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How health care workers assess their own communication with language-diverse patients during the COVID-19 pandemic

Written by Cindy Brantmeier, PhD, professor of applied linguistics, global studies and Institute faculty scholar, and Kim Furlow, communications manager for the Institute for Public Health

The problem with communication is the illusion that it has occurred.

George Bernard Shaw

A multidisciplinary team of researchers from Washington University in St. Louis, led by Institute Faculty Scholar, Cindy Brantmeier, recently published a study titled, Health Care Workers and Self-Assessed Communication with Language Diverse Patients in the St. Louis Region at the Onset and One Year into COVID-19. The study, currently in the Journal of Nursing and Patient Health Care, examines health care workers and their self-assessed communication with language-diverse patients in the St. Louis region at the onset of, and one year into, the COVID-19 pandemic.


For this research, a survey informed by work in the disciplines of Global Public Health and Applied Linguistics was developed and administered to more than 300 health care workers to examine their perceptions of communications with language minority patients during the COVID-19 pandemic. For the purposes of this study, a language minority patient is a patient who uses a language other than English as their dominant language. Self-assessment (SA) is a factor previously researched in second language acquisition studies with a contextualized, criterion-referenced instrument for language, in which learners self-diagnose their own strengths and weaknesses across language abilities. This is validated through actual performance (Brantmeier, 2005; 2006; Brantmeier & Vanderplank, 2008; Brantmeier, Vanderplank & Strube, 2012; Liu & Brantmeier, 2019).

Self assessment of English-speaking ability by patients has been an important reference for the health workforce. Some attention has been given to the health disparities exacerbated by the COVID-19 pandemic. Race, ethnicity and socioeconomic status continue to be driving forces behind differing health outcomes. Health literacy, or an individual’s capacity to acquire and use new health information (Baker, 2006), is an additional strong predictor of health status (DeWalt et al, 2004). Abdel-Latif (2020) recently cited a report by Paasche-Orlow (2005) that says 26% of all people living in the U.S. have low general health literacy. Before COVID-19, many postulated that language is one of the most significant, and yet underexplored, social determinants of health and one that deserves increased attention in our medical system (Showstack et al, 2020 and Ortega et al, 2019).

In the present study, more than 300 health care workers (82% female, 63% nurses) completed the survey providing feedback on information available from the community and health care facilities, oral communication with patients, and the training of health care professionals. Results showed a significant difference between perceptions when comparing current reports (one year into the pandemic) with concurrent recall of conditions at the beginning of the pandemic time (p < .001); however, the majority disagreed that health information access was sufficient even at the later time point. Respondents indicated a significant improvement in feeling prepared to discuss knowledge of COVID-19 with language diverse patients; and, feeling that patients understood what individual words meant in the context of discussing COVID-19.

A majority of health care workers received communication training and are interested in further training. Additionally, a key finding from this study is that most health care workers indicated that the St. Louis community and their facilities were aware of the needs of COVID-19 resources for language minorities, and provided an increased amount of communication resources over time. Respondents also indicated positive and responsive leadership and initiatives that attempted to ensure equal health care access during the St. Louis public health crisis.

The study’s findings hold positive implications for language diverse patients in the St. Louis region. There are approximately 2.8 million people living in the St. Louis metro area, with 5,500 foreign-born people (immigrants, refugees and foreign students) in 2017-2018 (Mueller et al, 2019). Demographic data from 2020 Missouri Department of Elementary and Secondary Education shows an enrollment of more than 10,000 students in the St. Louis Metro area, who were categorized as Limited English Proficiency. This group includes those in the city of St. Louis. In 2019 in Missouri, 34.5% of the foreign-born population indicated that they speak English less than “very well,” whereas only 0.6% of the total U.S. born population in Missouri indicated that they speak English less than “very well”. (Migration Policy Institute’s State Immigration Data Profiles).

The present study emphasizes the need for medical professionals to learn about self-assessment in perceived competency and accordingly, to develop communication strategies and tools. Given the findings of the current study, Brantmeier and team feel that a future investigation could examine the existing knowledge that health care workers have about the theory and research on language acquisition and use, and how to attend to immediate language needs, especially when no language interpreter is present. This can inform training modules and include principled strategies on how to modify oral communication so that it is immediately more comprehensible to the patient.

Also according to Brantmeier and team, examining health care workers’ perspectives about communication with language minorities is merely the start. Future research should go beyond this study and investigate the perception of both patients and clients about actual communication immediately following a visit, they say.

One goal of the present study is to promote self-reflection among health care workers on the role of communication with language-diverse patients. Another goal is to inspire future research and practice changes during this global public health emergency and beyond. The study summarizes that, going forward, emphasis on language diversity should continue among initiatives aimed at decreasing bias and discrimination in health care.

Read more about the study in the Journal of Nursing and Patient Health Care.

The study Health Care Workers and Self-Assessed Communication with Language Diverse Patients in the St. Louis Region at the Onset and One Year into COVID-19 and journal article were authored by: Cindy Brantmeier, PhD, MA, professor of applied linguistics, global studies and Faculty Scholar at the Institute for Public Health at Washington University in St. Louis (WUSTL); Amanda R. Dube, MD, instructor in Pediatric Hospital Medicine at Washington University School of Medicine in St. Louis; Sophia Shijia Li, occupational therapy doctoral candidate at the School of Medicine; Michael Strube, PhD, MS, WUSTL professor of psychological & brain sciences and professor of physical therapy at the School of Medicine; David Balmaceda M., MA, WUSTL applied linguistics PhD candidate; and, Jacaranda van Rheenen, PhD, manager of the Global Health Center at the Institute for Public Health at Washington University in St. Louis.