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A toolkit for collecting race, ethnicity, and primary language information from patients.
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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.

IOM Subcommittee Template of Spoken Language Categories and Coding (Table I-1 in Appendix I of IOM Report)

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.

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Race/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.

Granular Code Set II (PPT)

IOM Subcommittee Template of Granular Ethnicity Categories (Table E-1 in Appendix E of IOM Report)

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