Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

Wael ElRayes

Second Committee Member

Athena Ramos

Third Committee Member

Dejun Su


Refugees and immigrants in the United States from a multitude of backgrounds are impacted by limited English proficiency (LEP), resulting in a health disparity. LEP in vulnerable populations can create obstacles in healthcare. In healthcare settings LEP patients experience adverse health events such as longer hospital stays, negative drug reaction, and patient dissatisfaction (Berdahl & Kirby, 2019). The following project aims to identify barriers for refugees and immigrants with limited English proficiency (LEP) in primary healthcare settings in Nebraska. The project utilized a systematic literature review using peer-reviewed and gray literature. The research was conducted utilizing databases: PsycINFO, PubMed, Google Scholar, EMBASE, and CINAHL. Key terms for the search criteria included “LEP in Nebraska'' and “Healthcare”, “Language disparities in the United States'', and “LEP” and “Health disparities''. Literature outside the United States was excluded to maintain area-specific relevance. Literature with measurable demographic information (English proficiency level, county/city, native language) between 2015-2022 was included. The barriers include healthcare access, and quality, alongside health education. The study expands the understanding of the topic by providing public awareness to generate research further. By providing recommendations, the study hopes to incorporate implementable solutions to further combat the matter. The literature included four articles focusing on LEP barriers in Nebraska, two others on the Midwest region, and the final two identifying barriers in other US neighboring states. The project provided different barriers found in Nebraska LEP refugees and immigrants including lack of accommodation, health system complexity, and discrimination/racism. The project includes implications for developing primary healthcare professionals with the necessary training in assisting LEP patients, and research implications to broaden knowledge on the subject. Due to the increased rates of immigration and resettlement in Nebraska, it is crucial to account for LEP in healthcare, so that the barriers are fully addressed.

Included in

Public Health Commons