Addressing Limited English Proficiency and Disparities for Hispanic Postpartum Women

  • Charlene Pope
    Medical University of South Carolina (MUSC) College of Nursing, Charleston, South Carolina, PO Box 250160, Charleston, SC 29425.
    Medical University of South Carolina College of Nursing Charleston.
    Search for articles by this author
      The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.


      To read this article in full you will need to make a payment
      AWHONN Member Login
      AWHONN Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Agency for Healthcare Research and Quality
        Patient safety indicators: Version 2.1.
        (Retrieved January 19, 2004, from)
        • Agency for Healthcare Research and Quality
        Prevention quality indicators: Version 2.1 (revision 2).
        (Retrieved January 19, 2004, from)
        • Ainsworth-Vaughn N.
        Claiming power in doctor-patient talk.
        Oxford University Press, New York1998
        • Andrulis D.
        • Goodman N.
        • Pryor C.
        What a difference an interpreter can make: Health care experiences of uninsured with limited English proficiency.
        The Access Project, Boston2002 (Retrieved January 19, 2004, from
        • Ashton C.
        • Haidet P.
        • Paterniti D.
        • Collins T.
        • Gordon H.
        • O’Malley K.
        • et al.
        Racial and ethnic disparities in the use of health services: Bias, preferences or poor communication?.
        Journal of General Internal Medicine. 2003; 18: 146-152
        • Bancroft M.
        • Goldin G.
        Overcoming language barriers Part II: For administrators. A Volunteers in Health Care Guide. Pawtucket, RI: Volunteers in Health Care.
        (Retrieved on April 2, 2004, from)
        • Bell R.
        • Camacho F.
        • Goonan K.
        • Duren-Winfield V.
        • Anderson R.
        • Konen J.
        • et al.
        Quality of diabetes care among low income patients in North Carolina.
        American Journal of Preventive Medicine. 2001; 21: 124-131
        • Blackford J.
        • Street A.
        Cultural conflict: The impact of western feminism(s) on nurses caring for women of non-English speaking background.
        Journal of Clinical Nursing. 2002; 11: 664-671
        • Bodnar L.
        • Scanlon K.
        • Freedman D.
        • Siega-Riz A.
        • Cogswell M.
        High prevalence of postpartum anemia among low-income women in the United States.
        American Journal of Obstetrics and Gynecology. 2001; 185: 438-443
        • Callister L.C.
        Culturally competent care of women and newborns: Knowledge, attitudes, and skills.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2001; 30: 209-215
        • Cargile A.
        • Giles H.
        • Clement R.
        Language, conflict, and ethnolinguistic identity theory.
        Research in Human Social Conflict. 1995; 1: 189-208
        • Cargile A.
        • Giles H.
        • Ryan E.
        • Bradac J.
        Language attitudes as social process: A conceptual model and new directions.
        Language & Communication. 1994; 14: 211-236
        • Cegala D.
        • Broz S.L.
        Physician communication skills training: A review of theoretical backgrounds, objectives, and skills.
        Medical Education. 2002; 35: 1004-1016
        • Chant S.
        • Tim M.
        • Randle J.
        • Russell G.
        • Webb C.
        Communication skills training in healthcare: A review of the literature.
        Nurse Education Today. 2002; 22: 189-202
        • Chesla C.
        • Skaff M.
        • Bartz R.
        • Mullan J.
        • Fisher L.
        Differences in personal models among Latinos and European Americans: Implications for clinical care.
        Diabetes Care. 2000; 23: 1780-1785
        • Cioffi R.
        Communicating with culturally and linguistically diverse patients in an acute care setting: Nurses’ experiences.
        International Journal of Nursing Studies. 2003; 40: 299-306
        • Cooper L.
        • Roter D.
        Patient-provider communication: The effect of race and ethnicity on the process and outcomes of healthcare.
        in: Smedley B. Stith A. Nelson A. Unequal treatment: Confronting racial and ethnic disparities in health care (Institute of Medicine Report for the National Academies). National Academies Press, Washington, DC2003: 552-593
        • Cubbin C.
