Exploring the ‘Patient Experience’ of Individuals with Limited English Proficiency: A Scoping Review

  • Ariel Yeheskel
  • Shail Rawal
Review Paper


Individuals with limited English proficiency (LEP) face barriers to safe and high-quality health care. ‘Patient-experience’ is increasingly viewed as an important component of health care quality. However, the impact of language proficiency on ‘patient-experience’ is not well-described. This scoping review mapped the literature on the patient experience of individuals with LEP. We reviewed sixty qualitative and mixed-methods studies from EMBASE and MEDLINE published between 2007 and 2017. We identified four major themes: (1) Communication, language barriers, and health literacy, (2) Relationships with health care professionals, (3) Discrimination and intersection with other dimensions of identity, and (4) Cultural safety. We also identified factors that may improve LEP patient experience, including: mitigating language barriers through interpretation or language-concordant providers, offering translated patient resources, and educating health care professionals about cultural safety.


Patient experience Equity Limited English proficiency Patient satisfaction Cultural safety 


  1. 1.
    U.S. Census Bureau. Selected social characteristics in the United States: 2016 American Community Survey 1-Year Estimates [Internet]. United States Census Bureau.
  2. 2.
    Zong J, Batalova J. The limited english proficient population in the United States. Online J Migr Policy Inst. 2015.
  3. 3.
    Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5:276–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Jiang HJ, Andrews R, Stryer D, Friedman B. Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. Am J Public Health. 2005;95:1561–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    John-Baptiste A, Naglie G, Tomlinson G, Alibhai SMH, Etchells E, Cheung A, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19:221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parker MM, Fernández A, Moffet HH, Grant RW, Torreblanca A, Karter AJ. Association of patient-physician language concordance and glycemic control for limited-english proficiency latinos with type 2 diabetes. JAMA Intern Med. 2017;177:380–7CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Njeru JW, Boehm DH, Jacobson DJ, Guzman-Corrales LM, Fan C, Shimotsu S, et al. Diabetes outcome and process measures among patients who require language interpreter services in minnesota primary care practices. J Community Health. 2017;42:819–825CrossRefPubMedGoogle Scholar
  8. 8.
    Kim EJ, Kim T, Paasche-Orlow MK, Rose AJ, Hanchate AD. Disparities in hypertension associated with limited english proficiency. J Gen Intern Med. 2017;32:632–639CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lee JS, Pérez-Stable EJ, Gregorich SE, Crawford MH, Green A, Livaudais-Toman J, et al. Increased access to professional interpreters in the hospital improves informed consent for patients with limited english proficiency. J Gen Intern Med. 2017;32:863–870Google Scholar
  10. 10.
    Patel DN, Wakeam E, Genoff M, Mujawar I, Ashley SW, Diamond LC. Preoperative consent for patients with limited English proficiency. J Surg Res. 2016;200:514–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen AL. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005;116:575–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19:60–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3:e001570.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Defining patient experience—The Beryl Institute—Improving the patient experience. Beryl Inst. 2017.
  15. 15.
    Wolf J, Niederhauser V, Marshburn D, LaVela S. Defining patient experience. Patient Exp J. 2014;1:7–19.Google Scholar
  16. 16.
    Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ Can Med Assoc J. 1995;152:1423–33.Google Scholar
  17. 17.
    Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients. N Engl J Med. 1964;270:825–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Rainey LC. Effects of preparatory patient education for radiation oncology patients. Cancer. 1985;56:1056–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Zolnierek KBH, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47:826–34.CrossRefPubMedGoogle Scholar
  20. 20.
    Glickman SW, Anstrom KJ, Lin L, Chandra A, Laskowitz DT, Woods CW, et al. Challenges in enrollment of minority, pediatric, and geriatric patients in emergency and acute care clinical research. Ann Emerg Med. 2008;51:775–80.e3.CrossRefPubMedGoogle Scholar
  21. 21.
    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.CrossRefGoogle Scholar
  22. 22.
