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Language Barriers in Mental Health Care: A Survey of Primary Care Practitioners
Abstract
Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners' experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.
... One of the most common language support options reported by HSCPs in the provision of mental health services to TCNs is the use of professional interpreters [13,18,22,25,28,35], both in person [5,36,40,42] and remotely [57]. HSCPs using interpreters report reducing the content/information in their communication with TCNs to account for the time required for interpreting [22,43]. ...
... HSCPs using interpreters report reducing the content/information in their communication with TCNs to account for the time required for interpreting [22,43]. When the use of professional interpreters is not an option, HSCPs rely on informal interpreters [5,9,14,40,42]. This may include the use of children as interpreters for low-level follow-up [40]. ...
... There are also situations where HSCPs refer TCNs to linguistically and culturally concordant HSCPs, rather than using a third person (such as an interpreter or cultural broker) to mediate the communication [1,25,36,40,42,57]. Other language support options reported by HSCPs include the use of simplified language [22,43], bilingual staff members [5], linguistically capable staff at key points of contact [25], translated/multilingual information materials and telephone menus [5,25], a 24-hour toll-free linguistically competent telephone [25] and tele-counselling programmes [1]. Moreover, HSCPs use visual aids [5,43] such as signs/instruction posters, automatic translation of prescriptions [5], Google Translate [57], self-located online multilingual resources, such as multilingual healthcare websites [5], multilingual electronic systems [16], interactive, touchscreen-based self-assessment tool for common mental disorders provided in TCNs' and the host countries' languages [8] and translated screening tools [35]. ...
... According to Statistics Canada (2009), there are 18,010 psychologists working in Canada (92% of all Canadian professional psychologists). What is relevant is that these psychologists are not evenly distributed across Canada, nor between rural and urban areas (Moroz et al., 2020;Statistics Canada, 2009), and most problematically, there are not enough diverse mental health care providers to meet the needs of individuals in communities of colour, who often prefer an ethnic and linguistically similar clinician (Brisset et al., 2014;Thomson et al., 2015). As contemplated at the May 2019 summit on the Future of Professional Psychology training, health human resource data indicates that the current number of mental health providers in Canada is not sufficient to meet the mental health needs of the population (Mikail & Nicholson, 2019). ...
... Given these many barriers, people of colour may not be able to access mental health care, and if they do, they may not receive adequate treatment. These individuals often require someone who speaks their language, understands their culture, and is part of their community (e.g., Brisset et al., 2014;King et al., 2022). However, the dearth of psychologists in Canada makes it difficult to find the best care for those most in need of services. ...
... There is an important need for mental health services for immigrants and refugees, and there are clear benefits of being able to offer treatment in a person's preferred language (Brisset et al., 2014). As a diverse nation, with 7.7 million Canadians with an immigrant mother tongue, Canada has a high need for mental health providers with knowledge of multiple languages. ...
L’objectif de cet article est de faire la lumière sur la façon dont les politiques instrumentalisées soutiennent un système conçu pour exclure les personnes racisées de la profession de psychologue, contribuant ainsi à la pénurie de prestataires de soins de santé mentale, qui à son tour contribue à une crise de la santé mentale au Canada. Nous décrivons d’abord les origines de la pénurie actuelle et du manque de représentation diversifiée dans la psychologie professionnelle et nous concluons par une liste de recommandations visant à démanteler les politiques historiques et injustes. Le racisme explicite étant de plus en plus stigmatisé au fil des décennies, les outils politiques ont évolué pour devenir plus abstraits et donner un vernis d’équité tout en maintenant le résultat d’exclusion initial. Les politiques instrumentalisées font partie d’une boîte à outils structurelle très utilisée, mais peu examinée qui sert à priver de leurs droits les groupes privés de pouvoir. Nous éclairons l’histoire et l’adoption de ces politiques à l’aide d’exemples, montrons comment elles ont été explicitement créées pour empêcher les personnes de couleur d’accéder au pouvoir par l’éducation, et comment elles protègent les systèmes racistes existants. L’absence de perspective historique dans la formation donne aux politiques aversives un déni plausible, rendant difficile le changement structurel. Ces politiques se sont métastasées et se sont enracinées, persistant secrètement dans une multitude de politiques et de procédures qui continuent à étrangler les possibilités d’éducation pour les personnes de couleur et à priver le Canada de fournisseurs et de dirigeants professionnels de la santé mentale agréés et diversifiés.
... Reviews have concluded that professional interpreters can improve quality of care with fewer errors in translation, greater satisfaction among both patients and practitioners, and a greater increase in clinical outcome than ad hoc interpreters [3,16,17]. However, the role of the interpreter is not necessarily tied to whether the interpreter is professional or ad hoc [18,19]; patients may prefer family interpreters because they provide a different kind of support [17,18,20]. Particularly in uncomplicated situations, patients may show a preference for family members. ...
... In all consultations with an interpreter present, either professional or ad hoc, it is challenging for doctors to convey empathy [19] and difficult to establish a trusting relationship [2]. Doctors have also been shown to be less affective when working with patients from ethnic minority groups [2,9]. ...
... They were not always experienced by the GP as being neutral, for example in situations where the family wanted the patient to receive some social benefit or if asymmetric gender roles were enacted, as also shown in the literature [25,29]. The consultations with family interpreters became a conversation with three interlocutors, leading to the doctors feeling a loss of control, as also found by Zendedel et al. [1], and, in line with Brisset et al. [19], to a change in the power dynamic in the consultation. However, although they preferred professional interpreters, the participants found that there was no clear-cut answer as to whether to use family members, because in addition to interpreting the family members often also had other roles. ...
Background
In 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter.
Methods
The study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis.
Results
The GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas.
Conclusions
The GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.
... This was predominately in the context of newly arrived migrants, as their English or French language skills were quite limited (Clark, 2018;O'Mahony & Donnelly, 2007b). The availability of a translator becomes an important resource, but Brisset et al. (2014) argues that is dependent on who exactly the individual is (Brisset et al., 2014). For many women within the studies, generally their partner or child translate for them, but this has mixed results as sometimes they could not convey to the health care or MHCS provider an accurate description (Brisset et al., 2014;Clark, 2018;Donnelly et al., 2011). ...
... This was predominately in the context of newly arrived migrants, as their English or French language skills were quite limited (Clark, 2018;O'Mahony & Donnelly, 2007b). The availability of a translator becomes an important resource, but Brisset et al. (2014) argues that is dependent on who exactly the individual is (Brisset et al., 2014). For many women within the studies, generally their partner or child translate for them, but this has mixed results as sometimes they could not convey to the health care or MHCS provider an accurate description (Brisset et al., 2014;Clark, 2018;Donnelly et al., 2011). ...
... The availability of a translator becomes an important resource, but Brisset et al. (2014) argues that is dependent on who exactly the individual is (Brisset et al., 2014). For many women within the studies, generally their partner or child translate for them, but this has mixed results as sometimes they could not convey to the health care or MHCS provider an accurate description (Brisset et al., 2014;Clark, 2018;Donnelly et al., 2011). However, through a study conducted by Brisset et al. (2014), translators who were trained professionals specifically within the medical context were an asset for both provider and patient. ...
There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: “what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19–32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.
... Language barriers can affect each of these areas, right from initial service access involving telephone systems, answering machines, intake forms, and screening protocol (Bowen, 2001). Differences in access based on language and culture are perhaps even better observed in countries with universal health care like Canada, where socioeconomic status is much less of a variable than in countries with private health care, such as the United States (Brisset et al., 2013). ...
... Further, in a study by Brisset et al. (2013), primary care mental health practitioners in Montreal reported that accessing Allophone clients' emotions and show empathy toward them by way of an interpreter was very challenging. Using interpreters as a solution introduces a series of other concerns including the interpreter's knowledge of the mental health field, the interpreter's ability to accurately convey empathy while maintaining neutrality and their ability to translate sociocultural information (Brisset et al., 2013). ...
... Further, in a study by Brisset et al. (2013), primary care mental health practitioners in Montreal reported that accessing Allophone clients' emotions and show empathy toward them by way of an interpreter was very challenging. Using interpreters as a solution introduces a series of other concerns including the interpreter's knowledge of the mental health field, the interpreter's ability to accurately convey empathy while maintaining neutrality and their ability to translate sociocultural information (Brisset et al., 2013). Common reported problems related to interpreting are omission, addition, condensation, substitution, normalization and alteration, as "the ability to speak the language does not necessarily imply having the skills to convey the exact sameness of meaning," (Arafat, 2015, p. 72) thereby leaving room for inappropriate intervention. ...
In 2019, Statistics Canada reported that the death by suicide rate among Inuit in Canada was approximately nine times higher than that of their non-Indigenous counterparts. This alarming statistic reflects the ongoing impact of colonial legacy on Inuit society, which has been characterized as cultural genocide and linguicide (TRC, 2015). In the last two decades, various organizations have taken up efforts to help heal communities, however there is little research examining what makes those efforts effective, and virtually none that has addressed the place of language within mental health programming. Yet, language is a pillar of Inuit health and wellness (ITK, 2016). This thesis explores institutional language policies pertaining to the provision of mental health services to Inuit in Nunavut from a decolonial perspective. I conduct a document review and six semi-structured interviews to examine which government-funded mental health programs provide services in the Inuit Language, the challenges they face in doing so, and solutions that they may envision.
... Due to the lack of interpreters, it can be hard to find someone that can take up the role and fulfil it properly. According to Brisset et al (2013), although interpreters may seem like a necessity, most of them were provided minimal training. Therefore, clients often voiced their concerns about having their confidentiality broken and having the interpreters' beliefs and values being imposed on them during their conversation with counsellors (Brisset et al., 2013;Boor & White, 2019). ...
... According to Brisset et al (2013), although interpreters may seem like a necessity, most of them were provided minimal training. Therefore, clients often voiced their concerns about having their confidentiality broken and having the interpreters' beliefs and values being imposed on them during their conversation with counsellors (Brisset et al., 2013;Boor & White, 2019). This is because most often than not, the process of evaluating the interpreter-client fit was ignored (Salami et al., 2019). ...
... Another concern was the lack of funding to hire full-time positions of interpreters (Brisset et al., 2013). These translational services were rarely available, especially for those who have rare spoken languages and dialects (van der Boor & White, 2019). ...
... Brisset et al., 2014;Pottie et al., 2008;Salam et al., 2022) and may have dramatic repercussions for those who need access to public health care delivery, like more coercive measures throughout hospitalization (Miteva et al., 2022) and leading to isolation, misunderstanding, and stigma. Patients facing language barriers are more likely to report conflicts and misunderstandings and are more at risk of medical errors and wrong diagnoses (Crosby, 2013). ...
... In this sense, conflicts about the interpreter's role can also arise even if interpreters are trained, leading to the dynamic Schouten (2017) describes. Practitioners should be trained to work with interpreters, to become aware of interpreters' complex impact on the clinical encounter (Leanza, 2008), the differences in communication dynamics (Brisset et al., 2014), and the modifications entailed for the clinical encounter (Rosenberg et al., 2007). Such training would offer interactive training or practiced-based interventions (Davis et al., 1995(Davis et al., , 1999 that allow practitioners to experiment collaborating with interpreters through a more reflexive and hands-on approach (Atger et al., 2020;Larchanché & Rostirolla, 2020). ...
Language barriers are among the most critical factors in health care disparities. Low language proficiency is consistently associated with a high prevalence and severity of mental health disorder symptoms. Despite the advantages of working with an interpreter, most practitioners report difficulties, especially with trust and the feeling of control. The main objective of this exploratory qualitative intervention research is to examine the impact of training when working with interpreters and their inclusion in follow-ups. This impact is evaluated in the changes in feelings of control and trust for the practitioners who received the training, for the trained interpreters included in follow-ups and for the patients of these follow-ups. Semistructured interviews were conducted with individuals involved in five follow-ups at four public mental health clinics in Paris, France. The project had two phases: before (N = 18) and a few months after (N = 12) the training. Interviews were transcribed and thematically analyzed. Before the training, practitioners perceived the potential for collaboration with interpreters and the complexity of triadic consultations. Interpreters expressed irritation and disappointment at the lack of recognition, and patients seemed confident because they had already built a relationship with practitioners. After the training and inclusion of interpreters, trust is better established between interpreters and practitioners, which has substantial effects. All the protagonists state that trust positively impacts the relationship with patients and the therapeutic process. Although some practitioners still doubt the sessions’ control, the intervention helps them to gain knowledge and critically examines their clinical modus operandi.
