Protocol - English Proficiency

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The respondent completes a question from the California Health Interview Survey (CHIS) asking for the respondent’s own opinion of how well he or she speaks English.

Specific Instructions

The Working Group recommends that the interviewer ascertain what language is spoken in the home, such as “Does this person speak a language other than English at home?” and “What is this language?”. This protocol is only asked of a participant who speaks a language other than English at home. For languages other than English, this protocol may need to be asked by a translator. See http://healthpolicy.ucla.edu/chis/design/Pages/Questionnaires%20(Translated).aspx for translated protocols in languages other than English.




Since you speak a language other than English at home, we are interested in your own opinion of how well you speak English. Would you say you speak English…

[ ] 1 Very well,

[ ] 2 Well,

[ ] 3 Not well, or

[ ] 4 Not at all?



Personnel and Training Required


Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire




Aged 18 years or older

Selection Rationale

The question provides a standard, accepted measure of limited English proficiency(LEP) status.


Chinese, English, Spanish, Other languages available at source

Derived Variables


Process and Review

Not applicable

Protocol Name from Source

California Health Interview Survey (CHIS), Adult questionnaire, 2018


Regents of the University of California. (2019). CHIS 2018 Adult Questionnaire, question number “QA18_G8” is represented in this protocol as question 1. Retrieved from http://healthpolicy.ucla.edu/chis/design/Pages/questionnairesEnglish.aspx

General References

U.S. Census Bureau. (2020). American Community Survey (ACS), 2020. Washington, DC: Author. Question number: Person 1, #14a and #14b.

Berdahl, T. A., & Kirby, J. B. (2018). Patient-provider communication disparities by limited English proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006-2015. Journal of General Internal Medicine, 1–7.

Chan, K. S., Keeler, E., Schonlau, M., Rosen, M., & Mangione-Smith, R. (2005). How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma? Archives of Pediatrics and Adolescent Medicine, 159(3), 283–289.

Fernandez, A., Warton, E. M., Schillinger, D., Moffet, H. H., Kruger, J., Adler, N., & Karter, A. J. (2018). Language barriers and LDL-C/SBP control among Latinos with diabetes. American Journal of Managed Care, 24(9), 405–410.

Kim, E. J., Kim, T., Paasche-Orlow, M. K., Rose, A. J., & Hanchate, A. D. (2017). Disparities in hypertension associated with limited English proficiency. Journal of General Internal Medicine, 32(6), 632–639.

Njeru, J. W., Boehm, D. H., Jacobson, D. J., Guzman-Corrales, L. M., Fan, C.,

Shimotsu, S., & Wieland, M. L. (2017). Diabetes outcome and process measures among patients who require language interpreter services in Minnesota primary care practices. Journal of Community Health, 42(4), 819–825.

Taira, B. R., Kim, K., & Mody, N. (2019). Hospital and health system-level interventions to improve care for limited English proficiency patients: A systematic review. Joint Commission Journal on Quality and Patient Safety, 45(6), 446–458.

U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau. (2016). American Community Survey (ACS): Why we ask questions about… Language spoken at home. Retrieved from https://www.census.gov/acs/www/about/why-we-ask-each-question/language/

U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau. (2020). Get help responding to the ACS. Retrieved from https://www.census.gov/programs-surveys/acs/respond/get-help.html

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX270201010000 Since you speak a language other than more
English at home, we are interested in your own opinion of how well you speak English. Would you say you speak English...? show less
Social Determinants of Health: Core
Measure Name

English Proficiency

Release Date

May 11, 2020


English proficiency is an individual-level measurement of spoken English language proficiency.


Limited English proficiency (LEP) status is associated with multiple health care disparities and places patients at risk for decreased quality of care and in disaster/safety events. It is associated with lower educational attainment and limited employment opportunities. These questions help understand how well an individual speaks English and analyze and plan programs for adults and children with limited proficiency.


ACS, American Community Survey, California Health Interview Survey, CHIS, Limited English Proficiency (LEP), Social Determinants of Health, U.S. Census, immigrant health

Measure Protocols
Protocol ID Protocol Name
270201 English Proficiency

Pomeroy, A., et al. (2022) Protocol for a Longitudinal Study of the Determinants of Metabolic Syndrome Risk in Young Adults. Translational Journal of the American College of Sports Medicine. 2022 April; 7(2): 8. doi: 10.1249/tjx.0000000000000197

Brown, L. D., et al. (2022) Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing. American Journal of Health Promotion. 2022 February; 36(2): 259-268. doi: 10.1177/08901171211049679

Young Hye, K., et al. (2021) Predicting multilingual effects on executive function and individual connectomes in children: An ABCD study. Proceedings of the National Academy of Sciences of the United States of America. 2021 December; 118(49): 1-11. doi: 10.1073/pnas.2110811118