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Acad Pediatr. 2014 Mar-Apr;14(2):128-36. doi: 10.1016/j.acap.2013.10.003.

Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review.

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Division of General Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif. Electronic address:
Division of General Pediatrics, Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif.
Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif.
Division of General Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif.



One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed.


To conduct a systematic review of peer-reviewed literature examining relationships between parental LEP and health outcomes for CSHCN.


PubMed, Scopus, Cochrane Library, Social Science Abstracts, bibliographies of included studies. Key search term categories: language, child, special health care needs, and health outcomes.


US studies published between 1964 and 2012 were included if: 1) subjects were CSHCN; 2) studies included some measure of parental LEP; 3) at least 1 outcome measure of child health status, access, utilization, costs, or quality; and 4) primary or secondary data analysis.


Three trained reviewers independently screened studies and extracted data. Two separate reviewers appraised studies for methodological rigor and quality.


From 2765 titles and abstracts, 31 studies met eligibility criteria. Five studies assessed child health status, 12 assessed access, 8 assessed utilization, 2 assessed costs, and 14 assessed quality. Nearly all (29 of 31) studies used only parent- or child-reported outcome measures, rather than objective measures. LEP parents were substantially more likely than English-proficient parents to report that their CSHCN were uninsured and had no usual source of care or medical home. LEP parents were also less likely to report family-centered care and satisfaction with care. Disparities persisted for children with LEP parents after adjustment for ethnicity and socioeconomic status.


Parental LEP is independently associated with worse health care access and quality for CSHCN. Health care providers should recognize LEP as an independent risk factor for poor health outcomes among CSHCN. Emerging models of chronic disease care should integrate and evaluate interventions that target access and quality disparities for LEP families.


access; children with special health care needs; disabled children; health care disparities; health services accessibility; health services research; language; limited English proficiency; minority health; quality of health care

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