... As communication is essential for the doctor-patient relationship, low language proficiency may lead to sub-optimal diagnosis and therapy; moreover, it obstructs access to medical care [5][6][7][8]. With globalisation leading to increasing linguistic and cultural diversity, people who do not speak the local language pose a considerable challenge for the health system, particularly in mental health [6]. ...
... As communication is essential for the doctor-patient relationship, low language proficiency may lead to sub-optimal diagnosis and therapy; moreover, it obstructs access to medical care [5][6][7][8]. With globalisation leading to increasing linguistic and cultural diversity, people who do not speak the local language pose a considerable challenge for the health system, particularly in mental health [6]. In psychiatry, language, speech and narrative are the main diagnostic and therapeutic tools. ...
Background
Mastery of a language is bound to place of origin; low language proficiency is thus related to migration and cultural differences, all of which influence access to mental health care, treatment and outcomes. Switzerland, being multilingual, allows the disentangling of language proficiency from migration and, to some extent, culture. This study uses propensity score matching to explore how language proficiency relates to help-seeking behaviour, service use, treatment and outcomes in patients with mental health disorders.
Methods
We used the first admission of patients admitted to and discharged from an academic psychiatric hospital in Switzerland between January 1st, 2013 and December 31st, 2019, with an observation period of one-year post-discharge. We paired 2101 patients with low language proficiency to 2101 language proficient patients, balancing baseline sociodemographic and clinical characteristics using propensity score matching.
Results
Patients with low language proficiency had a higher probability of compulsory admission (OR: 1.79, 99%CI: 1.60–2.02); which remaind after adjustment for confounders (OR: 1.51; 99%CI: 1.21–1.89). Whilst in treatment they had higher rates of compulsory medication (OR: 1.73, 99%CI: 1.16–2.59) and seclusion/restraint (OR: 1.87, 99%CI: 1.25–2.79). Furthermore, patients initially admitted voluntarily had a higher probability of being compulsorily retained (OR: 1.74, 99%CI: 1.24–2.46). Both groups showed similar clinical improvement rates and service use parameters.
Conclusions
Our results demonstrate that low language proficiency constitutes a risk factor for coercive treatment throughout hospitalisation. The results demonstrate the need for an increase in language sensitivity in psychiatric care.
... Additionally, translation and interpretation can support newcomers in navigating Canadian systems. For example, in a health and mental health context, the presence of a translator can reduce misdiagnosis and improve treatment outcomes [75]. Immigrant-serving organizations should refrain from over-prioritizing some services (particularly employment) at the expense of service provision that is more holistic, strategic, sustainable, and therefore more effective. ...
The local context of social services plays a crucial role in the transition and integration of newcomers in new places of settlement. This paper presents a summary of findings from an environmental scan that sought to examine the organizational and service landscape within the immigrant-serving sector, focusing on Calgary, Alberta as the site of study. As findings, we conceptualize Calgary’s immigrant-serving sector via a core-periphery model, whereby a small set of core organizations and service areas are prioritized, rather than more interconnections and diversity. Our preliminary empirical findings point to the sector’s strengths, but also the potential for accessing resources and collaborations that are still untapped. As an exploratory method and first step in a larger practice-based project, this environmental e-scan aims to provide an initial, approximate analysis to then prompt and raise questions for deeper empirical research and applications to practice in the future.
... However, a growing number of studies report effects of language barriers in healthcare context, such as concerns around the quality and security of care, poorer health outcomes and deepening healthcare disparity [2][3][4]. Institutional constraints and lack of training of healthcare professionals are significant challenges for overcoming language barriers in health care [5,6]. Some interventions were implemented in order to equip health professionals -especially medical doctors -with cultural competencies during their curricula, or to raise their use of interpreter services [7,8], with sometimes limited effects [9]. ...
Aims
This paper aims to shed light on routine communication practices between all types of hospital workers– medical, administrative and psycho-social -, and patients using a language other than French.
Methods
A cross-sectional survey was conducted at a University Hospital, located in a Parisian suburb, where the proportion of immigrants is high. The survey targeted any type of hospital employee, provided that the employee was in contact with patients. The survey items included: routine communication practices with patients using a language other than French; perceived quality of communication; issues experienced when communicating with non-French speaking patients; main languages raising communications difficulties; ways to improve communication with patients using a language other that French. Descriptive and bivariate analysis were conducted with R software. Survey findings were cross-analyzed with 2-year records of professional interpreter services at the University hospital.
Results
A total of 362 participants responded in June 2022 to the online survey, of which 353 had no missing value. All types of hospital staff were represented, the majority being paramedics and medical doctors. “The use of a professional interpreter” was ranked as third most used practice, behind “getting by” and “use of an accompanying adult”. South Asian languages were those fueling the most important communication issues. Medical doctors and psychologists had significantly more access to professional interpreters, whereas paramedics and administrative staff made more use of application software. Several negative consequences on everyday care, significantly impacting its perceived quality, were raised.
Conclusions
Our findings showed the importance of alleviating communication difficulties with patients using a language other than French, in order to achieve health equity, and means to achieve this are discussed.
... Hsieh, E has the most articles in the field, and the research orientation is relatively concentrated, mainly from the perspective of the medical environment, including how the interpreter understands of the role, doctor and interpreter interaction, patient and interpreter interaction, interpreter as a co-diagnoser, etc. [21][22][23][24][25] The second most productive author is Brisset, C. In the study of the role of the interpreter, there is a review on the medical interpreter, and most of the papers are related to the role of the interpreter in the psychiatric diagnosis environment. [9,28,27] Angelelli, C is a well-known scholar in interpretation research, who has great achievements in the field of research on interpretation. In the field of interpretation role, she mainly focuses on community interpretation and medical interpreter. ...
Interpreters play important roles in international communication, and the international research on interpreter’s role has a history of over 50 years. This study use Citespace tool to analyse the data of Web of Science from 2000 to 2022 in order to understand the status quo and trend of research. It is found that such research saw a general trend of increase in fluctuation and there seems to be lack of cooperative research with much room for future cooperation between different research institutions. Current research can be categorized into conference interpreting, medical interpreting, court interpreting, prison interpreting, community interpreting, sign language interpreting, telephone interpreting, etc. It can also be classified into professional and non-professional interpreting, self-perspective and others ’ perspective, interpreting practice, interpreting quality, interpreting history, professional and inter professional education, etc. Future research could further the traditional domains and integrate the research with other domains of interpreting studies and that of other sectors. It could be further combined with sociological theories, adopt more diversified research methods, take a broader view in terms of interpreter’s working environment, and combine more closely with technology.
... The participants in our study expressed concerns and difficulty in expressing their emotions in English, feeling that some concepts and descriptions could only be explained well in their native language. Previous healthcare research has demonstrated that language barriers between patients and practitioners are one of the most critical issues in healthcare disparities (Brandenberger et al., 2019;Brisset et al., 2014;Salam et al., 2022). Language is the central medium for building an alliance, conducting assessment, gaining access and understanding of an individual's experiences, emotions, and memories, and participating in therapeutic interventions (Leanza et al., 2024). ...
Past research has indicated the factors that prevented Asians/Asian Americans from seeking mental health services. However, few studies examined their experiences in receiving mental health services. This study utilized a convenience sample with a non-identifying online survey. As part of the larger survey, this analysis concentrated on addressing two open-ended questions that inquired about the obstacles and challenges that the participants encountered while receiving therapy and the strategies they employed to overcome these challenges. Using qualitative methods to analyze the data, four themes emerged to describe the obstacles Asian/Asian American clients experience in mental health services, including a lack of trust in therapy and therapists, lack of cultural understanding by therapists, language barrier, and challenges related to access and resources. Results are discussed along with best practices and clinical implications for therapists working with Asian/Asian American individuals, couples, and families.
... Specifcally, as with the inequal distribution of various health-related resources [11][12][13][14], individuals living in diferent places can have varying degrees of ease in reaching locations of the primary healthcare providers [15][16][17]. In terms of the sociodemographic factor, immigrant population, who do not speak the ofcial/dominant language, cannot make good use of the healthcare service due to the inability to communicate with the doctors [18][19][20]. Even when immigrants speak the ofcial/dominant language, they may still prefer family doctors capable of speaking their mother tongues because of cultural familiarity and preference [21][22][23]. ...
Family doctors serve as the initial contact for individuals seeking regular medical service like routine physical exam, diagnosis, and treatment of illness. Nonetheless, immigrant population who do not speak the official language usually prefers receiving healthcare in their own mother tongues. Past studies have focused on exploring accessibility to family doctors speaking Mandarin Chinese, which is not mutually intelligible with another major Chinese language called Cantonese. Despite the significant number of Cantonese-speaking population in the Greater Toronto Area (GTA) and a recent wave of immigration from Hong Kong, China (hereafter “Hong Kong”) to Canada, little knowledge has been obtained regarding the geographic accessibility to Cantonese-speaking family doctors. This study seeks to fill the knowledge gap of spatial accessibility to Cantonese-speaking family doctors in the GTA by using the two-step floating catchment area (2SFCA) method. By considering the vulnerability in terms of spatial accessibility and attractiveness to the new immigrants from Hong Kong, we have unveiled that more than 90% of neighbourhoods, with below-median accessibility scores across all five thresholds yet high likelihood of attracting new Hong Kong immigrants, are clustered within four lower-tier municipalities of Markham, Toronto, Richmond Hill, and Vaughan. This study not only sheds lights on the knowledge gap but also provides timely guidance in formulating public health policies in light of the incoming Cantonese-speaking immigrants from Hong Kong.
... Language barriers affect access to healthcare services and the outcome, as many migrants are unable to communicate in the official language of the host country [35]. To overcome this, migrants are often in difficult situations, having to revert to relatives to provide informal interpretation during patient encounters [36,37]. ...
Background
Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population.
Methods
Adhering to a qualitative research paradigm, the study centers on stakeholders’ perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach.
Results
The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants.
Conclusions
This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers’ capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.
... This trend suggests that language barriers at the individual or family level may be an additional barrier to receiving a psychiatric diagnosis for minority ethnic children. 51 Another potential mechanism behind these trends is differences in the way that psychiatric traits within minority youth are interpreted by family members, teachers, guidance counsellors, health-care professionals and youth themselves, all of whom play key roles in the recognition of psychiatric disorders. Mental health-care provider racial bias has also been demonstrated as a contributing factor in the misdiagnosis of ethnic and racial youth. ...
Objective
Racial/ethnic disparities in the prevalence of psychiatric disorders have been reported, but have not accounted for the prevalence of the traits that underlie these disorders. Examining rates of diagnoses in relation to traits may yield a clearer understanding of the degree to which racial/ethnic minority youth in Canada differ in their access to care. We sought to examine differences in self/parent-reported rates of diagnoses for obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders after adjusting for differences in trait levels between youth from three racial/ethnic groups: White, South Asian and East Asian.
Method
We collected parent or self-reported ratings of OCD, ADHD and anxiety traits and diagnoses for 6- to 17-year-olds from a Canadian general population sample (Spit for Science). We examined racial/ethnic differences in trait levels and the odds of reporting a diagnosis using mixed-effects linear models and logistic regression models.
Results
East Asian ( N = 1301) and South Asian ( N = 730) youth reported significantly higher levels of OCD and anxiety traits than White youth ( N = 6896). East Asian and South Asian youth had significantly lower odds of reporting a diagnosis for OCD (odds ratio [ OR] East Asian = 0.08 [0.02, 0.41]; OR South Asian = 0.05 [0.00, 0.81]), ADHD ( OR East Asian = 0.27 [0.16, 0.45]; OR South Asian = 0.09 [0.03, 0.30]) and anxiety ( OR East Asian = 0.21 [0.11, 0.39]; OR South Asian = 0.12 [0.05, 0.32]) than White youth after accounting for psychiatric trait levels.
Conclusions
These results suggest a discrepancy between trait levels of OCD, ADHD and anxiety and rates of diagnoses for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse youth to access mental health care. Efforts to understand and mitigate these barriers in Canada are needed.
... of aging and the large number of older adults suffering from mental illness, including depression, anxiety, and mood disorders (Brisset et al., 2014). MH disorders of older adults are more prevalent in developing or underdeveloped countries and regions, sharing higher morbidity and mortality, and posing multilevel and multifactorial social burden (Gureje, 2020). ...
