English-language competency of self-declared English-speaking Hispanic patients using written tests of health literacy.

INTRODUCTION: Hispanic patients comprise the largest minority population in the United States. The federal government mandates that healthcare providers be able to communicate with those patients who have limited English ability. The primary purpose of this study was to assess the English-language proficiency of self-declared English-speaking Hispanic patients in the emergency department (ED). The secondary purpose was to determine concordance between patients' tested English proficiency and perceived proficiency by nurses and physicians. We hypothesized that many patients who state that they are able to speak English do not in fact possess sufficient ability to communicate in English.
METHODS: A convenience study was conducted in an urban level-1 pediatrics and adult trauma center with 45,000 annual visits. Participants included adult patients and parents of pediatric patients, all of which spoke Spanish as their first language. Since there were no verbal tests of English-language ability used in medicine, two written tests were used as surrogates-the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (STOFHLA). Research assistants administered these tests to patients with Hispanic surnames to assess the English comprehension of patients who stated that they spoke English. Score of seventh grade or better on the REALM and > or = 23 on the STOFHLA was considered a level of English competency. Data was entered into SPSS and analyzed for correlations. This study was approved by the institutional review board as exempt.
RESULTS: Three-hundred-fifty-four patients with Hispanic names were approached and asked if they spoke English, Spanish or both. One-hundred-five patients, all self-proclaimed English speakers, were enrolled in the study. Patients ranged from 18-89 years of age, with 37.1% (39/105) male and 62.9% (66/105) and female; 49% (50/102) patients had only completed grade school. Sixty-five of 98 (66.3%) of self-proclaimed English speakers scored at or above a seventh grade reading level on the REALM, and 72.0% (67/93) scored in the category of adequate or better on the STOFHLA. There was a significant difference between patients' tested level of English competency and the physicians' and nurses' assessments of the patients' language competency (p=0.002).
CONCLUSION: This study demonstrated that a significant number of patients who report English proficiency have an inadequate level of English health literacy and therefore English-language ability. Furthermore, there was a discrepancy between level of English competency found in the study and in the perceived English competency of the patients in the judgment of the physicians and nurses in the ED. This study demonstrated that that there was significant lack of English-language ability of self-declared Hispanic patients, suggesting that a more liberal use of interpreters may be indicated.