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Language
1. How would you rate your ability to speak and understand English?
- Very Well
- Well
- Not Well
- Not at all
- Declined
- Unavailable
2. What language do you feel most comfortable speaking with your doctor or nurse?
| African languages American Sign Language Arabic Armenian Chinese English French French Creole German Greek Gujarathi Hebrew Hindi |
Hungarian Italian Japanese Korean Laotian Miao Hmong Mon-Khmer Cambodian Navajo Other Native North American languages Persian Polish Portuguese Portuguese Creole |
Russian Scandinavian languages Serbo-Croatian Spanish Tagalog Thai Urdu Vietnamese Yiddish Availability of Sign Language or other auxiliary aids or services Other, please specify: ___ Do not know Unavailable Declined |
Language categories should be based on the community you serve.
3. Would you like an interpreter?
- Yes
- No
- Do not know
- Declined
- Unavailable
4. In which language would you feel most comfortable reading medical or health care instructions?
| African languages American Sign Language Arabic Armenian Chinese English French French Creole German Greek Gujarathi Hebrew Hindi |
Hungarian Italian Japanese Korean Laotian Miao Hmong Mon-Khmer Cambodian Navajo Other Native North American languages Persian Polish Portuguese Portuguese Creole |
Russian Scandinavian languages Serbo-Croatian Spanish Tagalog Thai Urdu Vietnamese Yiddish Availability of Sign Language or other auxiliary aids or services Other, please specify: ___ Do not know Unavailable Declined |
5. How satisfied are you with your ability to read English?
- Very satisfied
- Somewhat satisfied
- Satisfied
- Somewhat dissatisfied
- Very dissatisfied
- Declined
- Unavailable
How to Ask the Questions
As we suggested in the Collecting the Data section of the Toolkit, we recommend that health care organizations/health plans provide a rationale for why they are asking patients/enrollees for information about their racial and ethnic background. Suggested wording for the rationale is:
"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care."
We have found that people feel comfortable responding to the question about race/ethnicity, but they sometimes have their own questions or want more clarity. And some people may prefer to not answer the question at all.
The following link to a response matrix (PPT) provides real world examples of questions people have asked as well as suggested responses. This response matrix is not all inclusive. You may encounter different scenarios, and you may not hear any concerns from patients after asking these questions. The response matrix serves as a tool for you and your staff, and it is excellent for facilitating dialogue during training sessions.
top of this pageRace/Ethnicity
Using Broad (OMB) Categories
"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care."
Ethnicity Question
(OMB recommends asking ethnicity before race.)
Do you consider yourself Hispanic/Latino?
- Yes
- No
- Declined
- Unavailable/Unknown
Race Question
Which category best describes your race?
- American Indian/Alaska Native
- Asian
- Black or African American
- Native Hawaiian/Other Pacific Islander
- White
- Some other race
- Declined
- Unavailable/Unknown
Using Granular Categories
"We want to make sure that all our patients get the best care possible. We would like you to tell us your racial/ethnic background so that we can review the treatment that all patients receive and make sure that everyone gets the highest quality of care. I would like you to describe your race or ethnic background. You can use specific terms such as Korean, Mexican, Haitian, Somali, etc…"
You can provide all or some of the granular categories based on the community you serve.
IOM Subcommittee Template of Granular Ethnicity Categories (Table E-1 in Appendix E of IOM Report)
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