Background
Mental health, conceptualized as psychological status that includes rational cognition, emotional stability, and interpersonal harmony, is highly relevant to the expected health and well-being of all humans. China is facing the dual risk of increased aging and mental health disorders in older adults, while the established studies have rarely focused on the influence of dialect on the mental health of Chinese older adults. The present study aims to capture the relationship between dialect and mental health in Chinese older adults.
Methods
We use cross-sectional data from the nationally representative China Family Panel Studies, which encompasses the dialect use, mental health, and other socioeconomic features of 4,420 respondents. We construct a moderated mediation model that uses dialects and mental health as the independent and dependent variables and income inequality and subjective well-being as the mediator and moderator to reveal the relationship between dialect and mental health in Chinese older adults.
Results
(1) Dialects are shown to have a negative influence on the mental health of older adults in the current study (coefficient = −0.354, 95% CI = [−0.608, −0.097]). (2) Income inequality positively mediates the correlation between dialects and mental health (coefficient = 0.019, 95% CI = [0.010, 0.045]). (3) Subjective well-being negatively moderates the potential mechanism between dialects and mental health (coefficient = −0.126, 95% CI = [−0.284, −0.010]).
Conclusion
The use of dialects is associated with worse mental health outcomes in Chinese older adults, while this negative influence is positively mediated by income inequality and negatively moderated by subjective well-being, simultaneously. This study contributes to the knowledge enrichment of government workers, older adults with mental disorders, medical staff, and other stakeholders.
... This burden falls disproportionately on racialized Canadians as it is racialized students who gravitate to the PsyD programs given the barriers that keep them from entering Ph.D. programs (Faber et al., in press). As such, this type of policy is an example of weaponization because it disproportionately denies diverse mental health professionals to visible minority Canadians suffering from mental health issues as 85% of current providers in Canada are White (Brisset et al., 2014;Thomson et al., 2015). Notably, Francophones reported fewer barriers as compared to Anglophones, and this may be due in part to Quebec producing more accredited PsyDs through their university programs (CPA, 2018). ...
... For example, we know that even with the growing population, Latine individuals encounter a shortage of Spanish-speaking behavioral health providers (Pro et al., 2022;Haag, 2000). Language barriers in patient-physician communication are one of the most important contributors to health disparities (Brisset et al., 2014). Similarly, English language proficiency is associated with delayed treatment and lower adherence to treatment among Asian populations (Jang & Kim;2019 ;Li et al., 2013;Gilmer et al., 2009;Chiang et al., 2005) and a lack of knowledge about psychosis can delay treatment (Li et al., 2013). ...
The population of persons of color (POC) are increasing in the United States. Unfortunately, POC are significantly impacted by serious mental illness; psychosis represents a mental health disparity among POC. Fortunately, first episode coordinated specialty care (CSC) is an effective treatment for individuals who are in the early phases of a psychotic disorder. This systematic review of the literature examined POC inclusion rates in randomized controlled trials (RCT) examining First Episode Psychosis (FEP) programs. Our review yielded seven articles that met inclusion criteria. Our findings were mixed-researchers conducting RCTs on FEP programs did an excellent job including African American participants suggesting that findings from RCTs on FEP programs may generalize to African American participants. Regarding Latines, they were broadly underrepresented in RCTs on FEP CSC. Based on the data, we cannot definitively conclude to what extent findings from RCTs on FEP CSC generalize to Latines although results from studies that included a reasonable number of Latines offer promising results. Asians were overrepresented in three of the seven studies included in this review; thus it seems that the findings from RCTs on FEP CSC generalize to the Asian population in the United States.
... Recommandations consultées Patients et leurs proches Bouchard, 2013 ;Bouchard, Beaulieu et al., 2012 ;Farmanova et al., 2018. Considérant que les professionnels de la santé représentent le premier point de contact des patients issus des CLOSM avec le système de la santé, il est recommandé aux professionnels de la santé de : Bouchard, 2011Bouchard, , 2013Bouchard, Chomienne et al., 2012 ;Brisset et al., 2014 ;de Moissac et Bowen, 2017Drolet et al., 2014 ;Drouin et Jean, 2002 ;Drouin et Rivet, 2003 ;Hien et Lafontant, 2013 ;Kalay et al., 2013 ;Lacaze-Masmonteil et al., 2013 ;Ngwakongnwi, Hemmelgarn, Musto, King-Shier et al., 2012. M. Muray, G. Peguero-Rodriguez, E Scarlett, A. Perron, J. Chartrand • L'accès 1. Renforcer l'importance de l'offre active auprès des Canadiens (campagnes, vulgarisation des politiques, utilisation des médias sociaux) ; 2. Évaluer la rigueur des politiques linguistiques, ainsi que leur efficacité et leur effet sur la santé des CLOSM ; 3. Appuyer l'identification et la désignation des établissements de santé qui sont en mesure de servir les CLOSM dans la langue minoritaire ; 4. Soutenir la prestation et le développement de services offerts de diverses façons aux CLOSM (en personne, par téléphone, par télémédecine, en ligne et en format hybride) ; 5. Encourager les centres de santé communautaires à offrir des programmes intégrés de soins primaires dans la langue minoritaire, tant dans les centres urbains que dans les régions éloignées où il y a moins de services ; 6. Prévoir des campagnes de sensibilisation s'adressant à la population canadienne afin de faire connaître les enjeux qui touchent les droits linguistiques des CLOSM et les enjeux qui s'y rattachent ; 7. Encourager le réseautage des minorités linguistiques; 8. Faciliter la mise en oeuvre de services d'accompagnement ainsi que des centres de santé primaire intégrés pour les CLOSM ; 9. Promouvoir l'ajout de la préférence linguistique des Canadiens sur les cartes santé à l'échelle nationale ; 10. Appuyer la recherche sur la santé des CLOSM en y consacrant un financement spécial. ...
... Similarly, limited language proficiency may result in acculturative stress (Fritz et al., 2008;Shadowen and Terplan, 2019). Because limited language proficiency affects international students' effective communication, they may not seek help (Prieto-Welch, 2016), resulting in further mental health problems (Kirmayer et al., 2011;Brisset et al., 2014). ...
This study examines depressive symptoms faced by non-native international medical students studying in China during the COVID-19 pandemic. The targeted population for this cross-sectional study included non-native medical students studying in Chinese universities. This study used convenience sampling. An online, self-administered questionnaire was distributed to international medical students studying in Chinese universities from February 2020 to June 2021. The questionnaire collected demographic data, information regarding struggles faced, and used the CES-D-10 Likert scale to assess both the challenges and depression symptoms, respectively. By analyzing the 1,207 students’ responses, the study found that students with poor Chinese language were two times more likely to suffer from depressive symptoms (OR = 2.67; value of p 0.00). Moreover, female students were found more prone (76.35%) than their male counterparts (44.96%). The study found that food adaptability, health issues, accommodation issues, and financial issues were related factors contributing to depressive symptoms among non-native international medical students during the COVID-19 pandemic. The study tried to highlight the factors that resulted in depressive symptoms among non-native international medical students, and the findings may help diplomatic representatives take necessary actions to help their citizens during this difficult time.
... This trend suggests that language barriers at the individual or family level may be an additional barrier to receiving a mental health diagnosis for minority ethnic children. 49 Another potential mechanism behind these trends is differences in the way that mental health traits within minority youth are interpreted by family members, teachers, health care professionals and youth themselves, all of whom play key roles in the recognition of mental health disorders. Mental health care provider racial bias has also been demonstrated as a contributing factor in the misdiagnosis of ethnic and racial youth. ...
Abstract
Background
Existing literature on ethnic and racial disparities in youth mental health is largely based in the US and focuses on the prevalence of mental health diagnoses rather than the underlying prevalence of mental health traits. It is critical to examine rates of mental health diagnoses in relation to the prevalence of mental health traits to examine whether youth from different ethnic/racial groups in Canada differ in their levels of mental health symptoms and access to mental health care.
Objective
We examined ethnic and racial differences in self/parent-reported trait levels and rates of diagnoses and treatment for Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), and anxiety disorders between youth from Canada’s three largest ethnic/racial groups: White, South Asian, and East Asian.We also sought to examine whether neighborhood-level socioeconomic indicators mediated any associations between race and ethnicity , trait levels and rates of diagnoses/treatment.
Methods
We collected ratings of youth behavior and ratings of community mental health diagnoses by parent or self-report from a local science center. We examined trait level differences between ethnic/racial groups using mixed-effects linear models. We calculated the probabilities of reporting a community diagnosis and treatment for each mental disorder examined after adjusting for corresponding self/parent reported trait levels for each ethnic/racial group examined using multivariable logistic regression models. Subgroup analyses examined the effects of socioeconomic indicators such as residential instability, material deprivation, dependency, and ethnic concentration.
Results
East Asian (N = 1283) and South Asian (N = 720) youth reported significantly higher levels of anxiety and OCD traits than White youth (N = 5628), but had significantly lower rates of community diagnosis/treatment for OCD (Odds Ratio (OR) East Asian = 0.08 [0.02 , 0.41] ; OR South Asian = 0.05 [0.00, 0.81]), ADHD (OR East Asian = 0.27 [0.16, 0.45]; OR South Asian = 0.09 [0.03, 0.30] ), and Anxiety (OR East Asian = 0.21 [0.11, 0.39]; OR South Asian = 0.12 [0.05, 0.32]).
Conclusions
These results suggest a discrepancy between reported symptoms of OCD, ADHD and anxiety and rates of receiving treatment and/or diagnoses for the same conditions for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse young people to accessing mental health care in Canada. Efforts to further understand and mitigate barriers to mental health care for ethnic youth are critically needed.
... These minority-language speakers often face barriers to access or utilization of healthcare services (3). This is true regardless of whether they are speakers of an official minority language or a non-official minority language (4,5). A key barrier encountered by minority language speakers is discordance between them and their healthcare practitioner's preferred or known language, which in turn can lead to communication breakdowns that can have important consequences for patients' health and well-being (6). ...
Introduction
Minority-language speakers in the general population face barriers to accessing healthcare services. This scoping review aims to examine the barriers to healthcare access for minority-language speakers who have a neurodevelopmental disorder. Our goal is to inform healthcare practitioners and policy makers thus improving healthcare services for this population.
Inclusion criteria
Information was collected from studies whose participants include individuals with a neurodevelopmental disorder (NDD) who are minority-language speakers, their family members, and healthcare professionals who work with them. We examined access to healthcare services across both medical and para-medical services.
Method
Searches were completed using several databases. We included all types of experimental, quasi-experimental, observational and descriptive studies, as well as studies using qualitative methodologies. Evidence selection and data extraction was completed by two independent reviewers and compared. Data extraction focused on the barriers to accessing and to utilizing healthcare for minority-language speakers with NDDs. The search process and ensuing results were fully reported using a diagram from the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.
Results
Following the database search, a total of 28 articles met our final selection criteria and two articles were hand-picked based on our knowledge of the literature, for a total of 30 articles. These studies revealed that minority-language speakers with NDDs and their families experience several barriers to accessing and utilizing healthcare services. These barriers, identified at the Systems, Provider and Family Experience levels, have important consequences on children's outcomes and families' well-being.
Discussion
While our review outlined several barriers to access and utilization of healthcare services for minority-language speakers with NDDs and their families, our findings give rise to concrete solutions. These solutions have the potential to mitigate the identified barriers, including development and implementation of policies and guidelines that support minority-language speakers, practitioner training, availability of referral pathways to appropriate services, access to tools and other resources such as interpretation services, and partnership with caregivers. Further research needs to shift from describing barriers to examining the efficacy of the proposed solutions in mitigating and eliminating identified barriers, and ensuring equity in healthcare for minority-language speakers with NDDs.
... Two years after the introduction of this service, we sought to investigate how the allophone migrant patients perceive the use of this telephone-interpreting service during primary care consultations. As evidence from allophone migrant patients' perspective is missing [21,22], the insights provided could help to better integrate this service into the practice of general practitioners (GPs) and primary care practitioners. ...
Objectives
The language barrier prevents allophone migrant patients from accessing healthcare when arriving in a country, and interpreters are often needed to help them to be understood. This study aimed to understand perceptions and experiences of allophone migrant patients who used a telephone-interpreting service during primary care consultations.
Study design
A qualitative study using semi-structured interviews was undertaken between September 2019 and January 2020. Interviews were transcribed and analysed using thematic analysis framework.