        • Braveman P.
        • Marchi K.
        • Chavez G.
        • Santelli J.
        • Gilbert B.
        Socioeconomic and racial/ethnic disparities in unintended pregnancy among postpartum women in California.
        Maternal and Child Health Journal. 2002; 6: 237-246
        • Davidson B.
        A model for the construction of conversational common ground in interpreted discourse.
        Journal of Pragmatics. 2002; 34: 1273-1300
        • Derose K.P.
        • Baker D.
        Limited English proficiency and Latinos’ use of physician services.
        Medical Care Research and Review. 2000; 57: 76-91
        • Diaz E.
        • Prigerson H.
        • Desai R.
        • Rosenheck R.
        Perceived needs and service use of Spanish speaking monolingual patients followed at a Hispanic clinic.
        Community Mental Health Journal. 2001; 37: 335-346
        • Duffy M.
        A critique of cultural education in nursing.
        Journal of Nursing Education. 2001; 36: 487-495
        • Elderkin-Thompson V.
        • Silver R.
        • Waitzkin H.
        When nurses double as interpreters: A study of Spanishspeaking patients in a US primary care setting.
        Social Science & Medicine. 2001; 52: 1343-1358
        • Enslein J.
        • Tripp-Reimer T.
        • Kelley L.
        • Choi E.
        • McCarty L.
        Evidence-based protocol: Interpreter facilitation for individuals with limited English proficiency.
        Journal of Gerontological Nursing. 2002; 28: 5-13
        • Executive Order 13166: Improving access to services for people with limited English proficiency
        Federal Register, 65, 50121-50125.
        (Available from)
        • Fiscella K.
        • Franks P.
        • Doescher M.
        • Saver B.
        Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample.
        Medical Care. 2002; 40: 52-59
        • Fiscella K.
        • Franks P.
        • Gold M.
        • Clancy C.
        Inequality in quality: Addressing socioeconomic, racial and ethnic disparities in health care.
        Journal of the American Medical Association. 2000; 283: 2579-2584
        • Flaskerud J.
        • Lesser J.
        • Dixon E.
        • Anderson N.
        • Conde F.
        • Kim S.
        • et al.
        Health disparities in vulnerable populations.
        Nursing Research. 2002; 51: 74-85
        • Flores G.
        • Laws M.B.
        • Mayo S.
        • Zuckerman B.
        • Abreu M.
        • Medina L.
        • et al.
        Errors in medical interpretation and their potential clinical consequences in pediatric encounters.
        Pediatrics. 2003; 111: 6-14
        • Fuentes-Afflick E.
        • Korenbrot C.
        • Greene J.
        Ethnic disparity in the performance of prenatal nutrition risk assessment among Medicaid-eligible women.
        Public Health Reports. 1995; 110: 764-773
        • Guzman B.
        The Hispanic Population: Census 2000 Brief.
        (Washington, DC: U.S. Census Bureau) (Retrieved December 3, 2003, from)
        • Hahn E.
        • Cella D.
        Health outcomes assessment in vulnerable populations: Measurement challenges and recommendations.
        Archives of Physical Medicine & Rehabilitation. 2003; 84 (4Suppl2): S35-S42
        • Hajek C.
        • Giles H.
        New directions in intercultural communication competence: The process model.
        in: Greene J. Burleson B. Handbook of communication and social interaction skills. Sage Publications, Thousand Oaks, CA2003: 935-957
        • Hall J.
        Some observations on provider-patient communication.
        Patient Education and Counseling. 2003; 50: 9-12
        • Hargraves J.
        Race, ethnicity, and preventive services: No gains for Hispanics.
        Issue Brief/Center for Studying Health System Change. 2001; 34: 1-4
        • Hargraves J.
        • Cunningham P.
        • Hughes R.
        Racial and ethnic differences in access to medical care in managed care plans.
        HSR: Health Services Research. 2001; 36: 853-868
        • Harrykissoon S.
        • Rickert V.
        • Wiemann C.
        Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period.