    Burnham J, Shearer B. Comparison of CINAHL, EMBASE, and MEDLINE Databases for the Nurse Researcher. Med Ref Serv Q. 1993;12:45–57.CrossRefPubMedGoogle Scholar
  23. 23.
    Zotero. Fairfax, VA: Center for History and New Media at George Mason University; 2018.Google Scholar
  24. 24.
    Microsoft Excel 2016. Redmond. WA, USA: Microsoft; 2018.Google Scholar
  25. 25.
    Snilstveit B, Oliver S, Vojtkova M. Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. J Dev Eff. 2012;4:409–29.CrossRefGoogle Scholar
  26. 26.
    Alhomoud F, Dhillon S, Aslanpour Z, Smith F. South Asian and Middle Eastern patients’ perspectives on medicine-related problems in the United Kingdom. Int J Clin Pharm. 2015;37:607–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Hannah CT, Lê Q. Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study. Rural Remote Health. 2012;12:2118.PubMedGoogle Scholar
  28. 28.
    McKenzie H, Kwok C, Tsang H, Moreau E. Community nursing care of Chinese-Australian Cancer patients: a qualitative study. Cancer Nurs. 2015;38:E53–60.CrossRefPubMedGoogle Scholar
  29. 29.
    Riera A, Ocasio A, Tiyyagura G, Krumeich L, Ragins K, Thomas A, et al. Latino caregiver experiences with asthma health communication. Qual Health Res. 2015;25:16–26.CrossRefPubMedGoogle Scholar
  30. 30.
    Davies J, Bukulatjpi S, Sharma S, Davis J, Johnston V. Only your blood can tell the story”—a qualitative research study using semi-structured interviews to explore the hepatitis B related knowledge, perceptions and experiences of remote dwelling Indigenous Australians and their health care providers in northern Australia. BMC Public Health. 2014;14:1233.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    MacFarlane A, Dzebisova Z, Karapish D, Kovacevic B, Ogbebor F, Okonkwo E. Arranging and negotiating the use of informal interpreters in general practice consultations: experiences of refugees and asylum seekers in the west of Ireland. Soc Sci Med. 2009;69:210–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Binder P, Borne Y, Johnsdotter S, Essen B. Shared language is essential: communication in a multiethnic obstetric care setting. J Health Commun. 2012;17:1171–86.CrossRefPubMedGoogle Scholar
  33. 33.
    Lowell A, Maypilama E, Yikaniwuy S, Rrapa E, Williams R, Dunn S. “Hiding the story”: indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. Int J Speech Lang Pathol. 2012;14:200–208.CrossRefPubMedGoogle Scholar
  34. 34.
    Jowsey T, Gillespie J, Aspin C. Effective communication is crucial to self-management: The experiences of immigrants to Australia living with diabetes. Chronic Illn. 2011;7:6–19.CrossRefPubMedGoogle Scholar
  35. 35.
    Shahid S, Finn LD, Thompson SC. Barriers to participation of aboriginal people in cancer care: communication in the hospital setting. Med J Aust. 2009;190:574–9.PubMedGoogle Scholar
  36. 36.
    Mohammad A, Saini B, Chaar BB. Exploring culturally and linguistically diverse consumer needs in relation to medicines use and health information within the pharmacy setting. Res Soc Adm Pharm. 2015;11:545–59.CrossRefGoogle Scholar
  37. 37.
    Brooks K, Stifani B, Batlle HR, Nunez MA, Erlich M, Diaz J. Patient perspectives on the need for and barriers to professional medical interpretation. R I Med J. 2016;99:30–3.Google Scholar
  38. 38.
    Shaw J, Zou X, Butow P. Treatment decision making experiences of migrant cancer patients and their families in Australia. Patient Educ Couns. 2015;98:742–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Seo JY, Kim W, Dickerson SS. Korean immigrant women’s lived experience of childbirth in the United States. J Obstet Gynecol Neonatal Nurs. 2014;43:305–17.CrossRefPubMedGoogle Scholar
  40. 40.