Setting
Allophone migrant patients from an accommodation centre for asylum-seekers who used a telephone-interpreting service during primary care consultations with a general practitioner.
Participants
A purposive sample of allophone migrant patients (n = 10).
Results
From the semi-structured interviews, we identified three themes: (1) multi-level difficulties of being an allophone migrant in the primary care pathway (i.e., before, during, and after the consultation); (2) the key role of the interpreter in the doctor-patient relationship, participating in improving the patient’s management by establishing a climate of trust between the two; and (3) advantages and limitations of the TIS. However, even if a telephone-interpreting service is very helpful, allowing quick access to interpreters speaking the allophone patient’s native language, certain situations would require the interpreter to see the patient to better guide the doctor during the consultation.
Conclusion
Telephone-interpreting services enable improving communication and comprehension between allophone migrant patients and doctors. Nevertheless, the interpreter may sometimes need to physically see the patient to better guide the doctor. To do so, interpreting services using videoconferencing deserve wider development.
... 11 To support the accurate and accessible translation of key messages within the clinical consultation professional interpreters have been recommended to improve patient health outcomes. 12,13 However, even interpreters when taken up concerns have been reported about availability, access, confidentiality, and the accuracy of translation. 5,14 Some of these concerns with professional interpreter use could be negated through language concordant care between the healthcare provider and patient. ...
Background
Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language‐concordant care. Emerging evidence suggests language‐concordance is associated with more positive reports of patient experience. Whether this is true for refugees and asylum seekers and their expectation of markers of quality patient‐centred care (PCC) remains to be explored. This study aimed to explore the expectations around the markers of PCC and the impacts of having language‐concordant care in Australian primary healthcare.
Methods
We conducted semi‐structured individual in‐language (Arabic, Dari, and Tamil) remote interviews with 22 refugee and asylum seekers and 9 general practitioners (GPs). Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis.
Results
Community member expectations of markers of PCC are constantly evolving and adapting based on invisible and visible actions during clinical encounters. Challenges can occur in the clinical encounter when expectations are ‘unsaid’ or unarticulated by both community members and GPs due to the assumption of shared understanding with language concordant care. Expectations of what constitutes satisfactory, quality PCC are dynamic outcomes, which are influenced by prior and current experiences of healthcare.
Conclusion
This study highlights the importance of understanding that language concordant care does not always support aligned expectations of the markers of quality PCC between community members and their GP. We recommend that GPs encourage community members to provide explicit descriptions about how their prior experiences have framed their expectations of what characterizes quality PCC. In addition, GPs could develop a collaborative approach, in which they explain their own decision‐making processes in providing PCC to refugees and asylum seekers.
Patient or Public Contribution
Bilingual researchers from multicultural backgrounds and experience working with people from refugee backgrounds were consulted on study design and analysis. This study included individuals with lived experiences as refugees and asylum seekers and clinicians as participants.
... Barriers such as unawareness of interpreting resources, concerns about costs of services, complicated administrative procedures, and lack of training on working with interpreters hinder the use of trained interpreters (Brisset et al., 2014;MacFarlane et al., 2009). Barriers to access aside, training for community interpreters remains scarce and optional in Canada (Leanza et al., 2017). ...
Language barriers can harm refugees’ health, and trained interpreters are a solution to overcome these barriers in all health consultations. This study trained interpreters and integrated them in a refugee clinic. Nepali-speaking migrants were recruited and underwent 50 hours of training to serve as interpreters for recently arrived Bhutanese refugees in Quebec City. To evaluate the project, mixed data were collected. At baseline and follow-up, patients’ health (as perceived by practitioners) and satisfaction were evaluated. Interpreters and practitioners were also interviewed and took part in joint discussion workshops. Patients’ health remained stable but, interestingly, patients were slightly less satisfied at follow-up. Practitioners and interpreters described both benefits and difficulties of the program. For example, integrating interpreters within the clinical team allowed for better collaboration and mutual knowledge of cultures. Challenges included work overload, conflicts between interpreters and practitioners, and role conflicts for interpreters. Overall, the full-time integration of trained interpreters in the clinic facilitated communication and case administration. This practice could be especially beneficial for refugee clients. In future interventions, interpreter roles should be better clarified to patients and practitioners, and particular attention should be paid to selection criteria for interpreters.
... Refugees often arrive to host countries facing significant language barriers, and therefore interpreters are integral helpers in the resettlement process, including improving access to mental health services. Because the need for therapy and assessment services for refugee survivors of trauma is greater than the availability of multilingual therapists, interpreters are often employed in therapeutic contexts (Brisset et al., 2014;Morina et al., 2017). With many evidencebased therapies and mental health assessments including the disclosure of personal trauma experiences (narratives) by clients (e.g., Schlaudt et al., 2020;Thompson et al., 2018), it may be important to be aware of how interpreters are impacted by not only hearing, but directly narrating clients' trauma experiences. ...
Vicarious trauma has been studied in a myriad of professionals working with traumatized populations; however, much of the existing research does not include interpreters working in refugee mental health, who face similar experiences as other professionals working with trauma survivors. The current study investigated the experiences of Arabic-speaking interpreters working in refugee mental health. Semi-structured interviews were conducted with each interpreter and qualitative grounded theory design allowed for the exploratory analysis of refugee mental health interpreter (n = 10) experiences. A total of 10 themes emerged from the findings related to interpreting experiences, support resources, and the current socio-political impact on participants. Although all participants reported work-related emotional distress, they also described experiencing positive growth from interpreting. These findings suggest that interpreters may develop a sense of resilience, empowerment, and positive life perspective due in part to experiencing marked emotional strain from interpreting refugee trauma narratives and receiving emotional support from friends, family, and coworkers/organizations. Overall, the current study provided insight into the challenges and needs of Arabic refugee mental health interpreters.
... Even in the absence of discrimination, some minority group members such as recent migrants may experience additional obstacles (Kirmayer et al., 2011). For example, there may be linguistic barriers to effective health communication by public health officials or medical professionals (Brisset et al., 2014;Doucerain et al., 2015;Zhao et al., 2019). Unfamiliarity with how to access community resources or ongoing visa status concerns can add to the stress burden. ...
Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture–mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, transmission rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: (1) cross-society differences; (2) within-society communities and intergroup relations; and (3) individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions.
... Limited English-language proficiency may further intensify acculturative stress (Fritz et al., 2008;Prieto-Welch, 2016;Shadowen et al., 2019), as it can hinder the ability of IS to effectively communicate and seek help (Prieto-Welch, 2016), consequently leading to mental health troubles (Brisset et al., 2014;Kirmayer et al., 2011). Language barriers may also impede participation in class lectures, assignment quality, and creation of positive social connections with domestic students (Shadowen et al., 2019). ...
International students are at heightened risk of developing psychological distress, yet little research has been conducted on their mental health or support needs. This quantitative study focused on undergraduate students at two mid-sized universities in Manitoba, Canada. Online and paper surveys were completed by 932 participants, of whom 21% identified as international students. This paper, descriptive in nature, outlines the sociodemographic profiles, current mental health status, psychological characteristics, and coping strategies of international students compared to domestic students in each institution. Data show that international students are more likely to report excellent mental health, score higher on the mental health scale, and report higher life satisfaction, higher self-esteem, and more positive body image than domestic respondents. However, they are less likely to talk about their hardships. Providing culturally-adapted supports that take into consideration ethnolinguistic differences, religious practice, and mental health literacy will better meet the needs of international students on campus.
... The present study is part of a larger study in which 178 French-speaking providers in the Province of Quebec, Canada, gave their opinions via a self-report survey about their experience of interpreted consultations (see Brisset et al. 2014, for the results in Montreal), and 23 also agreed to take part in an interview. ...
The conceptual vagueness surrounding the role of the public service interpreter can hinder collaboration between interpreters and providers. Inspired by Mason’s work on interpreter positioning, the study aimed to clarify providers’ expectations of the role of the interpreter in order to strengthen interprofessional collaboration. A typological analysis was conducted based on 23 healthcare providers’ perceptions of the public service interpreter. The Typology of Healthcare Interpreter Positionings features eight positionings that reinforce the interprofessional collaboration and nine that compromise it. The result is a concrete portrait that depicts the neutrality of the public service interpreter as a powerful driver of collaboration. Providers also agree that interpreters must be able to take their place in the consultation, even if it means being assertive and modifying the discourse of the interlocutors. Navigating such situations while maintaining the provider’s trust requires interactional knowledge (soft skills), which complements technical knowledge (hard skills). The Typology represents a communication tool that both providers and interpreters can use to foster collaboration. It also represents a professionalization tool as it reiterates the importance of neutrality in the work of public service interpreters and their social positioning as professionals.
... Although there has been a large body of research addressing the task of suicidal ideation based on social media, the detection performance remains to be constrained due to the disparity between the informal language used by social media users and the concepts defined by domain experts in medical knowledge bases [19,20,21]. Moreover, methods based on domain knowledge have been successful in many fields [22,23,24]. ...
A large number of individuals are suffering from suicidal ideation in the world. There are a number of causes behind why an individual might suffer from suicidal ideation. As the most popular platform for self-expression, emotion release, and personal interaction, individuals may exhibit a number of symptoms of suicidal ideation on social media. Nevertheless, challenges from both data and knowledge aspects remain as obstacles, constraining the social media-based detection performance. Data implicitness and sparsity make it difficult to discover the inner true intentions of individuals based on their posts. Inspired by psychological studies, we build and unify a high-level suicide-oriented knowledge graph with deep neural networks for suicidal ideation detection on social media. We further design a two-layered attention mechanism to explicitly reason and establish key risk factors to individual's suicidal ideation. The performance study on microblog and Reddit shows that: 1) with the constructed personal knowledge graph, the social media-based suicidal ideation detection can achieve over 93% accuracy; and 2) among the six categories of personal factors, post, personality, and experience are the top-3 key indicators. Under these categories, posted text, stress level, stress duration, posted image, and ruminant thinking contribute to one's suicidal ideation detection.
... Limited language options in mental health care service delivery has also been identified as a key barrier to access to appropriate health care among four constituencies in Canada: First Nations and Inuit communities, newcomers (immigrants and refugees), deaf persons, and, depending on location of residence, speakers of one of Canada's two official languages, English and French (Bowen, 2001). Language barriers are especially important in mental health services, where diagnosis and treatment depend heavily on communication between patients and professionals (Brisset et al., 2014;Kirmayer et al., 2014;Pottie et al., 2011). A growing body of literature indicates consistent and significant differences in patients' understanding of their conditions and their adherence to the treatment plan when a language barrier is present (Thomson et al., 2015). ...
Purpose
In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations.
Design/methodology/approach
In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted.
Findings
Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed.
Originality/value
Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.
De nouvelles approches axées sur la cybersanté mentale l’aide à la navigation du système, les cliniques sans rendez-vous, ainsi que les approches plus traditionnelles comme les lignes d’aide et de crise cohabitent afin de promouvoir ou d’intervenir précocement en santé mentale. Comment ces interventions répondent-elles aux besoins des francophones en contexte linguistique minoritaire alors que la communication est au coeur d’une consultation réussie? Objectif : Documenter six initiatives à Terre-Neuve-et-Labrador et dans les Territoires du Nord-Ouest. Méthode : Études de cas, incluant trente-six entrevues semi-dirigées auprès des autorités sanitaires, des fournisseurs de soins et des usagers. Résultats : La gratuité, l’anonymat, la rapidité, la présence des pairs travailleurs, l’absence de jugement et des démarches simples facilitent l’accès aux programmes. Parmi les limites, l’insuffisance de services en français et l’accent sur les thérapies brèves peuvent affecter la continuité des services, notamment pour les usagers francophones. Conclusion : Malgré les efforts pour améliorer l’offre de services en santé mentale aux francophones, des lacunes subsistent. L’article présente certaines stratégies qui permettraient d’améliorer l’offre de ces services.
This study examines how linguistic minorities’ language needs are overlooked in relation to interpreter arrangement via established monolingual practices and ideologies of language barriers. It seeks to problematise the common view of interpreting as a solution to language barriers, through which to highlight the importance of accommodating the often-multilingual nature of minority languages for interpreting to ensure access equity. Drawing on one-on-one interviews with health care interpreters in Australia, the study investigates common problems with language identification in the case of Afghan speakers not proficient in English. The findings reveal that Afghan people tend to identify Dari, one of the official languages of Afghanistan, with Farsi, commonly known as the language of Iran, owing to the historical sociolinguistic dynamics of Afghanistan. The Afghan tendency is, however, not accommodated in the Australian language assessment tool for minority individuals, which exclusively focuses on English language proficiency of minority groups, leading to problems with interpreter arrangement for Afghan people. By illuminating monolingual biases in language barriers involving minority groups, the research has both theoretical and practical implications through which to reapproach language barriers for ethnic minorities from an inclusive perspective.
