Moving Away From Limited English Proficiency—Alternative Terminology for Linguistically Diverse Patients

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While limited English proficiency (LEP), a term used to refer to linguistically diverse individuals who speak languages other than English, has its origins in the 1970s, it became an official US government term in 2000 following the issue of an executive order requiring federal agencies to establish policies and processes for individuals who speak languages other than English to gain equitable access to necessary public services.¹ In the realm of health care, the term LEP has been used in policies to help ensure that linguistically diverse patients understand their health conditions and can communicate with their health care practitioners. LEP status is also often used as a demographic variable in research studies. However, like many official terms, over time, LEP has taken on some pejorative connotations, requiring a reconsideration of its use.

Firstly, LEP is a deficit-focused term, implying that a patient is limited by their inability to speak English.² This connotation can often be seen in Limitations sections of research studies, where LEP status of patients is cited as a limitation. In reality, the limitation is a systemic one, caused by the lack of language-concordant care (eg, multilingual clinicians, interpreters, and translation of web portals and paperwork) in health systems. Secondly, LEP ignores the complexity that is inherent to multilingualism. LEP reduces language proficiency to a binary; a patient is either proficient in English or they are not. However, language researchers highlight that language proficiency is a spectrum that varies across contexts (eg, a casual conversation with a friend vs a serious conversation with a physician who uses lots of medical jargon) and language domains (eg, spoken vs written language).² In a health care setting, the needs of a multilingual patient, or their family members who are often present for conversations with health care practitioners, may vary depending on these contexts and domains.

Given these shortcomings, several alternatives to LEP have been proposed by researchers. Terms already being used in published JAMA Network articles include language other than English (LOE)³ and non-English language preference (NELP).^4,5 In their work on this terminology, Ortega et al² operationally defined NELP as “individuals who prefer a non-English language with respect to a particular type of service, benefit, or encounter.” Ortega et al² also coined the term non-English language skills (NELS) to refer to clinician-acquired skills related to communicating with linguistically diverse patients. All of these terms move away from the limitations of LEP and towards a more nuanced and affirmative understanding of multilingual patients and their needs. Researchers may want to consider using these alternatives in their studies, and manuscript editors may want to offer these alternatives when editing a scientific publication.

References

1. Yeboah D, McDaniel C, Lion KC. Language matters: why we should reconsider the term limited English proficiency. Hosp Pediatr. 2023;13(1):e11-e13. doi:10.1542/hpeds.2022-007014

2. Ortega P, Shin TM, Martínez GA. Rethinking the term "limited English proficiency" to improve language-appropriate healthcare for all. J Immigr Minor Health. 2022;24(3):799-805. doi:10.1007/s10903-021-01257-w

3. Hoffman H, Doan TT, Migliori O, et al. Researcher perceptions of inclusion of study participants who use languages other than English. JAMA Netw Open. 2025;8(3):e252380. doi:10.1001/jamanetworkopen.2025.2380

4. Ortega P, Miller De Rutté A, Vela M. Language equity in health technology for patients with non–English language preference. JAMA Netw Open. 2025;8(2):e2457424. doi:10.1001/jamanetworkopen.2024.57424

5. Linares M, Lipsitz S, Shaykevich S, Samal L, Rodriguez JA. Knowledge of interpreter rights and health care access. JAMA Netw Open. 2025;8(7):e2519244. doi:10.1001/jamanetworkopen.2025.19244