Fluency in a patient’s primary language by a clinician or public health worker is critical to the ongoing public health response to COVID-19 and efforts to prevent transmission. But there has been a lack of data on the impact of language concordance on public health actions related to COVID-19 in the United States, researchers say.
Amity Eliaz, MS, of the Institute for Global Health Sciences/University of California San Francisco (UCSF), and colleagues analyzed public health surveillance data (June to November 2020) from 2,668 Spanish-speaking close contacts of a case of COVID-19, and found that the odds of completing the COVID-19 test and being referred for isolation and quarantine (I&Q) support service were 20% and 53% higher, respectively when adults were interviewed by a Spanish-speaking contact tracer.
“These findings underscore the importance of language concordance in the ongoing COVID-19 public health response,” they wrote in Open Forum on Infectious Diseases. “The study underscores the importance of mobilizing culturally humble, language-concordant public health personnel to address health disparities that affect communities with limited English proficiency.”
Eliaz and colleagues showed that 70.4% of adults were affected by concordant language tracers, while 29.6% were affected by nonconcordant language tracers. Of the former, 80.2% completed full interviews, 43.9% completed COVID-19 testing during the 2-week quarantine period, and 35.4% received referrals from I&Q support services. They found that the odds of referral to I&Q support services were 1.53 times higher among contacts reached by concordant language tracers compared to non-concordant language tracers, and 1.49 times higher after adjusting for time.
In the following interview, Eliaz, who is an MD candidate at UCSF School of Medicine, discussed the results in more detail.
How do your results compare to those of previous studies?
Eliaz: We were not surprised to find that matching language contact tracing was associated with an increased likelihood of being tested for COVID-19 and being referred to I&Q support services, such as food, housing and life support equipment. Individual protection.
Previous studies have shown the benefit of language concordance in the clinical setting, and our experiences within the pandemic response team have illustrated the critical importance of effective communication during contact tracing. . Greater likelihood of testing and referral to I&Q support services when public health programs adopt language concordant approaches validates ongoing political discourse regarding the need to address institutional racism in state public health programs -United
What other discoveries have marked you?
Eliaz: Interestingly, there was no association between language concordance and completion of the contact tracing interview [OR 1.04, 95% CI 0.84-1.29]. These results suggest that contact tracers were able to conduct comprehensive interviews to the same extent, regardless of linguistic concordance. However, the results of these interviews, namely follow-up testing and access to essential support services, varied widely.
What are the implications of better linguistic concordance on health outcomes in general?
Eliaz: A number of recent studies have begun to shed light on the association between language concordance and health outcomes. Language forms the basis of communication that allows us to relate to patients, listen carefully, provide clear advice and form a therapeutic alliance. Although further studies are needed to explore the relationship between language concordance and follow-up care, it seems likely that improving language concordance between patients and providers has important implications for the trajectory of patient care. .
Besides the Latinx community, what other American populations would benefit from a better linguistic match?
Eliaz: We believe that all populations whose primary language is not English should have access to public health services tailored to their language preferences. The COVID-19 pandemic has provided insight into how specific races and ethnicities in the United States remain remote from public health services. United States public health departments need to tailor their language capabilities to the specific language needs of their communities. Certainly, in the San Francisco Bay Area, Spanish-speaking and Mayan communities have been disproportionately impacted by COVID-19.
In other places, meeting local language needs may mean investing in increased access to public health staff fluent in languages such as Mandarin or Haitian Creole.
How can physicians improve language concordance and health equity in their own practice?
Eliaz: Our findings speak to the importance of a culturally humble and linguistically diverse public health workforce to reach communities with limited English proficiency and improve access to essential public health resources. .
As public health and clinical staff, it is essential that we advance initiatives to increase the diversity of our workforce and advocate for the recruitment of a workforce that reflects the communities we serve. As providers, it is also important that we advocate for our patients with limited English proficiency and make concerted efforts to improve system-level access to care or language-matched interpreter services. As our findings show, such efforts are important for improving public health and advancing health equity.
What’s the next step in finding your group?
Eliaz: There is a critical need to evaluate new models for delivering culturally humble and linguistically congruent public health programs, particularly targeting the needs of vulnerable populations in the United States. The team I work with at UCSF is actively evaluating pilot programs in which concordant language community health workers are empowered to perform critical functions in the COVID-19 response, including addressing reluctance to vaccination, conducting case investigations and conducting risk communication activities.
We very much hope that these programs will gain sustained support from our public health departments to address disparities in access to public health resources now and beyond the pandemic.
You can read the summary of the study here.