Methods to Enhance the Quality of Care in Limited English-Proficient Patients

Methods to Enhance the Quality of Care in Limited English-Proficient Patients
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Abstract
This paper is aimed to conduct an integrative literature review based on six studies dealing with the linguistic barriers in healthcare settings and their impact on the quality of care. Most studies are based on mixed methods, providing the patients’ perspective of the language barriers through a survey followed by statistical analysis. The findings suggest that the traditional interpretation services fail to adequately address the linguistic barriers due to cultural incompetence and the cost associated with the added wait times due to the limited availability of professional interpreters. The researchers have also highlighted the need for alternative solutions with technology-based applications, telephonic interpretation services, and enhanced focus on training volunteer interpretation service providers emerging as potential alternatives. However, no consensus is obtained over the comparative importance of tools. Similarly, the review lacks reliability for 3/6 studies based on small sample sizes. Despite certain limitations, the research influences scholarly research around healthcare by creating the prospects for comparative analysis across different tools and deeper investigation into the applicability, relevance, and usefulness of the tools and options highlighted in these studies.
1.0. Introduction
1.1. Purpose
The integrative literature review is aimed to investigate the methods that can be integrated into the healthcare model to improve the quality of care for Limited English Proficiency (LEP) patients. A key objective of the study is stated as under:
To identify and evaluate the methods that can be used to enhance the quality of care for LEP patients.
1.2. Topic of Interest
The topic of interest is the ‘methods used to enhance the quality of care for LEP patients.' The topic is of interest since, despite the growing focus on equitable delivery of healthcare services, limited attention is paid to one of the key barriers, linguistic barriers (Shamsi et al., 2020). According to recent findings, 8% of the US population is recognized with LEP as having difficulties in speaking, writing, or listening to English for having other than English as their native language (Agency for Healthcare Research and Quality, 2023). Evidence also indicates that LEP is associated with poor patient health outcomes (Avalos et al., 2013; Ng et al., 2023). Hence, the criticality of the problem and its implications for the healthcare administration and the paucity of research in a given area warrants a deeper and comprehensive inquiry to address this topic.
1.3. Research Question
The primary research question is, “What methods can be utilized to enhance the quality of care in LEP patients?”
If a research proposal was to be prepared based on the background information gathered so far, the research hypothesis would be as under:
Hypothesis: Enhanced focus on volunteer interpreters' culturally-competent training combined with using the latest interpreting technology tools as the backup option can alleviate the linguistic barriers and subsequently improve the quality of care for LEP patients.
1.4. Variables
In line with the above research question, the variables that are of interest to me include as follows:
Methods to be Utilized: This is the independent variable which involves a comparative view of different methods, such as translator services, telephonic interpretation services, translating apps, and other assistance programs. The variables guide the integrative review as it provides a departure point: the comparison across different methods and their outcomes for patients.
Quality of Care: It is measured through patient satisfaction, patient health outcomes, compliance with the treatment plan, and overall patient satisfaction. The measures associated with this variable have also helped narrow the scope of research by looking into the relevant outcomes of the chosen intervention.
1.5. Background and Significance to Healthcare Administration
The significance of the study for the healthcare administration lies in the fact that quality of care is central to the vision of any healthcare organization. Poor health outcomes and compromise on patient satisfaction and safety may have a critical impact on the reputation and revenue of an organization (Diamond et al., 2019). Furthermore, growing emphasis on equitable delivery of care and growing awareness regarding the systematic inequalities and their impact on patients' behavior towards healthcare also presses the strategy makers and managers to take measures to address the root causes of inequalities to sustain a positive reputation (Zimmerman & Anderson, 2019). Therefore, it is important to identify the methods that can help minimize the impact of linguistic disparities and their outcomes related to the quality of delivery.
2.0. Literature Search (200)
2.1. Keywords and Combinations
The keywords were picked in line with the understanding of the research question. For example, the researcher has primarily researched using the keywords "linguistic barriers in healthcare," "language barriers in healthcare," "health outcomes for LEP patients," and "methods used to assist patients with low English proficiency." The most prolific and relevant of these was the keyword mentioned last.
2.2. Databases
The researcher has used the peer-reviewed journal articles available through Google Scholar since the research queries stated above generated adequate results and eliminated the need for considering other databases. Google Scholar is regarded as one of the most authentic and reliable databases, especially for the initial exploration aimed by this integrative review. It contains many accessible journal articles, verified as peer-reviewed, on a diverse range of topics. However, I made sure to double-check each article's status in terms of authenticity and reliability before finalizing the choice as a precautionary measure.
2.3. Inclusion and Exclusion Criteria
The inclusion and exclusion criteria for the research are stated as under:
Inclusion Criteria

