Survey of Communication Methods for Limited English Proficiency Dental Patients

Objective: Recent increases in immigrant populations in the state of North Carolina necessitated a study concerning how dental clinics communicate with patients of limited English proficiency (LEP). Methods: A cross-sectional survey was undertaken of all public health dental clinics in North Carolina (NC) to learn how they perceive and provide care for LEP patients. Question domains included: 1) methods of language translation services provided, 2) what factors (barriers, costs, perceived need, time) are associated with provision of these services, 3) if there are perceived differences in quality of care and patient education, and 4) what role legal issues play in communication barriers. Results: The 36-question survey was completed by 54 public health dental clinics (79%=RR). Half of responding clinics reported that 25% or greater of their total patient population does not speak English fluently. 91% provided language services in the clinic—only 65% using an in-person professional interpreter. 11% felt as though a patient's lack of English skills impacts the dentist's treatment recommendations, and 15% felt as though actual treatment provided is impacted. 57% reported dental visits for LEP patients were longer, averaging about 20 additional minutes, compared to English-speaking patients. Waiting for the interpreter and “saying things twice” accounted for the longer appointments. Only 69% of clinics felt any legal obligations for providing language services in their clinic, citing Title VI of the Civil Rights Act and the issue of “informed consent” as justification for such legal responsibility. Conclusions: There are several different ethnic and language groups seeking care in NC public health dental clinics. Most clinics felt a legal obligation for language services, and do so using many methods, at an additional cost to the clinics. Respondents perceive dental visits for LEP patients as longer than for English-speaking patients and some report that language barriers may affect the treatments recommended and actually provided to patients.