BACKGROUND: Language barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers.OBJECTIVE: To learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services. DESIGN:Computer-assisted telephone focus groups with open-ended discussion guide.SETTING: Small private practices in geographic areas that have experienced recent dramatic increases in LEP populations.PARTICIPANTS: Primary care physicians, specialists, and practice managers.APPROACH: Focus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups. RESULTS:Citing the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk.CONCLUSIONS: Health care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably. INTRODUCTIONThe 2000 U.S. Census reported that 47 million residents speak a language other than English at home, and almost half of them speak English less than "very well" by the U.S. Census definition. This limited English proficient (LEP) population is projected to increase dramatically by the year 2010, and immigrants and refugees are increasingly settling in areas of the country with relatively homogeneous English speaking populations 1 . This has created a situation in which many physicians previously unaccustomed to addressing language barriers in their practices now face the challenge of communicating across a language gap. Many health care systems and physician offices have responded to the challenge of communicating with LEP patient populations by using a variety of interpreters. They provide language access services in the form of face-to-face and telephonic professional interpreters and trained bilingual staff, rely on "ad hoc" interpreters such as untrained bilingual staff, and family and friends.2 Despite the fact that research has highlighted the poor quality of "ad hoc" interpretation and that it likely increases medical errors [3][4][5][6][7] , physicians are reluctant to work with professional interpreters, citing their cost and inefficiency 8 . However, it is no...

Increasing rates of HIV infection have been found in migrant farmworkers in the USA over the past decade. By virtue of lifestyle, language and culture, these workers are not exposed to the typical media HIV prevention messages. To determine their level of knowledge about this disease for use in prevention messages targeted specifically to this population, five gender specific focus groups were conducted among Haitian, Jamaican and African-American migrant farmworkers in upstate New York. The focus groups revealed that the health belief system of these Afro-American migrant workers primarily reflects that of their indigenous culture. This impacts their interpretation and utilization of risk aversive behaviours. The data also suggest that the culture of migrancy itself affects the extent of risky behaviours practised, but further studies are needed to examine this phenomenon.

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