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A clinician or public health worker's is essential to the ongoing public health response to COVID-19 and transmission-prevention efforts. But there has been a lack of data on the on public health actions related to COVID-19 in the U.S., according to researchers.

Amity Eliaz, MS, of the Institute for Global Health Sciences/University of California San Francisco (UCSF), and colleagues analyzed public health surveillance data (June to November 2020) from 2,668 Spanish-speaking , and found that the odds of completing COVID-19 testing, and being referred for isolation and quarantine (I&Q) support service, was 20% and 53% higher, respectively, when the adults were interviewed by a Spanish-speaking contact tracer.

"These findings highlight the importance of language concordance in the ongoing COVID-19 public health response," they wrote in "The study underscores the importance of mobilizing a culturally humble, to address health disparities impacting communities with limited English proficiency."

Eliaz and colleagues showed that 70.4% of adults were reached by language-concordant tracers while 29.6% were reached by language-nonconcordant tracers. Of the former, 80.2% completed full interviews, 43.9% completed COVID-19 testing during the 2-week quarantine period, and 35.4% received I&Q support service referrals. They found that the odds of referral to I&Q support services were 1.53 times higher among contacts reached by language-concordant tracers versus language-nonconcordant tracers, and 1.49 times higher after adjusting for time.

In the following interview, Eliaz, who is an MD candidate at UCSF School of Medicine, discussed the findings in greater detail.

How do your findings compare with those from earlier studies?

Eliaz: We were not surprised to find that language-concordant contact tracing was associated with increased likelihood of COVID-19 testing and referrals for I&Q support services, such as food, housing, and personal protective equipment.

Prior studies have shown the benefit of language concordance within the clinical context, and our experiences as part of the pandemic response team illustrated the critical importance of effective communication during contact tracing. Greater likelihood of testing and I&Q support service referrals when public health programs adopt language-concordant approaches validates ongoing policy discourse regarding the need to address structural barriers to accessing public health services in the U.S.

What other findings stood out for you?

Eliaz: Interestingly, there was no association between language concordance and contact-tracing interview completion [OR 1.04, 95% CI 0.84-1.29]. These findings suggest that contact tracers were able to complete full interviews to the same extent regardless of language concordance. However, the outcomes of those interviews -- namely, follow-up testing and access to essential support services -- varied significantly.

What are the implications of improved language concordance on health outcomes generally?

Eliaz: A number of recent studies have begun to shed light on the association between language concordance and health outcomes. Language forms the basis of communication that allows us to build rapport with patients, listen closely, provide clear guidance, and form a therapeutic alliance. While further studies are needed to explore the relationship between language concordance and follow-up care, it seems likely that improved language concordance between patients and providers carries important implications for the trajectory of patient care.

In addition to the Latinx community, what other U.S. populations would benefit from improved language concordance?

Eliaz: We believe that all populations for whom English is not the primary language should have access to public health services tailored to their language preferences. The COVID-19 pandemic has offered insight into how specific races and ethnicities in the U.S. remain estranged from public health services. Public health departments across the U.S. need to match their language capabilities to the specific language needs of their communities. Certainly, in the San Francisco Bay Area, Spanish and communities have been disproportionately impacted by COVID-19.

In other places, addressing local language-needs may mean investing in increased access to a public health workforce with fluency in languages such as Mandarin or Haitian Creole.

How can physicians improve language concordance and health equity in their own practice?

Eliaz: Our findings speak to the importance of a culturally humble, linguistically diverse public health workforce in order to reach communities with limited English proficiency, and improve access to essential public health resources.

As members of public health and clinical workforces, it is essential that we advance initiatives to increase the diversity of our staff and advocate for the recruitment of a workforce that reflects the communities we serve. As providers, it is also important that we advocate for our patients with limited English proficiency and place concerted efforts into improving systems-level access to either language-concordant care or interpreter services. As our findings show, such efforts are important to improve public health and advance health equity.

What's next for your group's research?

Eliaz: There is a critical need to assess new models for delivering culturally humble, language-concordant public health programs, especially targeting the needs of vulnerable populations in the U.S. The team that I work with at UCSF is actively evaluating pilot programs in which language-concordant community health workers are empowered to serve critical functions in the COVID-19 response, including addressing vaccine hesitancy, conducting case investigation, and performing risk communication activities.

We greatly hope that these programs will garner sustainable support from our public health departments in order to address disparities in access to public health resources now and beyond the pandemic.

You can read the study abstract here.