Relationship between self-assessed and tested non-English-language proficiency among primary care providers

UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



California; Communication Barriers; Female; Health Personnel; Humans; *Language; Male; Massachusetts; Multilingualism; Physicians; Primary Health Care; Professional-Patient Relations; *Self Report


Community Health and Preventive Medicine | Family Medicine | Preventive Medicine | Primary Care


BACKGROUND: Individuals with limited English proficiency experience poor patient-clinician communication. Most studies of language concordance have not measured clinician non-English-language proficiency.

OBJECTIVES: To evaluate the accuracy of the self-assessment of non-English-language proficiency by clinicians compared with an oral proficiency interview.

SUBJECTS: Primary care providers (PCPs) in California and Massachusetts.

MEASURES: PCPs first completed a self-assessment of non-English-language proficiency using a version of the Interagency Language Roundtable (ILR) Scale, followed by the Clinician Cultural and Linguistic Assessment (CCLA), a validated oral proficiency interview. We used nonparametric approaches to analyze CCLA scores at each ILR scale level and the correlation between CCLA and ILR scale scores.

RESULTS: Sixteen PCPs in California and 51 in Massachusetts participated (n=67). Participants spoke Spanish (79%), followed by Cantonese, Mandarin, French, Portuguese, and Vietnamese. The respondents self-assessed as having "excellent" proficiency 9% of the time, "very good" proficiency 24% of the time, "good" proficiency 46% of the time, "fair" proficiency 18% of the time, and "poor" proficiency 3% of the time. The average CCLA score was 76/100. There was a positive correlation between self-reported ILR scale and CCLA score (sigma=0.49, P < 0.001). The variance in CCLA scores was wider in the middle categories than in the low or high ILR categories (P=0.003).

CONCLUSIONS: Self-assessment of non-English-language proficiency using the ILR correlates to tested language proficiency, particularly on the low and high ends of the scale. Participants who self-assess in the middle of the scale may require additional testing. Further research needs to be conducted to identify the characteristics of PCP whose self-assessments are inaccurate and, thus, require proficiency testing.


health disparities, language, doctor-patient interaction, primary care, provider behavior

DOI of Published Version



Med Care. 2014 May;52(5):435-8. doi: 10.1097/MLR.0000000000000102. Link to article on publisher's site

Journal/Book/Conference Title

Medical care

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Link to Article in PubMed

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