Background
The planning and management of health policy is directly linked to evidence‐based research. To obtain the most rigorous results in research it is important to have a representative sample. However, ethnic minorities are often not accounted for in research. Migration, equality, and diversity issues are important priorities which need to be considered by researchers. The aim of this systematic review (SR) is to explore the literature examining the experiences of minority language users in Health and Social Care Research (HSCR).
Method
A SR of the literature was conducted. SPIDER framework and Cochrane principles were utilised to conduct the review. Five databases were searched, yielding 5311 papers initially. A SR protocol was developed and published in PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020225114analysis .
Results
Following the title and abstract review by two reviewers, 74 papers were included, and a narrative account was provided. Six themes were identified: 1. Disparities in healthcare; 2. Maternal health; 3. Mental health; 4. Methodology in health research; 5. Migrant and minority healthcare; 6. Racial and ethnic gaps in healthcare. Results showed that language barriers (including language proficiency) and cultural barriers still exist in terms of recruitment, possibly effecting the validity of the results. Several papers acknowledged language barriers but did not act to reduce them.
Conclusion
Despite research highlighting cultures over the past 40 years, there is a need for this to be acknowledged and embedded in the research process. We propose that future research should include details of languages spoken so readers can understand the sample composition to be able to interpret the results in the best way, recognising the significance of culture and language. If language is not considered as a significant aspect of research, the findings of the research cannot be rigorous and therefore the validity is compromised.
The aim of this article is to illustrate the goals, process and results of the first stage of a European project: MentalHealth4All. Partners from 9 different European countries have worked together to design a multilingual validated repository targeted at third-country nationals with limited language proficiency (LLP TCNs) and healthcare providers, which contains resources to improve this population’s knowledge and understanding of how to access interlinguistic support in mental healthcare services in the main languages of the countries involved in the project. The present article provides a detailed overview of the assessment process of resources and its main results.
The aim of this article is to illustrate the goals, process and results of the first stage of a European project: MentalHealth4All. Partners from 9 different European countries have worked together to design a multilingual validated repository targeted at third-country nationals with limited language proficiency (LLP TCNs) and healthcare providers, which contains resources to improve this population’s knowledge and understanding of how to access interlinguistic support in mental healthcare services in the main languages of the countries involved in the project. The present article provides a detailed overview of the assessment process of resources and its main results.
Refugees are exposed to numerous traumatic events such as exposure to armed conflict, witnessing atrocities, and life-threatening journeys, which enhances the risk of mental disorders. Post-migration stressors in the host countries (e.g., lengthy asylum-seeking process) enhance chronic psychological disorders in refugees after resettlement. One in three refugees or asylum seekers experiences high rates of post-traumatic stress disorders, anxiety, or depression. Prevalence rates of substance abuse among refugees vary widely. Risk of developing psychotic disorders is higher for refugees than for non-refugee migrants. The prevalence of personality disorders has hardly been investigated among refugees. Studies on refugees have reported substantially higher prevalence rates of suicidal ideation compared to the general population. Intimate partner violence is rather prevalent among refugees, which is associated with increased risk of mental health problems. Refugees often experience increased rates of physical health problems as a result of a lack of access to appropriate health care.KeywordsEpidemiologyEtiologyTraumaPost-migration stressorsPrevalencePost-traumatic stress disorderAnxietyDepression
Introduction
The use of psychotropics, such as benzodiazepine receptor agonists (BzRAs), among working-age adults in Belgium has shown educational differences. However, it is unclear how work status plays a role in this relationship. Therefore, this research aims to investigate whether work status explains observed educational differences in BzRA use. In addition, considering medicalisation processes, where non-medical factors, such as work status, are increasingly associated with medical mental health care-seeking behavior, this research also aims to investigate whether work status explains observed educational differences in BzRA use, regardless of mental health status.
Methods
Data are obtained from the Belgian Health Interview Survey (BHIS). Four successive waves are covered: 2004, 2008, 2013, and 2018. The weighted data represent a sample of 18,547 Belgian respondents aged 18 to 65 years old. Poisson regression models are used to analyze the research aims. Time evolutions are plotted using marginal means postestimation.
Results
The average use of BzRAs shows a slight decline over the waves studied (2004 = 5.99, 2008 = 5.88, 2013 = 5.33, 2018 = 4.31). Educational and work status differences in BzRA use are observed, regardless of mental health status. Individuals with longer education report lower use compared to individuals with shorter education, and individuals who are unemployed, (pre-)retired, or sick or disabled report higher use compared to employed individuals. Furthermore, work status acts as a mediator, partially explaining educational differences in BzRA use, regardless of mental health status.
Discussion
Work-related uncertainty leads to increased prescribing and medication use, regardless of mental health. Medicalisation and pharmaceuticalisation processes detach social problems from their social roots and treat them as personal failures. The marginalization of the social roots of unemployment, sick leave and involuntary (pre-)retirement has led to a personalization of responsibility. Negative feelings arising from such work statuses may cause isolated, non-specific symptoms for which medical treatment is sought.
Mental health problems are one of the various ills that afflict the world’s population. Early diagnosis and medical care are public health problems addressed from various perspectives. Among the mental illnesses that most afflict the population is depression; its early diagnosis is vitally important, as it can trigger more severe illnesses, such as suicidal ideation. Due to the lack of homogeneity in current diagnostic tools, the community has focused on using AI tools for opportune diagnosis. Unfortunately, there is a lack of data that allows the use of IA tools for the Spanish language. Our work has a cross-lingual scheme to address this issue, allowing us to identify Spanish and English texts. The experiments demonstrated the methodology’s effectiveness with an F1-score of 0.95. With this methodology, we propose a method to solve a classification problem for depression tweets (or short texts) by reusing English language databases with insufficient data to generate a classification model, such as in the Spanish language. We also validated the information obtained with public data to analyze the behavior of depression in Mexico during the COVID-19 pandemic. Our results show that the use of these methodologies can serve as support, not only in the diagnosis of depression, but also in the construction of different language databases that allow the creation of more efficient diagnostic tools.
Purpose
This study examined 46 articles in total, which yielded 5 recurring themes: perceived discrimination, language barriers, socioeconomic barriers, cultural barriers and educational/knowledge barriers. The two most dominant themes found were the inability to speak the country's primary language and belonging to a culture with different practices and values from the host country. The review provides vital insights into the numerous challenges that immigrants and refugees encounter as they navigate through the primary care systems of English-speaking (E-S) countries and potential solutions to overcome these barriers.
Design/methodology/approach
Access to adequate healthcare plays a central part in ensuring the physical and mental wellbeing of society. However, vulnerable groups such as immigrants and refugees, face numerous challenges when utilizing these healthcare services. To shed further light on the barriers impacting healthcare quality, the authors’ team performed a scoping thematic review of the available literature on immigrant and refugees' experiences in primary healthcare systems across E-S countries. Articles were systematically reviewed while focusing on healthcare perceptions by immigrants, potential barriers and suggestions to improve the quality of primary care.
Findings
This work looked at qualitative and quantitative information, attempting to combine both paradigms to give a rich and robust platform with which to devise a further study through focus groups. Qualitative inquiry accounted for 28/46, or 61%, of studies, and quantitative inquiry made up 9/46, or 20%, while 9/46 or 20% combined both qualitative and qualitative. Emerging themes are -perceived ethnic discrimination faced by immigrants accessing primary care, language barriers, socioeconomic barriers, cultural barriers and educational barriers.
Research limitations/implications
Most medical journals rely on quantitative data to relate “results” and cases. The authors set out to change ways in which medical reports can be done. Most of the authors were solely trained in quantitative research; consequently, they had to learn to isolate themes and to use a narrative approach in the article.
Practical implications
Research implications clearly indicated that using a qualitative (phenomenological) approach with quantitative data created a human and reachable discourse around patient comfort and the realities of immigrants and refugees to E-S countries. The use of this research opens medical practitioners (and patients) to a richer understanding within a usually difficult arena.
Social implications
By understanding the qualitative nature of medical research, practitioners, students and mentors are able to bridge medical quantitivity to the human, widening doors to social science and medical collaboratory research.
Originality/value
As stated above, this work is important as it understands the human/patient element and de-emphasizes the medical obsession with quantifying the lives of patients through hard data. This is a unique collaboration that relies on the qualitative to pinpoint and define the difficulties of newcomers to E-S countries.
Although it has been acknowledged that public service interpreting helps reduce the language barriers faced by migrant populations, these barriers continue to be a significant cause of healthcare inequality. With the current COVID-19 pandemic, remote interpreting appears to be the most appropriate solution to address the health inequalities of migrant populations while intervening to reduce the risk of the virus spreading. The purpose of the research was to identify ways of providing a framework for the remote interpretation of public service encounters in the province of Quebec, Canada. A series of recommendations available in the literature were discussed with 27 key actors in the field during focus groups and individual conversations. A thematic analysis of participant discourse allowed us to confirm the extent to which existing recommendations were applicable, to clarify certain recommendations and to add seven new ones. The Guide to the planning and practice of remote public service interpreting (see appendices) consists of 10 recommendations on the planning and management of remote interpreting services and 25 recommendations on the actual encounter. Results show that remote interpreting does not refer solely to telecommunications technology, but also to a knowledge and skill set needed to supervise and coordinate the use of that technology in very specific practice contexts while minimizing the effect of the virtual presence and encouraging the distribution of information among key actors through clearly identified communication channels. The Guide addressed these many features.
This chapter aims to provide an interpretation of the role of the mental health interpreter, using the concept of “third space” taken from the field of cultural translation and the psychoanalytical concept of transference/counter-transference. Such interpretation provides a unique and novel analysis of the work of the mental health interpreter through the perspective of the “third space”, thus enabling a broader view of the interpreter's role in the therapeutic session. The authors' insights are based on a reflective journal written by the first author while working as an interpreter during a parental training in a public mental health clinic in Israel. By reviewing the different roles, powerplays, and challenges in this third space, the authors will suggest some practical recommendation regarding the training and supervision of mental health interpreters, allowing them to serve as competent and ethical mediators between the patient and the therapist.
Objective
To investigate the reasons for not using interpreters to secure patient-safe communication.
Methods
Healthcare personnel at six paediatric oncology centres in Sweden responded to the Communication over Language Barriers questionnaire. Descriptive and comparative analyses were performed.
Results
The participants (n = 267) often cared for patients with limited Swedish proficiency, although they were not trained in using interpreters. A lack of time was perceived as a barrier in emergency care situations, but also in planned care situations. Another barrier was the interpreter’s ability to correctly interpret medical/care terminology. There were significant differences in evaluating the interpreters’ abilities between those with/without education in using interpreters, and between Medical Doctors and Nursing Assistants. Participants were unsure whether the patient had received the correct information and that it was difficult to control the family/patient’s understanding of the given information. The majority did not perceive financial constraints as a barrier for using interpreters.
Conclusions
Economic resources and legislation are not enough to increase the use of interpreters. Reasons for not using interpreters are found in limitations of time, training, and interpreters’ skills and knowledge.
Practice Implications
There is a need for a greater focus on training, interpreters’ skills, and booking procedures in paediatric healthcare.
A large number of individuals are suffering from suicidal ideation in the world. There are a number of causes behind why an individual might suffer from suicidal ideation. As the most popular platform for self-expression, emotion release, and personal interaction, individuals may exhibit a number of symptoms of suicidal ideation on social media. Nevertheless, challenges from both data and knowledge aspects remain as obstacles, constraining the social media based detection performance. Data implicitness and sparsity make it difficult to discover the inner true intentions of individuals based on their posts. Inspired by psychological studies, we build and unify a high-level suicide-oriented knowledge graph with deep neural networks for suicidal ideation detection on social media. We further design a two-layered attention mechanism to explicitly reason and establish key risk factors to individual's suicidal ideation. The performance study shows that: 1) with the constructed personal knowledge graph, the social media based suicidal ideation detection can achieve over 93% accuracy; and 2) among the six categories of personal factors, post, personality, and experience are the top-3 key indicators. Under these categories, posted text, stress level, stress duration, posted image, and
contribute the most to one's suicidal ideation detection.
Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. Primary care providers have strategies to promote mental well-being, including focusing on resilience and social determinants of health. Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.
Interpreting in medical and especially in psychiatric and psychotherapy settings is an ethical imperative. In mental health, clinical assessment and intervention require that the interpreter have specific skills and sensitivity to work with a patient-centered approach. This chapter provides an orientation to working with mental health interpreters, with a review of relevant research literature and theoretical models followed by guidelines and practical recommendations relevant to cultural consultation. Key principles are presented on how to work with interpreters in various contexts (e.g. CBT, psychodynamic, family therapy). Case vignettes from the CCS are provided throughout the text to illustrate the main points. In cultural consultation, issues of roles, neutrality and the interpreter’s identity (age, gender, ethnicity, religion, political orientation) should be carefully considered. In addition to the individual characteristics of interpreters, it is essential that organizational efforts are made to adapt institutional policies to patients’ linguistic and cultural diversity. Institutional change depends on recognizing interpreters’ skills and contributions to clinical work and encouraging practitioners to work with trained interpreters rather than untrained or ad hoc interpreters, especially family members. Quality assurance standards must formally require the routine use of interpreters in mental health and there must be mechanisms in place to monitor and enforce these standards.
Nowadays, young women and their children are the most important migrant users of healthcare services. In particular, these people may encounter different cultural constructions of health, disease, therapy, motherhood. The observed difficulties in intercultural communication encourage healthcare systems to promote mediation. Mediation consists in the intervention of a third person, who promotes reciprocal understanding and acceptance between participants.
The research we are presenting focuses on intercultural communication which is produced in these services between healthcare personnel and migrant patients. To achieve this goal our research aims at integrating different theoretical and methodological approaches: conversation analysis, in order to observe the interaction between healthcare personnel, pointing out the cues of the participants' turn-taking sequences; analysis of the cultural presuppositions of the healthcare system as a communication system with a specific function in society, by highlighting contextualization cues, that is, cultural presuppositions that steer interaction system, which result from the wider social context, and which are cues of the cultural identities that characterize it.
I observed that in most cases the patients have very few opportunities to answer to the physicians’ questions or to pose questions or doubts. Substituting the patients as main participants in interactions, the mediator never refuses the physicians’ indications, never expresses doubts, never asks to the patients if they have some reason to doubt or refuse. In these cases interlinguistic and intercultural mediation de-emphasises the importance of the larger social context and the durability of relationships between the parties.
We evaluated clinical information gained directly from 10 English-speakingand from 10non-English-speaking subjectsboth directly and through interpreter-mediated interviews. High levels of agreement between raters, when assessingboth cohorts, were found for all data with a non-significant tendency towards better agreement in the Asian than the English-speaking sample for family history data. Analysis of the interview contents showed a number of errors of interpretation which were similar to those noted in previous studies. The addition of quantitative data representsa significantadvantage over previousstudies, allowing the qualitative results to be placed into perspective.Recommendations are made for optimising and avoiding the pitfalls of interpreter-mediated interviews. The communication needs of non English-speak ing UK populations have never been system
Increasing immigration to Quebec has brought to the surface the need for adapting its public health systems and services, particularly in the area of primary care. The challenge is to take the heterogeneous nature of the population into account and to integrate diverse values, experience and know-how into the development of programmes and delivery of services, whilst simultaneously respecting the values of the various care providers and the norms of the institutions in the host country. This article addresses the question of adaptation strategies for health services, and namely the development of prevention and heath promotion programmes in public health within the framework of primary health care services within the intercultural context of Montreal. The issue of adaptation falls within the perspective and mandate of the Quebec government’s policy on health and well-being (La politique de santé et du bien-être, 1992). Furthermore, it is a response to frequent demands from various health professionals and groups concerned with the adaptation of public services with respect to intercultural relationships confronted with the emerging realities associated with immigration. The article provides a reflection on specific ways of adapting prevention and health promotion initiatives targeting cultural communities and those who are undergoing immigration procedures or transitions. It also examines the development of ethno-cultural or other indicators which make it possible to capture migration experiences and their health impact. Since the Quebec health and social services system is currently in the process of major reform, it is hoped that it will seize this opportunity in order to make health and social service centres accountable for the adaptation of their programmes and services to the diversity of the populations they serve.
Physician-patient discourse, even same-language discourse, may be viewed as a type of crosscultural interaction. Inside the US, there is a large and increasing number of adult Third World immigrant patients who do not speak English. For these patients the ‘‘cross-cultural’’ aspect of First World medical practice is underscored by the presence of the medical interpreter, who is herself faced with the task of negotiating both the content of utterances and also the cultural contexts from and into which these utterances are conveyed. Analysis shows that, through variable patterns of how and when utterances are interpreted, the interpreter functions, not as an ‘‘ally’’ of the patient nor as a neutral conveyer of propositions, but rather as a covert co-diagnostician and institutional gatekeeper. As one result, these patients are often seen as ‘‘passive’’ and ‘‘non-compliant’’ by physicians, with consequences for how care is delivered and for their treatment by the institutional State. [interpreting, discourse analysis, medical discourse, cross-cultural discourse]
This article explores the experiences of people who need interpreters to gain access to and use of a range of services, drawing on semi-structured interviews with people from Chinese, Kurdish, Bangladeshi, Indian and Polish minority ethnic groups living in Manchester and London, UK. We describe our research methodology, and place the study in its political and community context. We look at the qualities the people we interviewed considered made for a good interpreter, and their experiences using both professional interpreters, and family and friends as interpreters. We show how personal character and trust are important in people's understandings of good interpreting, leading them to prefer interpreters drawn from their own informal networks. We consider the implications of this for policy and practice.
This paper is an attempt at defining more clearly the various roles of community interpreters and the processes implicitly connected with each of them. While the role of the interpreter is a subject that has been widely discussed in the social science literature, it is less present in the biomedical one, which tends to emphasize the importance of interpreting in overcoming language barriers, rather than as a means of building bridges between patients and physicians. Hence, studies looking at interpreted medical interactions suggest that the presence of an interpreter is more beneficial to the healthcare providers than to the patient. This statement is illustrated by the results of a recent study in a pediatric outpatient clinic in Switzerland. It is suggested that, in the consultations, interpreters act mainly as linguistic agents and health system agents and rarely as community agents. This is consistent with the pediatricians' view of the interpreter as mainly a translating machine. A new typology of the varying roles of the interpreter is proposed, outlining the relation to cultural differences maintained therein. Some recommendations for the training of interpreters and healthcare providers are suggested.
The political and social transformations taking place in South Africa have given rise to a mood of optimism regarding the speed and extent of the changes that are possible in a short space of time. In the context of limited language resources for the delivery of health care, the role of the interpreter has particular currency. However, interpreters' multiple roles in health care contexts have been extensively and, at times, controversially described. These are briefly reviewed before we turn to a detailed consideration of the debate on the question of interpreter latitude. The issues raised regarding roles for interpreters are explored through the evaluation of an interpreter project at a Western Cape psychiatric hospital. We describe four themes in the talk of the service providers and the interpreters themselves that are nuanced in particular ways by high expectations and the social context. The themes of the interpreter as 'language specialist'; as 'culture specialist'; as 'patient advocate'; and as 'institutional therapist' are all explored in turn. We identify three potential areas of difficulty arising out of an uncritical acceptance of advocacy roles for South African interpreters. The question of organisational support for the advocacy role; the dynamics and micro-politics of multi-disciplinary team work, in psychiatry in particular; and the need for sub-specialisation in aspects of clinical psychology are all considered. These factors can be seen to operate at three levels in institutional contexts.
Background: Mental health professionals need to be able to work effectively with interpreters to promote good clinical practice and ensure equality of access and service delivery as well as meet the requirements of European law. The process offers practitioners an opportunity to enrich their understanding of the diverse idioms of distress, cultural constructions and explanatory health beliefs. Aims: This paper draws upon the literature and clinical accounts to provide a set of positive practice guidelines on working with interpreters in mental health. Method: Key indicator words for the literature review were “interpreters and mental health” and “language and mental health”. Papers that related purely to linguistic theory, cultural theory, or sign language interpreting were not included. To assist with triangulation of the data the authors also drew upon accounts of support and supervision groups for interpreters and bicultural workers, expert panels on the topic, training programmes and published guidelines for interpreters and clinicians. Results and Conclusions: Mental health services around the world need to be accessible, inclusive, appropriate and accord with best practice and national legislation. The paper reviews opportunities and challenges in working with interpreters in mental health services and offers some positive practice guidelines for clinicians based on the available literature. Declaration of interest: None.
Increases in immigration have led to an enormous growth in the number of cross-linguistic medical encounters taking place throughout the United States. In this article the role of hospital-based interpreters in cross-linguistic, internal medicine ‘medical interviews’ is examined. The interpreter's actions are analyzed against the historical and institutional context within which she is working, and also with an eye to the institutional goals that frame the patient-physician discourse. Interpreters are found not to be acting as ‘neutral’ machines of semantic conversion, but are rather shown to be active participants in the process of diagnosis. Since this process hinges on the evaluation of social and medical relevance of patient contributions to the discourse, the interpreter can be seen as an additional institutional gatekeeper for the recent immigrants for whom she is interpreting. Cross-linguistic medical interviews may also be viewed as a form of cross-cultural interaction; in this light, the larger political ramifications of the interpreters' actions are explored.
‘Interpreters are the most powerful people in a medical conversation.’ Head of Interpreting Services at a major private U.S. hospital, May 1999.
About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation.
To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation.
During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence.
Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media.
Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions are the most frequent type. Most errors have potential clinical consequences, and those committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters. Because errors by ad hoc interpreters are more likely to have potential clinical consequences, third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency.
Opinions vary on the generalizability of empirically supported treatments to diverse populations in naturalistic settings and on the relative merits of delivering treatments through interpreters. The authors present statistical analyses of outcome data from a community mental health program that served foreign-born refugees resettled in the U.S. The program used a manualized, empirically supported treatment, Cognitive Processing Therapy, to address symptoms of PTSD in this population. Participants received psychological treatment in native languages either with a therapist who spoke their language or with a therapist who used an interpreter. Results demonstrated that treatment of PTSD was highly effective whether delivered directly or through an interpreter.
To compare interpreter errors and their potential consequences in encounters with professional versus ad hoc versus no interpreters.
This was a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months in the 2 largest pediatric EDs in Massachusetts. Participants were Spanish-speaking limited-English-proficient patients, caregivers, and their interpreters. Outcome measures included interpreter error numbers, types, and potential consequences.
The 57 encounters included 20 with professional interpreters, 27 with ad hoc interpreters, and 10 with no interpreters; 1,884 interpreter errors were noted, and 18% had potential clinical consequences. The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. The median errors by professional interpreters with greater than or equal to 100 hours of training was significantly lower, at 12, versus 33 for those with fewer than 100 hours of training. Those with greater than or equal to 100 hours of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) and in every error category.
Professional interpreters result in a significantly lower likelihood of errors of potential consequence than ad hoc and no interpreters. Among professional interpreters, hours of previous training, but not years of experience, are associated with error numbers, types, and consequences. These findings suggest that requiring at least 100 hours of training for interpreters might have a major impact on reducing interpreter errors and their consequences in health care while improving quality and patient safety.
Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care.
The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO). A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis.
Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services.
Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.
Due to international migration, health care professionals in Switzerland increasingly encounter language barriers in communication with their patients. In order to examine health professionals' attitudes and practices related to healthcare interpreting, we sent a self-administered questionnaire to heads of medical and nursing departments in public healthcare services in the canton of Basel-Stadt (N = 205, response rate 56%). Strategies used to communicate with foreign-language speaking patients differed, depending on the patient's language. While nearly half of respondents relied on patients' relatives to translate for Albanian, Tamil, Bosnian, Croatian, Serbian, Portuguese and Turkish, a third did so for Spanish, and a fourth did so for Arabic. Eleven percent relied on professional interpreters for Spanish and 31% did so for Tamil and Arabic. Variations in strategies used appear to mainly reflect the availability of bilingual staff members for the different languages. Future efforts should focus on sensitizing health professionals to the problems associated with use of ad hoc interpreters, as well as facilitating access to professional interpreters.
This literature review examined the effects of patients' limited English proficiency and use of professional and ad hoc interpreters on the quality of psychiatric care.
