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Health Speak: When communication lags, health problems fester.

For millions of recent immigrants, a U.S. residency permit offers real hope for a better life. But attaining the American dream isn’t easy. Well-paying jobs are scarce. Educational opportunities are limited. Linguistic and cultural hurdles can restrict important social interactions. Health problems often go undiagnosed and untreated.

This last stumbling block to success—one that immigrants share with many disabled native-born Americans—is of particular concern to researchers such as MU’s Diane Smith, a professor of occupational therapy and occupational science.

Educators and health-care providers, she says, have mostly done a poor job boosting “health literacy,” a phrase denoting, in part, a person’s ability to read, understand and act appropriately on advice from health professionals.

“There is already a problem with low health literacy within the general population,” says Smith. “When looking at populations with disabilities or limited English proficiency, health professionals need to be more conscious that these particular populations may have more difficulty understanding information, such as treatment options or medication instructions, from their physicians.”

In two recent studies involving interviews with disabled and non-native English speakers, Smith and her research collaborators found ample evidence of a serious communication deficit. Patients said they felt doctors weren’t listening, that treatment options weren’t explained clearly, and that doctors weren’t as respectful and responsive as they should be. Many also said they didn’t feel involved in treatment decisions.

In an era of HMOs and harried physicians, such complaints are not uncommon. The difference, Smith says, is that those with limited English proficiency and disabilities voiced these complaints at a significantly higher rate than did the public at large. What’s more, these problems were compounded by doctors who often associated physical disabilities—or simple difficulties speaking English—with unrelated cognitive issues.

“Even within the health environment, there is a tendency to assume that if there is a physical disability, there is a cognitive one as well,” Smith says. Better training can change that, Smith’s study suggests, and organizations in Missouri are already hosting programs to build physician awareness of health literacy and communications issues. Technology may also help. Smith says the use of telehealth communications—a network that uses telecommunications to communicate health information and services—could, for example, provide non-native English speakers greater access to interpreters.

“If people don’t understand instructions, they’re not going to follow them,” Smith said. “All the best treatment plans in the world aren’t going to help if patients don’t understand what they are supposed to do.”

The first of Smith’s two studies was published in the journal Disability and Health in 2009. Her additional findings will be published in the Journal of Healthcare Disparities Research and Practice later this year.

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University of Missouri

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