Communication & Medicine, Vol 11, No 3 (2014)

Barriers and facilitators to preventive cancer screening in Limited English Proficient (LEP) patients: Physicians’ perspectives

Kelly H. Bruce, Rebecca J. Schwei, Linda S. Park, Elizabeth A. Jacobs
Issued Date: 27 Apr 2016


Background: Limited English Proficient (LEP) patients receive fewer recommended preventive screenings than English-speaking patients. Studies have explored patients’ perceptions of the factors that contribute to this disparity, but little research has focused on physicians’ perceptions. The objective of this paper is to describe physicians’ perceptions of the barriers and facilitators to preventive cancer screening in LEP patients, based on semi-structured interviews with eight primary care physicians from Wisconsin, systematically coded to illuminate important themes. It was found that a variety of barriers specifically hinder LEP patients’ receipt of cancer screening, including poor language proficiency, lack of transportation, unfamiliarity with the concept of prevention, complex scheduling systems, poor interpretation, and limited physician time to discuss preventive care. While physicians identified many factors that facilitate preventive screening in general, they mentioned few that are perceived as specific to LEP patients. We found that primary care physicians attribute the low rates of preventive cancer screening among LEP populations to a variety of patient, provider, interpreter, and system factors, most of which go beyond simple language barriers. Interventions designed to reduce these barriers and enhance the impact of identified facilitators should be multifactorial and designed to engage primary care physicians.

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DOI: 10.1558/cam.v11i3.24051


Akers, A. Y., Newmann, S. J. and Smith, J. S. (2007) Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Current Problems in Cancer 31 (3): 157–181.

Australian Government. 2013. Australia’s Migration Trends 2011-12. Belconnen, ACT: Department of Immigration and Citizenship. Retrieved from:

Barton, E., Eggly, S., Winckles, A. and Albrecht, T. L. (2014) Strategies of persuasion in offers to participate in cancer clinical trials I: Topic placement and topic framing. Communication and Medicine 11 (1): 1–14.

Beach, M. L., Flood, A. B., Robinson, C. M., Cassells, A. N., Tobin, J. N., Greene, M. A. and Dietrich, A. J. (2007) Can language-concordant prevention care managers improve cancer screening rates? Cancer Epidemiology Biomarkers & Prevention 16 (10): 2058–2064.

Bowen, G. A. (2008) Naturalistic inquiry and the saturation concept: A research note. Qualitative Research 8 (1): 137–152.

Caelli, K., Ray, L., and Mill, J. (2008) ‘Clear as mud’: Toward greater clarity in generic qualitative research. International Journal of Qualitative Methods 2 (2): 1–13.

Cheng, E. M., Chen, A. and Cunningham, W. (2007) Primary language and receipt of recommended health care among Hispanics in the United States. Journal of General Internal Medicine 22 (Suppl. 2): 283–288.

Cioffi, R. N. (2003) Communicating with culturally and linguistically diverse patients in an acute care setting: Nurses’ experiences. International Journal of Nursing Studies 40 (3): 299–306.

CTC and Associates LLC (2010) Limited English Proficiency in Wisconsin. Wisconsin Department of Transportation, Transportation Synthesis Report. Retrieved from:

De Alba, I. and Sweningson, J. M. (2006) English proficiency and physicians’ recommendation of Pap smears among Hispanics. Cancer Detection & Prevention, 30 (3): 292–296.

Diez Guardia N. and Pichelmann K. (2006) Labour Migration Patterns in Europe: Recent Trends, Future Challenges. Economic Papers 256. Brussels: Directorate-General for Economic and Financial Affairs, European Commission. Retrieved from:

Fang, D. M. and Baker, D. L. (2013) Barriers and facilitators of cervical cancer screening among women of Hmong origin. Journal of Health Care for the Poor & Underserved 24 (2): 540–555.

Fernandez, M. E., Gonzales, A., Tortolero-Luna, G., Williams, J., Saavedra-Embesi, M., Chan, W. and Vernon, S .W. (2009) Effectiveness of Cultivando la Salud: A breast and cervical cancer screening promotion program for low-income Hispanic women. American Journal of Public Health 99 (5): 936–943.

Gadon, M., Balch, G. I. and Jacobs, E. A. (2007) Caring for patients with limited English proficiency: The perspectives of small group practitioners. Journal of General Internal Medicine 22 (Suppl, 2): 341–346.