PubMed, PsycINFO, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were systematically searched for English-language publications from inception of each database to April 2009. Reference lists were reviewed, and expert sources were consulted. Among the 321 articles identified, 26 met inclusion criteria: peer-reviewed articles reporting primary data on clinical care for psychiatric disorders among patients with limited proficiency in English or in the provider's language.
Evaluation in a patient's nonprimary language can lead to incomplete or distorted mental status assessment. Although both untrained and trained interpreters may make errors, untrained interpreters' errors may have greater clinical impact, compromising diagnostic accuracy and clinicians' detection of disordered thought or delusional content. Use of professional interpreters may improve disclosure in patient-provider communications, referral to specialty care, and patient satisfaction.
Little systematic research has addressed the impact of language proficiency or interpreter use on the quality of psychiatric care in contemporary U.S. settings. Findings are insufficient to inform evidence-based guidelines for improving quality of care among patients with limited English proficiency. Clinicians should be aware of the ways in which quality of care can be compromised when they evaluate patients in a nonprimary language or use an interpreter. Given U.S. demographic trends, future research should help guide practice and policy by addressing deficits in the evidence base.
The purpose of the research was to explore the ability of ad hoc interpreters to integrate into the organizational climate at a federally qualified community health clinic (CHC) and create satisfactory services for limited-English-proficiency clients. Survey and interview data were gathered from staff (n = 17) and Latino clients (n = 30). The data indicate that clients felt satisfied with interpreters. Some friction existed between the interpreters and the medical staff due to incongruent expectations. The CHC's organizational climate and the interpreters' commitment to the Latino community mediated the impact of these tensions on services and satisfaction. The study offers important insight into how ad hoc interpreters can become professional medical interpreters within a limited-resource service environment.
This study examines (a) providers' expectations and concerns for interpreters' emotional support, and (b) the complexity and dilemma for interpreters to offer emotional support in health care settings.
We recruited 39 providers from 5 specialties to participate in in-depth interviews or focus groups. Grounded theory was used for data analysis to identify providers' expectations and concerns for interpreters' emotional support.
From the providers' perspective, interpreters' emotional support: (a) is embodied through their physical presence, (b) is to be both a human being but also a professional, (c) represents the extension of the providers' care, and (d) imposes potential risks to quality of care.
Emotional support in bilingual health care is accomplished through the alliance of providers and interpreters, complementing each other to support patients' emotional needs.
Interpreters should be vigilant about how their emotional support may impact the provider-patient relationship and the providers' therapeutic objectives. Interpreters should be aware that providers also rely on them to provide emotional support, which highlights the importance of giving medical talk and rapport-building talk equal attention in medical encounters.
This paper is a report of a study exploring nurse radiographers' experiences of examining patients who do not speak the native language.
The increased number of immigrant patients in Western countries poses a challenge to healthcare staff, as mutual understanding is needed in encounters with patients who do not speak the language of the host country. In particular, little is known about the quality of communication in the setting of radiological examinations, i.e. short encounters with demanding technical and caring components.
Three focus group interviews with experienced nurse radiographers (n = 11) were carried out in 2007. The interviews were audiotaped and transcribed. A qualitative content analysis method was applied to analyse the interview texts.
Four main categories emerged in the analysis: modes, needs, quality and improvements of interpreting. The need for an interpreter is strongly associated with the type of examination. For interventional procedures and contrast-enhanced examinations, a professional interpreter is required to inform the patient and to identify and handle side effects and complications. Friends, relatives, particularly children, and staff as interpreters were not considered ideal as an alternative. Shortage of time and lack of specific knowledge about radiological procedures were identified as problems with professional interpreters. Interpreter training and checklists specific for radiology department routines were suggested, as well as improved nurse radiographers' education on intercultural communication.
The need for an interpreter, and the native tongue of the patient, should be clearly stated on the radiology request form, to allow timely scheduling of an interpreter. Intercultural communication in nurse radiographers' education should be enhanced.
Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.
This article reviews empirical evidence and ethical norms in cross-linguistic nursing. Empirical evidence highlights that linguistic barriers between nurses and patients can perpetuate discrimination and compromise nursing care. There are significant organizational and relational challenges involved in ensuring adequate use of interpreters by nurses. Some evidence suggests that linguistic barriers are particularly problematic for nurses when compared with physicians. A comparative analysis of nursing ethical norms for cross-linguistic nursing was conducted using the codes of ethics of the American Nurses Association, the Canadian Nurses Association, and the International Council of Nurses. Five principal ethical norms for cross-linguistic nursing were identified: (1) respect for the patient as a unique person; (2) respect for the patient’s right to self-determination; (3) respect for patient privacy and confidentiality; (4) responsibility for one’s own competence, judgment, and action; and (5) responsibility to promote action better to meet the needs of patients, families, and groups.
Use of available interpreter services by hospital clinical staff is often suboptimal, despite evidence that trained interpreters contribute to quality of care and patient safety. Examination of intra-hospital variations in attitudes and practices regarding interpreter use can contribute to identifying factors that facilitate good practice. The purpose of this study was to describe attitudes, practices and preferences regarding communication with limited French proficiency (LFP) patients, examine how these vary across professions and departments within the hospital, and identify factors associated with good practices.
A self-administered questionnaire was mailed to random samples of 700 doctors, 700 nurses and 93 social workers at the Geneva University Hospitals, Switzerland.
Seventy percent of respondents encounter LFP patients at least once a month, but this varied by department. 66% of respondents said they preferred working with ad hoc interpreters (patient's family and bilingual staff), mainly because these were easier to access. During the 6 months preceding the study, ad hoc interpreters were used at least once by 71% of respondents, and professional interpreters were used at least once by 51%. Overall, only nine percent of respondents had received any training in how and why to work with a trained interpreter. Only 23.2% of respondents said the clinical service in which they currently worked encouraged them to use professional interpreters. Respondents working in services where use of professional interpreters was encouraged were more likely to be of the opinion that the hospital should systematically provide a professional interpreter to LFP patients (40.3%) as compared with those working in a department that discouraged use of professional interpreters (15.5%) and they used professional interpreters more often during the previous 6 months.
Attitudes and practices regarding communication with LFP patients vary across professions and hospital departments. In order to foster an institution-wide culture conducive to ensuring adequate communication with LFP patients will require both the development of a hospital-wide policy and service-level activities aimed at reinforcing this policy and putting it into practice.
In this study we examined the challenges to providers’ and interpreters’ collaboration in bilingual health care. We conducted in-depth interviews and focus groups with 26 medical interpreters (speaking 17 languages) and 32 providers (from four specialties) in the United States to provide an empirically based framework of provider—interpreter trust. Constant comparative analysis was used for data analysis. We identified four dimensions of trust, theoretical constructs that can strengthen or compromise provider—interpreter trust: interpreter competence, shared goals, professional boundaries, and established patterns of collaboration. In this article we describe how these dimensions highlight tensions and challenges that are unique in provider—interpreter relationships. We conclude with practical guidelines that can enhance provider—interpreter trust, and propose future research directions in bilingual health care.
Medical interpreters provide a bridge across the language gap for patients and practitioners. Research suggests that practitioners and interpreters experience numerous difficulties in their collaboration that can negatively affect service to patients with limited English proficiency, many of whom are immigrants. Using qualitative evidence from interviews with medical interpreters, I argue that many of these difficulties result from the fact that interpreter practice is based on a theoretical understanding of communication that does not adequately describe the problems faced by interpreters in negotiating between immigrant and practitioner groups. Suggestions for a more theoretically complete practice are offered.
Objective. To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals. Setting. Six joint Commission accredited hospitals in the USA. Method. Adverse event data on English speaking patients and patients with limited English proficiency were collected from six hospitals over 7 months in 2005 and classified using the National Quality Forum endorsed Patient Safety Event Taxonomy. Results. About 49.1% of limited English proficient patient adverse events involved some physical harm whereas only 29.5% of adverse events for patients who speak English resulted in physical harm. Of those adverse events resulting in physical harm, 46.8% of the limited English proficient patient adverse events had a level of harm ranging from moderate temporary barm to death, compared with 24.4% of English speaking patient adverse events. The adverse events that occurred to limited English proficient patients were also more likely to be the result of communication errors (52.4%) than adverse events for English speaking patients (35.9%). Conclusions. Language barriers appear to increase the risks to patient safety. It is important for patients with language barriers to have ready access to competent language services. Providers need to collect reliable language data at the patient point of entry and document the language services provided during the patient-provider encounter.
This volume – the first-ever collection of research on healthcare interpreting – centers on three interrelated themes: cross-cultural communication in healthcare settings, the interactional role of persons serving as interpreters and the discourse patterns of interpreter-mediated interaction. The individual chapters, by seven innovative researchers in the area of community-based interpreting, represent a pioneering attempt to look beyond stereotypical perceptions of interpreter-mediated interactions. First published as a Special Issue of Interpreting 7:2 (2005), this volume offers insights into the impact of the interpreter – whether s/he is a trained professional or a member of the patient's family – including ways in which s/he may either facilitate or impair reliable communication between patient and healthcare provider. The five articles cover a range of settings and specialties, from general medicine to pediatrics, psychiatry and speech therapy, using languages as diverse as Arabic, Dari, Farsi, Italian and Spanish in combination with Danish, Dutch, English and French.
While practitioners working in the mental health care context are making greater use of interpreters, there remains a paucity of literature that is informed by a critiqued theoretical, clinical, empirical, and research grounding. This study employed a qualitative methodology and used Interpretative Phenomenological Analysis (IPA) to elicit an in-depth understanding of child and adolescent mental health practitioners' experiences in carrying out assessments and therapeutic work with the help of an interpreter. Participants spoke about their reliance on language, and how the process of communication lost important attributes through translation. A striking quality about this work was related to the difficulties the participants experienced in being able to establish a constructive working alliance with an interpreter. This in turn had a negative effect on being able to establish a working alliance with families. The interventions offered by practitioners tended to become simplified. Such findings lead to a closer questioning of why these difficulties occur. It is suggested that addressing structural inequalities and training issues, and incorporating good practice guidelines can go a long way toward ensuring improved clinical services for many minority ethnic service users needing the help of interpreters during mental health consultations.
Analysis of transcripts of 40 medical interviews with a doctor, an older patient, and a family caregiver led to the identification of the caregiver as interpreter, in the sense of someone who facilitates communication between the layperson and the health professional. Three communication modes of the family caregiver were derived from the data: Facilitator, Intermediary, and Direct Source. Caregivers acted both as patient substitutes and doctor substitutes in the interactions. Comparisons of the family members' modes of communication and bilingual interpreter issues of role shifting, power, and divided loyalties are discussed. Implications for future research are addressed.
This study examined the use of interpreters with patients who are speakers of African languages at a recently integrated psychiatric institution in post-apartheid South Africa. The research process itself reflected important aspects of the institutional dynamics around the issues of language and ethnicity. The impact of inadequate language resources on service provision was profound. Interpreters have a role in alleviating the difficulties described, but routine organizational strategies for managing speakers of African languages are powerful obstacles to change. Complex institutional and societal discourses to do with race, identity, community, alienation and the practice of public psychiatry constellate around the language issue. Without sufficient recognition of the centrality of language in service provision, integration and institutional transformation will be impeded.
OBJECTIVE: To identify relational issues involved in working with interpreters in healthcare settings and to make recommendations for future research. METHODS: A systematic literature search in French and English was conducted. The matrix method and a meta-ethnographic analysis were used to organize and synthesize the data. RESULTS: Three themes emerged. Interpreters'roles: Interpreters fill a wide variety of roles. Based on Habermas's concepts, these roles vary between agent of the Lifeworld and agent of the System. This diversity and oscillation are sources of both tension and relational opportunities. Difficulties: The difficulties encountered by practitioners, interpreters and patients are related to issues of trust, control and power. There is a clear need for balance between the three, and institutional recognition of interpreters' roles is crucial. Communication characteristics: Non-literal translation appears to be a prerequisite for effective and accurate communication. CONCLUSION: The recognition of community interpreting as a profession would appear to be the next step. Without this recognition, it is unlikely that communication difficulties will be resolved. PRACTICE IMPLICATIONS: The healthcare (and scientific) community must pay more attention to the complex nature of interpreted interactions. Researchers need to investigate how relational issues in interpreted interactions affect patient care and health.
