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Promoting health equity among patients with limited English proficiency

Dziewulski, Gabriela (2023) Promoting health equity among patients with limited English proficiency. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: Research on social determinants of health and patient reported outcomes in adults with limited English proficiency (LEP) is very limited but suggests that patients with LEP have more social needs compared to English proficient patients. The purpose of this project is to examine if social determinants of health influence patient reported outcomes, specifically self-reported physical and mental health, in adults with LEP.
Methods: We used the All of Us Research Program, a National Institutes of Health biomedical database, to conduct a retrospective, cross-sectional analysis using data from adults with LEP, operationalized as adults (≥18 years of age) who report speaking English “not well” or “not at all.” We evaluated 13 determinants, including neighborhood cohesion, neighborhood disorder, neighborhood environment, social support, loneliness, everyday discrimination, discrimination in health care, food security, housing insecurity, housing instability, perceived stress, religiousness/spirituality, and religious attendance. We calculated physical and mental health t-scores using participant responses from the PROMIS Global Health short form survey v1.2. We conducted univariate linear regression and forward selection, adjusted for age and sex at birth, within the secure Researcher Workbench platform, to investigate relationships between determinants and physical and mental health.
Results: Participants (N=528) had a mean age of 55.28 years and were primarily female (75.57%) and Hispanic or Latino (87.69%). Overall physical health for the cohort was fair to good (mean=44.10; standard deviation [SD]=8.73) and mental health was good to very good (mean=48.05; SD=8.30). Perceived stress (b=-0.371, p<0.001) and neighborhood disorder (b=-0.225, p=0.021) were identified as the most important determinants for physical health (model R2=0.1671); higher levels were associated with poorer physical health. Similarly, perceived stress (b=-0.308, p=0.049), loneliness (b=-0.424, p<0.001), and neighborhood disorder (b=-0.213, p=0.007) were identified as the most important determinants for mental health (model R2=0.2754); higher levels were associated with poorer mental health.
Conclusions: Our study identified targets of nursing interventions for improving self-reported physical and mental health in patients with LEP. Special considerations, such as use of medical interpreters and instruments in a patient’s primary language, should be considered. Improving patient reported outcomes in patients with LEP is critical to promoting health equity for LEP populations.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Dziewulski, Gabrielagad49@pitt.edugad49
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorKoleck,
Committee MemberHershey, Tina
Committee MemberLor,
Committee MemberMartsolf,
Date: 24 April 2023
Date Type: Publication
Defense Date: 13 April 2023
Approval Date: 24 April 2023
Submission Date: 20 April 2023
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 36
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: limited English proficiency (LEP), health equity, social determinants of health, patient reported outcomes, physical health, mental health,
Date Deposited: 24 Apr 2023 18:48
Last Modified: 24 Apr 2024 05:15


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