Communication Practices for Families With Languages Other Than English in US Neonatal Care Units

The lack of provision of culturally and linguistically appropriate services (CLAS) to families with languages other than English (LOE) is a highly modifiable driver of health care inequities. In a nationally representative sample of level 2 to 4 US NICUs, we examined patterns and predictors of communication practices for families with LOE and ascertained clinical leaders' beliefs about barriers to CLAS provision.

We surveyed clinical leaders from 500 randomly selected US NICUs. Responses were weighted by the number of eligible NICUs per region and nonresponse rates. Outcomes included: consistent parental language documentation (≥75% of the time versus <75%) and consistent professional interpreter use (in-person or remote interpretation ≥75% of the time versus <75%). We used logistic regression to examine the associations of predictors (region, hospital characteristics, and the proportion of racial and ethnic minority and families with LOE served) with outcomes.

The overall response rate was 34%. A total of 63% of NICUs collected parental language data consistently, and 41% used interpreters consistently. Patterns of interpreter use varied by service hours and type of communication event. Teaching status, highest level of neonatal care, and larger NICU size were associated with consistent language documentation. Only a larger NICU size was associated with consistent interpreter use. Barriers to CLAS provision included untimely access to interpreter services and suboptimal quality of certain interpretation modalities.

Implementation guidance, accountability for compliance with existing mandates, and interventions tailored to the NICU context are needed to reduce linguistic disparities.