    Lee S, Chen L, Ma GX, Fang CY. What is lacking in patient-physician communication: perspectives from asian american breast cancer patients and oncologists. J Behav Health. 2012. PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Gurnah K, Khoshnood K, Bradley E, Yuan C. Lost in translation: reproductive health care experiences of Somali Bantu women in Hartford, Connecticut. J Midwifery Womens Health. 2011;56:340–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Tisnado DM, Mendez-Luck C, Metz J, Peirce K, Montaño B. Perceptions of survivorship care among Latina women with breast cancer in Los Angeles County. Public Health Nurs Boston Mass. 2017;34:118–29.CrossRefGoogle Scholar
  43. 43.
    Ochieng BM. Black African migrants: the barriers with accessing and utilizing health promotion services in the UK. Eur J Public Health. 2013.Google Scholar
  44. 44.
    Calo WA, Cubillos L, Breen J, Hall M, Rojas KF, Mooneyham R, et al. Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina. BMC Health Serv Res. 2015;15:570.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    DeCamp LR, Kieffer E, Zickafoose JS, DeMonner S, Valbuena F, Davis MM, et al. The voices of limited english proficiency Latina mothers on pediatric primary care: lessons for the medical home. Matern Child Health J. 2013;17:95–109.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    O’Donnell CA, Higgins M, Chauhan R, Mullen K. “They think we’re OK and we know we’re not”. A qualitative study of asylum seekers’ access, knowledge and views to health care in the UK. BMC Health Serv Res. 2007.Google Scholar
  47. 47.
    O’Callaghan C, Schofield P, Butow P, Nolte L, Price M, Tsintziras S, et al. “I might not have cancer if you didn’t mention it”: a qualitative study on information needed by culturally diverse cancer survivors. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2016;24:409–18.Google Scholar
  48. 48.
    Burke NJ, Napoles TM, Banks PJ, Orenstein FS, Luce JA, Joseph G. Survivorship care plan information needs: perspectives of safety-net breast cancer patients. PLoS ONE. 2016.
  49. 49.
    Nguyen GT, Barg FK, Armstrong K, Holmes JH, Hornik RC. Cancer and communication in the health care setting: experiences of older Vietnamese immigrants, a qualitative study. J Gen Intern Med. 2008;23:45–50.CrossRefPubMedGoogle Scholar
  50. 50.
    Fryer CE, Mackintosh SF, Stanley MJ, Crichton J. I understand all the major things: how older people with limited English proficiency decide their need for a professional interpreter during health care after stroke. Ethn Health. 2013.Google Scholar
  51. 51.
    Alzubaidi H, Mc Mamara K, Chapman C, Stevenson V, Marriott J. Medicine-taking experiences and associated factors: comparison between Arabic-speaking and Caucasian English-speaking patients with Type 2 diabetes. Diabet Med J Br Diabet Assoc. 2015;32:1625–33.CrossRefGoogle Scholar
  52. 52.
    White L, Klinner C. Medicine use of elderly Chinese and Vietnamese immigrants and attitudes to home medicines review. Aust J Prim Health. 2012;18:50–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Abdullahi A, Copping J, Kessel A, Luck M, Bonell C. Cervical screening: perceptions and barriers to uptake among Somali women in Camden. Public Health. 2009;123:680–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Lee S, Martinez G, Ma GX, Hsu CE, Robinson ES, Bawa J, et al. Barriers to health care access in 13 Asian American communities. Am J Health Behav. 2010;34:21–30.CrossRefPubMedGoogle Scholar
  55. 55.
    Simon MA, Ragas DM, Nonzee NJ, Phisuthikul AM, Luu TH, Dong X. Perceptions of patient-provider communication in breast and cervical cancer-related care: a qualitative study of low-income English- and Spanish-speaking women. J Community Health. 2013.Google Scholar
  56. 56.
    Baxley SM, Ibitayo K. Expectations of pregnant women of mexican origin regarding their health care providers. J Obstet Gynecol Neonatal Nurs. 2015;44:389–96.CrossRefPubMedGoogle Scholar
  57. 57.