        Archives of Pediatric Adolescent Medicine. 2002; 156: 325-330
      1. Hobbs, F., & Stoops, N. (2002). Demographic trends in the 20th century. Washington, DC: US Census Bureau (November 2002) 2000 Special Reports Series, CENSR-4. Retrieved December 3, 2003, from

        • Hurst I.
        Imposed burdens: A Mexican American mother’s experience of family resources in a newborn intensive care unit.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2004; 33: 156-163
        • Interagency Working Group on Limited English Proficiency
        Executive Order 13166: Improving access to services for persons with limited English proficiency.
        (Retrieved March 2, 2004, from)
        • Institute of Medicine
        Coverage matters: Insurance and health care. Committee on the Consequences of Uninsurance.
        National Academy Press, Washington, DC2002
        • Joint Commission on Accreditation of Healthcare Organizations
        Overview of the pregnancy and related conditions (PR) Core Measure Set.
        (Retrieved January 21, 2004, from)
        • Jones M.
        • Cason C.
        • Bond M.L.
        Access to preventive health care: Is method of payment a barrier for immigrant Hispanic women? Womens Health Issues.
        Official Publication of the Jacob’s Institute. 2002; 12: 129-137
      2. Ku, L., & Waidmann, T. (2003). How race/ethnicity, immigration, and language status affect health insurance coverage, access to care, and quality of care among the low income population. Prepared for the Kaiser Commission on Medicaid and the Uninsured, August 2003. Publication #4132. Retrieved March 10, 2004, from

        • Laditka J.
        • Laditka S.
        • Mastanduno M.
        Hospital utilization for ambulatory care sensitive conditions: Health outcome disparities associated with race and ethnicity.
        Social Science & Medicine. 2003; 57: 1429-1441
        • Lurie N.
        • Zhan C.
        • Sangl J.
        • Bierman A.
        • Sekscenski E.
        Variation in racial and ethnic differences in consumer assessments of health care.
        American Journal of Managed Care. 2003; 9: 502-509
        • Mateo J.
        • Gallardo E.
        Providing health care to limited English proficiency (LEP) patients: A manual of promising practices.
        California Primary Care Association. Also, Sacramento, CA2000 (available from
        • McKinley E.
        • Thompson J.
        • Briefer-French J.
        • Wilcox L.
        • Weisman C.
        • Andrews W.
        Performance indicators in women’s health: Incorporating women’s health in the Health Plan Employer Data and Information Set (HEDIS).
        Women’s Health Issues. 2001; 12: 46-58
        • Morales L.
        • Cunningham W.
        • Brown J.
        • Liu H.
        • Hays R.
        Are Latinos less satisfied with communication by health care providers?.
        Journal of General Internal Medicine. 1999; 14: 409-417
        • Nielsen P.
        • Thomson B.
        • Jackson R.
        • Kosman K.
        • Kiley K.
        Standard obstetric record charting system: Evaluation of a new electronic medical record.
        Obstetrics & Gynecology. 2000; 96: 1003-1008
        • Office of Minority Health
        National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS).
        U.S. Department of Health and Human Services, Washington, DC2001 (Also available from report.pdf)
      3. Office of Research and Statistics. (2002). Top 25 reasons for inpatient hospitalizations. Inpatient Hospital Discharge Database. South Carolina State Budget and Control Board. Retrieved January 19, 2004, from l&Submit=Get+Report

        • O’Rourke K.
        • Redlinger T.
        Postpartum supplemental vitamin use among Hispanic women on the US/Mexico border: Need for community health education.
        International Quarterly of Community Health Education. 2000; 19: 33-41
        • O’Rourke K.
        • Redlinger T.
        • Waller D.
        Declining levels of erythrocyte folate during the postpartum period among Hispanic women living on the Texas-Mexico border.
        Journal of Women’s Health & Gender-Based Medicine. 2000; 9: 397-403
        • Ortega A.
        • Stewart D.
        • Dowshen S.
        • Katz S.
        Perceived access to pediatric primary care by insurance status and race.
        Journal of Community Health. 2000; 25: 481-493
        • Petersen L.
        • Lindner D.
        • Kleiber C.