Based on a broad definition of the concept of community interpreting, the paper gives an overview of the development of community-based interpreting as a profession since the 1960s. Reviewing both the field of sign language interpreting and spoken-language community interpreting in the context of migration, major elements in the process of professionalization are described with reference to selected examples. The overall picture is one of great diversity of approaches, constraints and responses to the challenge of intra-social interpreting needs throughout the world, shaped by the variable interplay of factors like the existence of legal provisions, institutional arrangements for interpreter service delivery, an authority-driven or profession-based system of accreditation or certification more or less specifying standards of practice and professional ethics, training programs within (or outside) the established public system of higher education, and a professional organization more or less inclusive of various types of interpreting activity. Typically, interpreting services 'get organized' (by institutions or community agencies) before practitioners get organized to shape their professional terms of reference, and much progress in the evolution of community interpreting is still to be made.
This article presents a focus group study on the validation of the
California Standards for Healthcare Interpreters
produced by the California Healthcare Interpreting Association (CHIA) in 2002. The reactions of healthcare interpreters to the
Standards
, and their opinions and thoughts on its provisions are reviewed and analyzed. The article first addresses the issues and problems healthcare interpreters encounter when implementing the
Standards
, and highlights the challenges they face when trying to balance their professional mandate with the reality of their working environment. In particular, it describes the difficulties of defining the interpreter’s role in the system. The final section of the article draws attention to the need for bridges between research and practice as a means of guaranteeing that the field of interpreting will continue to develop.
Ever more American mental health professionals rely on interpreters to bridge language and cultural gaps between themselves and clients who do not speak English. This study analyzes in-depth ethnographic interviews with 10 mental health professionals involved in a torture treatment and assessment center to examine how the use of interpreters affects mental health service delivery. The findings highlight the following factors that affect the clinical process: challenges to communication, accuracy of communication (both linguistic content and cultural context), changes in therapy dynamics, and the emotional reactions of interpreters to the stories told by clients. This study discusses the need to properly train interpreters and to safeguard against their exposure to vicarious trauma.
This paper examines the process of cultural mediation in end of life care of Aboriginal people in urban hospitals. It summarises interview and observational data on the experience of ten Canadians from First Nations communities who were receiving palliative care for renal cancers and other forms of end stage renal disease. Parallel interviews were conducted with members in their families, their health care providers and Aboriginal health interpreters. Older informants and family members asserted cultural values prohibiting direct communication involving terminal prognosis or palliative care options. Their perspective appeared to reflect traditional prohibitions against ‘telling bad news’ related to beliefs that references to mortality had the capacity to create reality. Younger patients favoured more explicit communication about terminal prognosis and wanted to know what palliative care options were available. Interviews were conducted with eight interpreters involved in palliative care work. Interpreters played a major role, not only in providing linguistic services, but also in mediating conflicting cultural and ethical values guiding end of life decisions. Interpreters described situations in which they had been asked to ‘broker’ communication between terminally ill patients, family members and caregivers. Often each group held conflicting values about the need for truth‐telling and maintenance of autonomy. Interpreters expressed concern over their lack of formal power and complained that time constraints and role ambiguity restricted them to providing ‘reductionist’ or decontextualised explanations of diagnosis and treatment options. These messages often blurred fundamental differences in the value perspective of each participant in end of life decisions.
This paper explores the views of General Practitioners (GPs) about the appropriateness of children undertaking a task of interpretation between the GP and an adult patient in primary heath care consultations. We argue that the operational constraints that GPs face because of the limited availability of professional interpreters or bi-lingual Health Advocates create situations where children are accepted in this role by GPs, subject to specific limitations and contingencies. The contingent nature of perceptions of children's acceptability as informal interpreters is shown to be related primarily to the nature of the medical consultation in terms of whether it is likely to be straightforward, complex or sensitive. At the same time GPs express an ideological opposition to the appropriateness of this task for children generally. This ideological opposition is explicitly linked by GPs to broader constructions of a ‘proper’ childhood, characterised as a time of innocence and freedom from worry.
OBJECTIVE: To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment.
DESIGN: Cohort study.
SETTING: Public hospital emergency department.
PARTICIPANTS: English- and Spanish-speaking patients (N=714) presenting with nonemergent medical problems.
MEASUREMENTS AND MAIN RESULTS: Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P=.05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P=.78).
CONCLUSIONS: Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments.
OBJECTIVE: Outpatient drug complications have not been well studied. We sought to assess the incidence and characteristics of outpatient drug complications, identify their clinical and nonclinical correlates, and evaluate their impact on patient satisfaction.
DESIGN: Retrospective chart reviews and patient surveys.
SETTING: Eleven Boston-area ambulatory clinics.
PATIENTS: We randomly selected 2,248 outpatients, 20 to 75 years old.
MEASUREMENTS AND MAIN RESULTS: Among 2,248 patients reporting prescription drug use, 394 (18%) reported a drug complication. In contrast, chart review revealed an adverse drug event in only 64 patients (3%). In univariate analyses, significant correlates of patient-reported drug complications were number of medical problems, number of medications, renal disease, failure to explain side effects before treatment, lower medication compliance, and primary language other than English or Spanish. In multivariate analysis, independent correlates were number of medical problems (odds ratio [OR] 1.17; 95% confidence interval [95% CI] 1.05 to 1.30), failure to explain side effects (OR 1.65; 95% CI, 1.16 to 2.35), and primary language other than English or Spanish (OR 1.40; 95% CI, 1.01 to 1.95). Patient satisfaction was lower among patients who reported drug complications (P < .0001). In addition, 48% of those reporting drug complications sought medical attention and 49% experienced worry or discomfort. On chart review, 3 (5%) of the patients with an adverse drug event required hospitalization and 8 (13%) had a documented previous reaction to the causative drug.
CONCLUSIONS: Drug complications in the ambulatory setting were common, although most were not documented in the medical record. These complications increased use of the medical system and correlated with dissatisfaction with care. Our results indicate a need for better communication about potential side effects of medications, especially for patients with multiple medical problems.
In 1986 patient dissatisfaction with medical services in some Canadian Inuit communities reached alarming proportions. Many observers attributed the problem to poor communication. Through an analysis of the process of interpretation in the clinic from a historical and sociopolitical perspective, I investigated the relationship between patient satisfaction and clinical communication. Political and ideological barriers inherent in a colonial medical system were found to constrain Inuit medical interpreters from advocating for their patients' interests and thereby increasing satisfaction with the care. Enhancing Inuit interpreters' capacity to act as advocates may be possible only through changes in administrative priorities that result from macropolitical change.
Two descriptive, quantitive cross-sectional surveys including all services of internal medicine and psychiatric services examined how Swiss medical services address the problem of language barriers in health care and how they respond to the high number of allophone patients. Of all the medical services (MS), 244 responded to the questionnaire (Internal medicine: 166; Psychiatry: 78; overall response rate 86.6%). Half of them (51%) estimated the proportion of allophone to the total number of patients at 1-5%. Only 4% of the MS collected statistics on the number of allophone patients (2 internal medicine, 8 psychiatric services). A third of the MS perceive communication with allophone patients as significantly difficult. Only 14% often use qualified interpreters, while 79% often use relatives, 75% often health staff, 43% often employees. Qualified interpreters are less frequently used in internal medicine than in psychiatry. there is an expressed need for qualified interpreters speaking Albanian, Bosnian/Serbo-croat, Tamil and Kurdish. Only 11% of the studied MS have a budget for interpreters, and 17% have access to an interpreter service. 48% express the need to have access to interpreter services. There is a need to raise the awareness of health professionals on the advantages of having access to trained interpreters and on the limits of using relative as translators. This call for coordination at national level, policy development and training, in order to ensure adequate communication and quality care for migrants.
This small-scale study attempts to examine the languages spoken in medical consultations during a one-month period in an outpatient clinic in Geneva and the ways health professionals use to communicate with their allophone patients, in particular by using interpreters. Patients of foreign origin accounted for 58% of all the consultations during the survey. Of these, 37% were Non-French-speakers (NFS). The four major language groups of NFS were Albanian, Somali, Tamil and Serbo-croat. Qualified interpreters were used in 24% of the consultations, relatives acting as interpreters in 17%, and in the other consultations without anyone interpreting (59%) a common language had to be negotiated: French, English, Italian, Spanish or German. In only 14% of the consultations without interpreters, both patient's and doctors ability to speak a common language was rated as good. Our data suggest that there has been an increasing awareness of the possible language barriers in the medical outpatient clinic. Even if proxy solutions (informal interpreters or the use of a common language) still play an important role, access to an interpreter service has been widely used This calls for systematic and regular interpreter use, planning the interpreting needs in a timely manner: In the future, training in working with interpreters should become an integral part to the introductory sessions for the junior physicians assigned to the outpatient clinic.
African immigrants and refugees-almost half of them from Somalia-account for one of the fastest-growing groups in the United States. There is reason to suspect that Somali-Americans may be at risk for low completion of recommended preventive health services. This study's aim was to quantify disparities in preventive health services among Somali patients compared with non-Somali patients in an academic primary care practice in Rochester, Minn. It also examined the effect of medical interpreters, emergency department visits, and primary care visits on the completion of preventive services. Rates of pap smears, vaccinations (influenza, pneumococcus, and tetanus), lipid screening, colorectal cancer screening, and mammography were assessed in Somali and non-Somali patients during the second quarter of 2008. Data were collected regarding the utilization of medical interpreters, emergency services, and primary care services among Somali patients. Results were reported using standard descriptive statistics. Of the 91,557 patients identified in the database, 810 were Somali. Somali patients had significantly lower completion rates of colorectal cancer screening, mammography, pap smears, and influenza vaccination than non-Somali patients. Use of medical interpreters and primary care services were generally associated with higher completion rates of preventive services. There are significant discrepancies in the provision of preventive health services to Somali patients compared with that of non-Somali patients. These findings suggest the need to identify the root causes of these discrepancies so that interventions may be crafted to close the gap.
While working with trained interpreters in health care is strongly recommended, few studies have looked at the subtle differences in communication processes between trained and "ad hoc" interpreters, such as adult family members. Using Habermas' Communicative Action Theory (CAT) which distinguishes between the Lifeworld (contextually grounded experiences) and the System (decontextualized rules), we analysed 16 family practice consultations with interpreters, 10 with a trained interpreter and 6 with a family member. We found clear differences in communication patterns between consultations with a trained interpreter and consultations with a family member as interpreter. In both cases the Lifeworld is frequently interrupted and the outcomes are similar: the Lifeworld is rarely heard and acknowledged by the physician. Physicians interrupt the Voice of the Lifeworld significantly more with a trained interpreter than with a family member. Family members and trained interpreters also interrupt the Voice of the Lifeworld just as much. However, these interruptions differ in their functions (both physicians and interpreters interrupt to keep the interview on track to meet the biomedical goals; family interpreters interrupt to control the agenda). We have identified patients' resistance when physicians ignore their Lifeworld, but this resistance is usually only transmitted by professional interpreters (and not by family interpreters). We identified specific risks of working with family interpreters: imposing their own agenda (vs. the patient's one) and controlling the consultation process. Even if the collaboration with trained interpreters becomes more widespread, work with "ad hoc" interpreters will continue to occur. Therefore, institutions should provide training and organizational support to help physicians and patients to achieve communication in all situations.
The number of foreign-born people who do not share a common language has increased due to extensive international migration, which will increase in the future. There is limited knowledge about the users' perceptions of interpreters in health care. Aim: To describe how individuals from former Yugoslavia, living in Sweden, perceived the use of interpreters in Swedish healthcare services.
A phenomenographic approach was employed. Data were collected by semi-structured interviews during 2006-2007 with 17 people, aged 29-75 years, from former Yugoslavia, living in Sweden.
Three descriptive categories were identified: (1) prerequisites for good interpretation situations; (2) the interpretation situation - aspects of satisfaction or dissatisfaction; and (3) measures to facilitate and improve the interpreter situation. The interpreter's competence, attitude, appearance and an appropriate environment are important prerequisites for interpretation. The interpreter was perceived as being a communication aid and a guide in the healthcare system in terms of information and practical issues, but also as a hindrance. A desirable professional interpreter was perceived as highly skilled in medical terminology and language, working in face-to-face interaction.
Using an interpreter was perceived as a hindrance, though also needed in communication with healthcare staff and as a guide in the healthcare system. Face-to-face interaction was preferred, with the interpreter as an aid to communication. As part of individual care planning it is important to use interpreters according to the patients' desires. Healthcare organizations and guidelines for interpreters need to be developed in order for patients to have easy access to highly skilled professional interpreters.