11(1):16452.
4. Kisely S. No mental health without oral health. Can J Psychiatry. 2016;61(5):277-.
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6. Estevan E. La traducción y comunicación del consentimiento informado como medida para garantizar su comprensibilidad. In: Montalt V, Zethsen K, Karwacka W, eds. Retos actuales y tendencias emergentes en traducción médica / Current challenges and emerging trends in medical translation. MonTI. 2018;10:75-91.
7. Tribe R, Tunariu A. Mind your language: working with interpreters in healthcare settings and therapeutic encounters. Sex Relation Ther. 2009;24(1):74-84.
8. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: a systematic review. Oman Med J. 2020;35(2):e122.