Exclusion Criteria

* Peer-reviewed journals
* Articles no older than 2013
* Articles focused on methods used to address the needs of LEP patients
* Articles narrowly focused on LEP patients

* The information available through unauthentic journal articles
* Articles older than 2013
* Articles having divided scope, such as considering other variables affecting the health outcomes for patients than methods to help LEP patients
* Focusing on patients in general

Before finalizing my sample, I gathered 15 studies that were relevant to the chosen topic area. Then, I applied my criteria for inclusion and exclusion. Using the built-in database filters, I easily filtered out the outdated articles from the start. Hence, the currency was not an issue. However, I had to narrow the sample to six articles after the eliminated pieces were found non-compliant with either one or a combination of criteria items (such as broader focus, lack of authenticity, and focus on the general population).
3.0. Methodology Analysis
3.1. Methodology and Statistical Analysis Used
Most of the studies are based on a survey-based approach (Berdahl & Kirby, 2018
; Kornbluth et al., 2022; Avalos, 2013; Ng et al., 2023). The survey-based methodology is combined with pre-assessment and post-assessment or descriptive statistical analysis. The methodology is appropriate as it offers adequate insights into the patient's perspective of healthcare outcomes due to their lack of English proficiency and allows for considering a large population (which is essential to ensure the generalizability of research) (*). However, combining this method with a qualitative view through the practitioners' lens is important for a more effective and holistic approach, as exemplified by Kornbluth et al. (2022). This perspective is essential to gain a realistic idea of the viability of each tool from an administrative standpoint. However, the systematic literature review that Shamsi et al. (2020) focused only on 34 studies does not serve the purpose since a reliable model requires much more studies to avoid incorporating bias. This method is also undesirable due to the paucity of research in the chosen topic area, outlining difficulty in achieving an adequate sample of studies narrowly dealing with the given subject matter.
3.2. Gaps in the Literature
Even though the studies chosen for the integrative analysis meet the inclusion criteria, critical gaps in the literature cannot be overlooked. For example, 3/6 studies have a sample below 50 items/participants which questions the generalizability of findings (Shamsi et al., 2020; Avalos, 2013; Michalec et al., 2015). To ensure higher external validity and generalizability, the researchers should have aimed at much larger samples of studies or participants, controlling particularly for cultural differences (considering the high cultural disparity among patients in the US) (*). Similarly, the studies have not adequately focused on emerging technologies and their prospective role in enabling healthcare organizations to navigate linguistic barriers. For example, only Shamsi et al. (2020), among the chosen sources, have hinted at the effectiveness of the technology-based translation tools, such as Medi Babble; however, the discussion is seen as a supplementary consideration, and more research is needed to further explore this area. Similarly, there is also a need to ensure the participation of all key cultural groups, such as Hispanic, Asians, and African-Americans, to allow for a comprehensive understanding of the problem and simulate the real-world scenario facing patients in America. Currently, the studies do not ensure adequate representation of each cultural group due to the limited size of samples, with a few exceptions only.
3.3. Inconsistencies
There is considerable consensus among the studies regarding the ineffectiveness of interpreters used traditionally to bridge linguistic gaps (Shamsi et al., 2020; Kornbluth et al., 2022; Avalos et al., 2013). However, there is a marked inconsistency across the studies regarding what researchers have found the most appropriate solutions to address the linguistic barriers and minimize their impact on the patients’ health outcomes. For example, Shamsi et al. outline the need for considering the latest translation applications, while Kornbluth et al., 2022 hold telephonic interpretation services in high regard. Furthermore, Avalos et al. (2013) highlight the importance of enhancing the focus on volunteer interpretation services. Avalos et al.'s non-consideration of the latest technology-based tools can be explained by considering the timing of the study (i.e., 2013). Similarly, the difference in opinion regarding the optimal solution can also be explained by considering the focus of each study, as most of the studies are devoted to evaluating the importance of a single method/tool without considering a comparative analysis. Therefore, as indicated by the current research question, a comparative ...