    Wojnar DM. Perinatal experiences of Somali couples in the United States. J Obstet Gynecol Neonatal Nurs. 2015;44:358–69.CrossRefPubMedGoogle Scholar
  58. 58.
    Harrison L, Scarinci I. Child health needs of rural Alabama Latino families. J Community Health Nurs. 2007;24:31–47.CrossRefPubMedGoogle Scholar
  59. 59.
    Park L, Schwei RJ, Xiong P, Jacobs EA. Addressing cultural determinants of health for Latino and Hmong Patients with limited english proficiency: practical strategies to reduce health disparities. J Racial Ethn Health Disparities. 2017.Google Scholar
  60. 60.
    Hunt LM, de Voogd KB. Are good intentions good enough? Informed consent without trained interpreters. J Gen Intern Med. 2007;22:598–605.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Murray L, Windsor C, Parker E, Tewfik O. The experiences of African women giving birth in Brisbane, Australia. Health Care Women Int. 2010;31:458–72.CrossRefPubMedGoogle Scholar
  62. 62.
    Lo M-CM, Bahar R. Resisting the colonization of the lifeworld? Immigrant patients’ experiences with co-ethnic healthcare workers. Soc Sci Med. 2013;87:68–76.CrossRefPubMedGoogle Scholar
  63. 63.
    Gil S, Hooke MC, Niess D. The limited english proficiency patient family advocate role: fostering respectful and effective care across language and culture in a pediatric oncology setting. J Pediatr Oncol Nurs. 2016;33:190–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Carmichael S. Black Power, a critique of the system of international white supremacy & international capitalism. In: Cooper D, editor. The dialectics of liberation. New York: Penguin; 1968. p. 151.Google Scholar
  65. 65.
    Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med 1982. 2014;103:126–33.Google Scholar
  66. 66.
    Choi JY. Negotiating old and new ways: contextualizing adapted health care-seeking behaviors of Korean immigrants in Hawaii. Ethn Health. 2013;18:350–66.CrossRefPubMedGoogle Scholar
  67. 67.
    Clark L, Redman RW. Mexican immigrant mothers’ expectations for children’s health services. West J Nurs Res. 2007;29:670–90.CrossRefPubMedGoogle Scholar
  68. 68.
    De Gagne JC, Oh J, So A, Kim S-S. The healthcare experiences of Koreans living in North Carolina: a mixed methods study. Health Soc Care Community. 2014;22:417–28.CrossRefPubMedGoogle Scholar
  69. 69.
    Cleveland LM. A Mexican American mother’s experience in the neonatal intensive care unit. J Perinat Neonatal Nurs. 2009;23:178–85.CrossRefPubMedGoogle Scholar
  70. 70.
    Graham CL, Ivey SL, Neuhauser L. From hospital to home: Assessing the transitional care needs of vulnerable seniors. Gerontologist. 2009.Google Scholar
  71. 71.
    Mutchler JE, Bacigalupe G, Coppin A, Gottlieb A. Language barriers surrounding medication use among older Latinos. J Cross-Cult Gerontol. 2007;22:101–14.CrossRefPubMedGoogle Scholar
  72. 72.
    Lindsay AC, de Oliveira MG, Wallington SF, Greaney ML, Machado MMT, Freitag Pagliuca LM, et al. Access and utilization of healthcare services in Massachusetts, United States: a qualitative study of the perspectives and experiences of Brazilian-born immigrant women. BMC Health Serv Res. 2016;16:467.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Ransford HE, Carrillo FR, Rivera Y. Health care-seeking among Latino immigrants: blocked access, use of traditional medicine, and the role of religion. J Health Care Poor Underserved. 2010;21:862–78.CrossRefPubMedGoogle Scholar
  74. 74.
    Bozorgzad P, Negarandeh R, Raiesifar A, Poortaghi S. Cultural safety: an evolutionary concept analysis. Holist Nurs Pract. 2016;30:33–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Carbone ET, Rosal MC, Torres MI, Goins KV, Bermudez OI. Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Educ Couns. 2007;66:202–10.CrossRefPubMedGoogle Scholar
  76. 76.
