There were 37.4 million Latinos in the United States in 2002, representing 13.3 % of the U.S. population, thus becoming the largest minority in the United States. Latinos and other immigrants who are limited English proficient (LEP) encounter multiple barriers accessing health care. On August 11, 2000 President Clinton issued the executive order 13166 (See 65 Fed. Reg. 50121), entitled: "Improving Access to Services for Persons With Limited English Proficiency." After a process of public comment and input, the HHS Office of Minority Health issued the National Standards on Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) on December 22, 2000 (See 65 Fed. Reg. 80865).

There are few studies that focus on the ability of rural hospitals to comply with CLAS standards. This project will survey rural hospitals in order to:

• Determine the extent to which rural hospitals in areas of high Hispanic population growth have implemented plans for compliance with the DHHS LEP regulations.
• Describe the difficulties rural hospitals must overcome in order to provide culturally and linguistically appropriate health care to Hispanic clients.
• Ascertain the translation techniques most commonly used by rural hospitals in high Hispanic population growth counties.
• Describe the approaches that rural hospitals perceive to be most effective for the provision of culturally competent health care to Hispanic clients.

Products of the survey will include a technical report to be submitted to ORHP. In order to make this document accessible to a practitioner audience, the report will incorporate vignettes illustrating how rural hospitals are successfully addressing the needs of LEP patients. "Key Facts" sheets will be developed for distribution to policymakers and the public. To address the academic and medical communities, findings will be presented at state and national meetings, with an emphasis on organizations serving Hispanic populations. In addition, scholarly papers are anticipated, such as quality implications of oral translation techniques currently used by rural hospitals in high Hispanic growth communities, and the relationship between size of Hispanic community and translation approaches used by rural hospitals.

There may be products related to this project; please contact the lead researcher for more information.