        • Zimmerman M.B.
        • Hinton A.
        • Yankowitz J.
        Factors that predict low hematocrit levels in the postpartum patient after vaginal delivery.
        American Journal of Obstetrics and Gynecology. 2002; 186: 737-744
        • Reichman J.
        Language-specific response patterns and subjective assessment of health: A sociolinguistic analysis.
        Hispanic Journal of Behavioral Sciences. 1997; 19: 353-368
        • Rivadeneyra R.
        • Elderkin-Thompson V.
        • Silver R.
        • Waitzkin H.
        Patient-centeredness in medical encounters requiring an interpreter.
        American Journal of Medicine. 2000; 108: 470-474
        • Sarver J.
        • Baker D.
        Effect of language barriers on follow-up appointments after an emergency department visit.
        Journal of General Internal Medicine. 2000; 15: 256-264
        • Schillinger D.
        • Piette J.
        • Grumbach K.
        • Wang F.
        • Wilson C.
        • Daher C.
        • et al.
        Closing the loop: Physician communication with diabetic patients who have low health literacy.
        Archives of Internal Medicine. 2003; 163: 83-90
        • Schwartz M.
        • Wang C.
        • Eckert L.
        • Critchlow C.
        Risk factors for urinary tract infection in the postpartum period.
        American Journal of Obstetrics and Gynecology. 1999; 181: 547-553
        • Shin H.
        • Bruno R.
        Language use and English speaking ability: 2000. (October 2003). Census 2000 Brief C2KBR-29.
        (Retrieved March 5, 2004, from)
        • Smedley B.
        • Stith A.
        • Nelson A.
        Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Institute of Medicine Report for the National Academies).
        (Eds)in: Institute of Medicine, Washington, DC2003
        • Stevens G.
        • Shi L.
        Effect of managed care on childrens’ relationships with their primary care physicians.
        Archives of Pediatric and Adolescent Medicine. 2002; 156: 369-377
        • Street R.
        Gender differences in health care provider-patient communication: Are they due to style, stereotypes or accommodation?.
        Patient Education & Counseling. 2002; 48: 201-206
        • Taira D.
        • Safran D.
        • Seto T.
        • Rogers W.
        • Inui T.
        • Montgomery J.
        • et al.
        Do patient assessments of primary care differ by patient ethnicity? HSR/Health Services Research, 36 (Part I), 1059-1071.
        • Therrien M.
        • Ramirez R.
        The Hispanic population in the United States: March, 2000. Current Population Reports, P20-535.
        U.S. Census Bureau, Washington, DC2000 (Retrieved March 5, 2004, from population/cen2000/phct20/tab01.pdf)
        • Timmons C.
        The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice.
        Journal of Midwifery and Women’s Health. 2002; 47: 80-96
        • Towers P.
        Urinary tract infections.
        Journal of the American Academy of Nurse Practitioners. 2000; 12: 149-154
        • Trussel J.
        • Vaughn B.
        Contraceptive failure, method-related discontinuation, and resumption of use: Results from the 1995 National Survey of Family Growth.
        Family Planning Perspectives. 1999; 31: 93
        • van Ryn M.
        • Burke J.
        The effect of patient race and socio-economic status on physicians’ perceptions of patients.
        Social Science & Medicine. 2000; 50: 813-828
        • van Ryn M.
        • Fu S.
        Paved with good intentions: Do public health and human service providers contribute to racial/ethnic disparities in health?.
        American Journal of Public Health. 2003; 93: 248-255
        • Weech-Maldonado R.
        • Morales L.
        • Spritzer K.
        • Elliott M.
        • Hays R.
        Racial and ethnic differences in parents’ assessments of pediatric care in Medicaid managed care.
        HSR/Health Service Research. 2001; 36: 575-594
        • Yonkers K.
        • Ramin S.
        • Rush A.J.
        • Navarrete C.
        • Carmody T.
        • March D.
        • et al.
        Onset and prevalence of postpartum depression in an inner-city maternal health clinic system.
        American Journal of Psychiatry. 2001; 158: 1856-1863