    Nam S, Song H-J, Park S-Y, Song Y Challenges of diabetes management in immigrant Korean Americans. Diabetes Educ. 2013.Google Scholar
  77. 77.
    Lee S-Y, Weiss SJ. When East meets West: intensive care unit experiences among first-generation Chinese American parents. J Nurs Scholarsh Off Publ Sigma Theta Tau Int Honor Soc Nurs. 2009;41:268–75.Google Scholar
  78. 78.
    Taniguchi H, Baruffi G. Childbirth overseas: the experience of Japanese women in Hawaii. Nurs Health Sci. 2007;9:90–5.CrossRefPubMedGoogle Scholar
  79. 79.
    Liu Z, Beaver K, Speed S. Chinese Elders’ views on their interactions in general practice: a Grounded Theory study. Ethn Health. 2015;20:129–44.CrossRefPubMedGoogle Scholar
  80. 80.
    Blignault I, Ponzio V, Ye R, Eisenbruch M. A qualitative study of barriers to mental health services utilisation among migrants from mainland China in South-East Sydney. Int. J. Soc. Psychiatry. 2008.Google Scholar
  81. 81.
    Fang ML, Malcoe LH, Sixsmith J, Wong LYM, Callender M. Exploring traditional end-of-life beliefs, values, expectations, and practices among Chinese women living in England: Informing culturally safe care. Palliat Support Care. 2015;13:1261–74.CrossRefPubMedGoogle Scholar
  82. 82.
    Dohan D, Levintova M. Barriers beyond words: cancer, culture, and translation in a community of Russian speakers. J Gen Intern Med. 2007;22(Suppl 2):300–5.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Mitchison D, Butow P, Sze M, Aldridge L, Hui R, Vardy J, et al. Prognostic communication preferences of migrant patients and their relatives. Psychooncology. 2012;21:496–504.CrossRefPubMedGoogle Scholar
  84. 84.
    Bagchi AD, Dale S, Verbitsky-Savitz N, Andrecheck S, Zavotsky K, Eisenstein R. Examining effectiveness of medical interpreters in emergency departments for Spanish-speaking patients with limited English proficiency: results of a randomized controlled trial. Ann Emerg Med. 2011;57:248–56.CrossRefPubMedGoogle Scholar
  85. 85.
    Garrett PW, Dickson HG, Young L, Whelan AK. “The Happy Migrant Effect”: perceptions of negative experiences of healthcare by patients with little or no English: a qualitative study across seven language groups. Qual Saf Health Care. 2008;17:101–3.CrossRefPubMedGoogle Scholar
  86. 86.
    Leng J, Lee T, Sarpel U, Lau J, Li Y, Cheng C, et al. Identifying the informational and psychosocial needs of Chinese immigrant cancer patients: a focus group study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2012;20:3221–9.Google Scholar
  87. 87.
    Thomson MD, Hoffman-Goetz L. Colon cancer information preferences of English-as-a-second-language immigrant women: does language of interview matter? J Cancer Educ Off J Am Assoc Cancer Educ. 2010;25:229–35.CrossRefGoogle Scholar
  88. 88.
    Gillespie RJ, Harrison L, Mullan J. Medication management concerns of ethnic minority family caregivers of people living with dementia. Dement Lond Engl. 2015.Google Scholar
  89. 89.
    Vishram S, Crosland A, Unsworth J, Long S. Engaging women from South Asian communities in cardiac rehabilitation. Br J Community Nurs. 2007;12:13–8.CrossRefPubMedGoogle Scholar
  90. 90.
    Frayne SM, Burns RB, Hardt EJ, Rosen AK, Moskowitz MA. The exclusion of non-English-speaking persons from research. J Gen Intern Med. 1996;11:39–43.CrossRefPubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Division of General Internal MedicineUniversity Health NetworkTorontoCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada

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