For a patient who is not comfortable in English, a discharge plan or medication instruction written only in English may never really reach them. That makes language a practical question for any hospital, clinic, or pharmacy planning patient education.
How many patients this affects
In its report on language use in the United States, the Census Bureau found that in 2019, 67,802,345 people, or 22 percent of the population age 5 and over, spoke a language other than English at home. Spanish was the most common, with about 41.8 million speakers. Across the whole population age 5 and over, 8 percent spoke English less than "very well", down from 9 percent in 2009.
Those are national figures. The mix in any one hospital's or pharmacy's community can look very different, which is why local data on preferred language matters more than any national average.
What the federal rule says
Section 1557 of the Affordable Care Act prohibits discrimination in covered health programs, and its implementing regulation lists national origin among the protected grounds, along with race, color, sex, age, and disability. Its regulation on language access, 45 CFR 92.201, as published in the Code of Federal Regulations, includes several points that bear directly on patient education:
- Covered entities must take reasonable steps to provide meaningful access to each individual with limited English proficiency.
- When interpretation is needed, they must offer a qualified interpreter. When translation is needed, they must use a qualified translator.
- They may not require patients to bring their own interpreter, and may not rely on a minor child to interpret except as a temporary measure, while finding a qualified interpreter, in an emergency involving an imminent threat to someone's safety or welfare.
- If machine translation is used for material that is critical to an individual's rights, benefits, or meaningful access, where accuracy is essential, or where the content contains complex, non-literal, or technical language, the translation must be reviewed by a qualified human translator.
That last point matters for anyone producing translated handouts or videos. Medication instructions and discharge plans may fall into those categories; your compliance team can confirm.
Practical steps
- Record each patient's preferred language in their chart.
- Have translated materials reviewed by a qualified human translator, especially dosing and warning-sign content.
- Keep the same clinical content in every language, so a Spanish-speaking family gets the same instructions an English-speaking one does.
- Offer formats that do not depend on reading level, such as narrated video, alongside written materials.
Qik Productions makes patient education videos in English, Spanish, or any language a client's patients need, with written transcripts available. See how it works.
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