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Published, Version of Record (VoR)Open Access (License Unspecified), Open
Journal article
Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US
JAMA pediatrics, v 176(8), pp 776-786
13 Jun 2022
PMID: 35696195
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness.
To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families.
This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?"
Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics.
Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions.
This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.
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Details
- Title
- Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US
- Creators
- Alisa Khan - Harvard Medical SchoolVictoria Parente - Duke UniversityJennifer D Baird - Children's Hospital of Los AngelesShilpa J Patel - Pacific Health FoundationSharon Cray - St. Christopher's Hospital for ChildrenDionne A Graham - Harvard UniversityMonique Halley - Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, MassachusettsTyler Johnson - Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, MassachusettsErin Knoebel - Mayo ClinicKheyandra D Lewis - St. Christopher's Hospital for ChildrenIsabella Liss - Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, MassachusettsEileen M Romano - Lurie Children's HospitalShrunjal Trivedi - National Patient Safety FoundationNancy D Spector - Drexel UniversityChristopher P Landrigan - Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, MassachusettsEllen J Bass - Drexel UniversitySharon Calaman - New York UniversityApril E Fegley - Society of Hospital MedicineAndrew J Knighton - Intermountain HealthcareJennifer K O'Toole - Cincinnati Children's Hospital Medical Center, Cincinnati, OhioTheodore C Sectish - Harvard Medical SchoolRajendu Srivastava - Intermountain HealthcareAmy J Starmer - Harvard Medical SchoolDaniel C West - University of PennsylvaniaPatient and Family Centered I-PASS SCORE Scientific Oversight Committee
- Publication Details
- JAMA pediatrics, v 176(8), pp 776-786
- Publisher
- American Medical Association
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Information Science; Pediatrics
- Web of Science ID
- WOS:000812369700002
- Scopus ID
- 2-s2.0-85132799609
- Other Identifier
- 991019168129704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Pediatrics