University of Wisconsin–Madison Medical College of Wisconsin

How Patients With Limited English Proficiency Make Health Care Decisions: Hmong Patients’ Perspectives

Phia Xiong, MD, MPH; Maichou Lor, PhD, RN; Linda S. Park, PhD; Elizabeth A. Jacobs, MD, MPP

WMJ. 2023;122(3):178-183

Download full-text pdf.

Earn Continuing Education Credit.


Introduction: Information about how the limited English proficiency immigrants make their decisions to seek health care is not well understood. With acculturation, immigrants tend to shift their beliefs and practices towards the practices of their host country. Yet, little is known whether this holds true for the Hmong’s health care decision-making.

Methods: To understand the health care decision-making process of limited English proficiency Hmong, we conducted semistructured interviews with 11 Hmong adults with limited English proficiency. Interviews were audio-recorded, transcribed, and analyzed using directed and conventional content analysis.

Results: We identified several themes: participants sought advice and information from family members who were proficient in English and Hmong and/or who had a health background for a treatment that they perceived to be potentially life-threatening. However, participants were more reliant on their own decision-making in medical situations that were time sensitive. Participants without immediate family asked for health advice from community members or peers who had personal experience with the health condition or treatment.

Conclusions: Our findings suggest a cultural shift in Hmong health care decision-making processes from relying on clan leaders and elders to seeking out the advice of adult children and spouses. Understanding this change in cultural decision-making dynamics will help health care professionals provide more culturally competent care in areas where the Hmong community have a prominent presence.

Author Affiliations: SUNY Downstate University Medical Center, Brooklyn, New York (Xiong); University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin (Lor): University of Wisconsin School of Medicine and Public Health, Madison, Wis (Park); MaineHealth Institute for Research, Scarborough, Maine (Jacobs).
Corresponding Author: Maichou Lor, PhD, RN, University of Wisconsin-Madison, School of Nursing, 701 Highland Ave, Madison, WI 53705; phone 608.265.4248; email; ORCID ID 0000-0001-8451-4364
Funding/Support: None declared.
Financial Disclosures: None declared.
Share WMJ