Ginsburg, J. A. (2007) Language Services for Patients with Limited English Proficiency: Results of a National Survey of Internal Medicine Physicians: A Position Paper. Philadelphia: American College of Physicians. Retrieved from:

Graneheim, U. H. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24 (2) 105–112.

Harlan, L. C., Bernstein, A. B. and Kessler, L. G. (1991) Cervical cancer screening: Who is not screened and why? American Journal of Public Health 81 (7): 885–890.

Hsieh, H. F. and Shannon, S. E. (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15 (9): 1277–1288.

Jacobs, E. A., Karavolos, K., Rathouz, P. J., Ferris, T. G. and Powell, L. H. (2005) Limited English proficiency and breast and cervical cancer screening in a multiethnic population. American Journal of Public Health 95 (8): 1410–1416.

Liang, W., Wang, J. H., Chen, M. Y. and Mandelblatt, J. S. (2009) Language use and the receipt of cancer screening recommendations by immigrant Chinese American women. Journal of Women’s Health 18 (2): 201–207.

Lim, J. W. (2010) Linguistic and ethnic disparities in breast and cervical cancer screening and health risk behaviors among Latina and Asian American women. Journal of Women’s Health 19 (6): 1097–1107.

Lor, M. and Bowers, B. (2014) Evaluating teaching techniques in the Hmong breast and cervical cancer health awareness project. Journal of Cancer Education 29 (2): 358–365.

Lor, M., Khang, P. Y., Xiong, P., Moua, K. F. and Lauver, D. (2013) Understanding Hmong women’s beliefs, feelings, norms, and external conditions about breast and cervical cancer screening. Public Health Nursing 30 (5): 420–428.

Maar, M., Burchell, A., Little, J., Ogilvie, G., Severini, A., Yang, J. M. and Zahbe, I. (2013) A qualitative study of provider perspectives of structural barriers to cervical cancer screening among first nations women. Women’s Health Issues 23 (5): e319–e325.

Natale-Pereira, A., Marks, J., Vega, M., Mouzon, D., Hudson, S. V. and Salas-Lopez, D. (2008) Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders. Cancer Control 15 (2): 157–165.

Navarro, A. M., Senn, K. L., McNicholas, L. J., Kaplan, R. M., Roppe, B. and Campo, M. C. (1998) Por La Vida model intervention enhances use of cancer screening tests among Latinas. American Journal of Preventive Medicine 15 (1): 32–41.

Ogilvie, G., Krajden, M., Maginley, J., Isaac-Renton, J., Hislop, G., Elwood-Martin, R., Sherlock, C., Taylor, D. and Rekart, M. (2007) Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women. Canadian Medical Association Journal 177 (5): 480–483.

Pandya, C., Jeanne Batalova, J. and McHugh, M. (2011) Limited English Proficient Individuals in the United States: Number, Share, Growth, and Linguistic Diversity. Washington, DC: Migration Policy Institute. Retrieved from:

Roberts, G. W., Irvine, F. E., Jones, P. R., Spencer, L. H., Baker, C. R. and Williams, C. (2007) Language awareness in the bilingual healthcare setting: A national survey. International Journal of Nursing Studies 44 (7): 1177–1186.

Somerville, W. (2009) Future Immigration Patterns and Policies in the United Kingdom. Washington, DC: Migration Policy Institute. Retrieved from:

Tu, S. P., Yip, M. P., Chun, A., Choe, J., Bastani, R. and Taylor, V. (2008) Development of intervention materials for individuals with limited English proficiency: Lessons learned from ‘Colorectal Cancer Screening in Chinese Americans’. Medical Care 46 (9 Suppl. 1): S51–S61.

United States Census Bureau (2014) Language Use. Retrieved from: Accessed February 26, 2014.

Watts, L., Joseph, N., Velazquez, A., Gonzalez, M., Munro, E., Muzikansky, A., Rauh-Hain, J. A. and Del Carmen, M. G. (2009) Understanding barriers to cervical cancer screening among Hispanic women. American Journal of Obstetrics and Gynecology 201 (2): 199.e1–199.e8.

World Health Organization. Cancer country profiles 2014. Retrieved from: Accessed January 23, 2015.

Yarnall, K. S., Pollak, K. I., Ostbye, T., Krause, K. M. and Michener, J. L. (2003) Primary care: Is there enough time for prevention? American Journal of Public Health 93 (4): 635–641.

Youdelman, M., Kohn, N., Pryor, C., Rukavina, M. and Seifert, R. (2004) Language Services Action Kit: The Growing Need for Language Services. Washington, DC: National Health Law Program (NHeLP) and the Access Project.


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