Journal of General Internal Medicine

, Volume 12, Issue 8, pp 472–477

Is language a barrier to the use of preventive services?

  • Steven Woloshin
  • Lisa M. Schwartz
  • Steven J. Katz
  • H. Gilbert Welch
Original Articles



To isolate the effect of spoken language from financial barriers to care, we examined the relation of language to use of preventive services in a system with universal access.


Cross-sectional survey.


Household population of women living in Ontario, Canada, in 1990.


Subjects were 22,448 women completing the 1990 Ontario Health Survey, a population-based random sample of households.

Measurements and Main Results

We defined language as the language spoken in the home and assessed self-reported receipt of breast examination, mammogram and Pap testing. We used logistic regression to calculate odds ratios for each service adjusting for potential sources of confounding: socioeconomic characteristics, contact with the health care system, and measures reflecting culture. Ten percent of the women spoke a non-English language at home (4% French. 6% other). After adjustment, compared with English speakers, French-speaking women were significantly less likely to receive breast exams or mammography, and other language speakers were less likely to receive Pap testing.


Women whose main spoken language was not English were less likely to receive important preventive services. Improving communication with patients with limited English may enhance participation in screening programs.

Key Words

language preventive health services accessibility of health services communication barriers 


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Copyright information

© Society of General Internal Medicine 1997

Authors and Affiliations

  • Steven Woloshin
    • 3
  • Lisa M. Schwartz
    • 3
  • Steven J. Katz
    • 1
    • 2
  • H. Gilbert Welch
    • 3
  1. 1.Departments of Medicine and Health Management and PolicyUniversity of Michigan Medical CenterAnn Arbor
  2. 2.the Consortium for Health Outcomes, Innovation and Cost-Effectiveness Studies (CHOICES)University of Michigan Medical CenterAnn Arbor
  3. 3.Department of Veterans Affairs Medical CenterVA Outcomes Group (111B)White River Junction

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