{"title":"Development of a language access index: a mixed methods analysis.","authors":"Dru Bhattacharya","doi":"10.1186/s12963-026-00475-4","DOIUrl":null,"url":null,"abstract":"<p><p>Language barriers in healthcare are associated with increased adverse events, communication failures, and inequitable outcomes among individuals with Limited English Proficiency (LEP). Despite federal mandates requiring meaningful language access, language services remain inconsistently operationalized and rarely evaluated using standardized system-level metrics. This mixed-methods study developed and preliminarily evaluated a Language Access Index (LAI) as a domain-based preparedness measure to assess organizational capacity for reliable language-concordant care. Phase I employed semi-structured stakeholder interviews using a Jobs-to-Be-Done framework to identify functional system requirements necessary to support safe and equitable communication across care settings. Twelve multidisciplinary stakeholders contributed to domain derivation, yielding ten domains: Access; Patient Experience; Clinical Performance Outcomes; Compliance; Patient Engagement; Financial Stewardship; Quality and Safety; Workforce Development; Workflow Optimization; and Technology Innovation. Phase II consisted of a structured scoping review mapping empirical evidence to these domains. A PubMed search identified 4,102 records, and structured citation tracking added seven additional studies (4,109 screened). Following staged screening using predefined reproducible criteria with excerpt-level validation, 215 empirical studies (2020-2025) were retained to inform operationalization of 20 core key performance indicators (two per domain). Phase III assessed implementation perceptions among 25 healthcare leaders using validated implementation outcome measures.² Acceptability, appropriateness, and feasibility were rated highly (means 4.72-4.88/5), with 99.6% of responses exceeding a viability threshold and strong internal consistency (Cronbach's α = 0.91). The LAI offers a structured, transparent framework for assessing preparedness for language-concordant care. Further validation is needed to evaluate real-world implementation performance and associations with patient-level outcomes.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Population Health Metrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12963-026-00475-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Language barriers in healthcare are associated with increased adverse events, communication failures, and inequitable outcomes among individuals with Limited English Proficiency (LEP). Despite federal mandates requiring meaningful language access, language services remain inconsistently operationalized and rarely evaluated using standardized system-level metrics. This mixed-methods study developed and preliminarily evaluated a Language Access Index (LAI) as a domain-based preparedness measure to assess organizational capacity for reliable language-concordant care. Phase I employed semi-structured stakeholder interviews using a Jobs-to-Be-Done framework to identify functional system requirements necessary to support safe and equitable communication across care settings. Twelve multidisciplinary stakeholders contributed to domain derivation, yielding ten domains: Access; Patient Experience; Clinical Performance Outcomes; Compliance; Patient Engagement; Financial Stewardship; Quality and Safety; Workforce Development; Workflow Optimization; and Technology Innovation. Phase II consisted of a structured scoping review mapping empirical evidence to these domains. A PubMed search identified 4,102 records, and structured citation tracking added seven additional studies (4,109 screened). Following staged screening using predefined reproducible criteria with excerpt-level validation, 215 empirical studies (2020-2025) were retained to inform operationalization of 20 core key performance indicators (two per domain). Phase III assessed implementation perceptions among 25 healthcare leaders using validated implementation outcome measures.² Acceptability, appropriateness, and feasibility were rated highly (means 4.72-4.88/5), with 99.6% of responses exceeding a viability threshold and strong internal consistency (Cronbach's α = 0.91). The LAI offers a structured, transparent framework for assessing preparedness for language-concordant care. Further validation is needed to evaluate real-world implementation performance and associations with patient-level outcomes.
期刊介绍：
Population Health Metrics aims to advance the science of population health assessment, and welcomes papers relating to concepts, methods, ethics, applications, and summary measures of population health. The journal provides a unique platform for population health researchers to share their findings with the global community. We seek research that addresses the communication of population health measures and policy implications to stakeholders; this includes papers related to burden estimation and risk assessment, and research addressing population health across the full range of development. Population Health Metrics covers a broad range of topics encompassing health state measurement and valuation, summary measures of population health, descriptive epidemiology at the population level, burden of disease and injury analysis, disease and risk factor modeling for populations, and comparative assessment of risks to health at the population level. The journal is also interested in how to use and communicate indicators of population health to reduce disease burden, and the approaches for translating from indicators of population health to health-advancing actions. As a cross-cutting topic of importance, we are particularly interested in inequalities in population health and their measurement.
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