Interpreter services in healthcare. Policy recommendations for healthcare agencies

'A drop of water in the pool': information and engagement of linguistic communities around a municipal pesticide bylaw to protect the public's health

The Multicultural Yard Health and Environment Project (MYHEP) used Toronto's Pesticide Bylaw roll-out process to examine how culturally specific perceptions and practices might influence the relevance of municipal public health information and community engagement strategies and the effectiveness of health protection initiatives. In Canada, and particularly in Toronto, such information is needed for governments to effectively engage with increasingly diverse populations. Focus groups and individual interviews were conducted with Spanish- and Cantonese-speaking participants to document opinions about pesticide use and regulation and views on municipal information and engagement strategies. MYHEP participants reported a need for more accessible environmental health messaging. There was confusion over the safety and legality of pesticide products available for sale in Toronto stores. Most participants indicated they were unwilling to make formal complaints about neighbours who were not complying with the bylaw (an important mechanism for enforcement). Results indicate that environmental health communication and engagement strategies need to be more carefully tailored to address local sociocultural and linguistic contexts in order to provide more equitable environmental health protection and promotion for all residents. These findings led Toronto Public Health to adapt its efforts so as to better engage communities regarding environmental health.

Midwives' views on factors that contribute to health care inequalities among immigrants in Sweden: a qualitative study

INTRODUCTION

Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants.

METHODS

Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis.

RESULTS

The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept".

CONCLUSIONS

This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits.

Providing family planning and reproductive healthcare to Canadian immigrants: perceptions of healthcare providers

Cultural impacts on health experiences and behaviours are profound in the area of reproductive health and family planning. Explored through interviews with family planning healthcare professionals, this paper evaluates their experiences in providing family planning and reproductive healthcare to immigrants in the Greater Toronto and Hamilton area of Ontario, Canada. Results reveal the complexity of delivering care to members of this group, particularly when dealing with language barriers, situations when professional and non-professional interpreters are used, and instances where healthcare professionals realize that they themselves have misconceptions and misunderstandings about other cultures. The paper concludes by discussing future research options and implications for the delivery of reproductive health family planning services to this population.

Health care reform and the paradox of efficiency: "writing in" culture

Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations.

Using telehealth technology to improve the delivery of health services to people who are deaf

The use of technology to access sign language interpreters from a remote location can have a significant impact on the timely access of such services for people who are deaf. The potential integration of such services is contingent on factors such as the availability of suitable equipment and the acceptance of the technological solution by people who are deaf, sign language interpreters and the health professionals. A system was assembled to address the needs of the users while maintaining focused on the requirement of the system being feasible such that it remains an option for small clinics and even medical offices. The technological solution was tested using simulated sessions involving people who are deaf, health professionals and sign language interpreters. The sessions simulated typical health conditions seen in hospital emergency rooms, medical clinics and doctor offices. Data collected from all participants indicate the technology proved to be acceptable in most simulated situations.

Understanding medical interpreters: reconceptualizing bilingual health communication

This article provides a new approach in conceptualizing bilingual health communication, emphasizing the differences between types of medical interpreters as well as the interrelationships among all participants in bilingual health communication. Confronted by the conflicting results of interpreting services in medical settings, the author used past research to explain why medical interpreters should be categorized into different categories (i.e., chance interpreters, untrained interpreters, bilingual health care providers, on-site interpreters, and telephone interpreters) so that their characteristics and interpreting styles can be better observed and understood. In addition, by recognizing that interpreter-mediated communications in health settings are dynamic situations and that all participants can influence the outcomes of the communication, researchers can start to investigate the interrelationships among all the participants and, thus, develop different strategies that will improve the quality of bilingual health communication.

Exploring the 'fit' between people and providers: refugee health needs and health care services in Mt Roskill, Auckland, New Zealand

The needs of refugees and the struggles on the part of service providers to address this diverse population have received limited attention within the academic literature. This paper profiles Hauora o Puketapapa/Roskill Union and Community Health Centre (HoP), which is a non-profit, community owned and operated health clinic designed to deliver accessible, affordable and appropriate primary health care services to low-income groups in the Mt Roskill area of Auckland, New Zealand. The clinic's locality has undergone considerable demographic change over recent years with the arrival of refugees from diverse backgrounds. This situation has resulted in new sets of health needs and expectations which need to be addressed. The study took place in 2002-2003 and employed qualitative methods. In-depth interviews with community representatives, clinic users and health service staff members revealed that refugees face considerable barriers in accessing and utilising health services. Similarly, we found that health practitioners face the daunting task of endeavouring to meet these needs in an effective and culturally appropriate manner within a limited funding environment. We conclude that, despite these challenges, HoP has successfully established itself as a well-regarded place of primary health care. In so doing, it has strengthened the capacity of the local community to respond to the changing policy environment. However, long-term sustainability issues remain unless resourcing issues are adequately addressed.

Bridging the language barrier: the use of interpreters in primary care nursing

Language barriers present a major obstacle to minority ethnic communities accessing primary healthcare. Whereas it is recognised that interpreting services are generally inadequate and inappropriate reliance is placed on family members to interpret, little is known about how nurses working in primary care utilise interpreters to overcome language barriers. The present paper reports on a study examining the utilisation of interpreting services by a range of primary care nurses from the perspectives of the nurses, interpreters and minority ethnic communities. Focus groups were undertaken with five separate groups of district nurses, health visitors, practice nurses, community midwives and specialist nurses, three groups of interpreters from different interpreting services, and five groups of participants from the main community languages in the locality where the study was undertaken (i.e. Arabic, Bengali, Cantonese, Somali and Urdu). Focus group discussions were tape-recorded and subsequently transcribed. Data analysis drew upon the principles of 'framework' analysis. The use of interpreters by primary care nurses varied considerably. Nurses who had received training in using interpreters and who had most control over the timing of patient visits were more likely to use interpreting services. Inadequate training of both nurses and interpreters adversely affected the quality of interaction where interpreters were used. Primary care nurses acted as gatekeepers to interpreting services. Whereas interpreting services were generally perceived to be inadequate, many nurses were accepting of the status quo and prepared to rely on family members to interpret rather than champion the need to improve services.

Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral

The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.

Health needs assessment in the health visiting service and the impact on the ethnic community

The purpose of this article is to share the experience of using a health needs assessment tool in health visiting practice in Great Britain, with clients who do not speak English. This is an important issue in developing equity of practice across the growing multi-cultural and diverse populations of the United Kingdom. The paper outlines the findings relevant to these issues drawn from a wider study that used qualitative methods to observe and interview both health visitors and clients regarding the use of the tool. It focuses on one vignette to demonstrate the practical and difficult issues when a formal system is used to assess needs in clients who do not speak English as a first language.

The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice

Although Spanish was the primary language of an estimated 11 % of adults in the year 2000, the U.S. health care system is largely geared toward serving English speakers. A systematic review was conducted of studies published in biomedical journals from 1990 to 2000 examining language barriers in health care for Latino populations. Aspects of the problem examined were access to health care, quality of care, and health status/health outcomes. Five (55%) of the nine studies examining access to care found a significant adverse effect of language; three (33%) found mixed or weak evidence that language affected access. Six (86%) of the seven studies evaluating quality of care found a significant detrimental effect of language barriers. Two of the three studies examining health status or outcomes found language to be a risk factor for adverse outcomes. Evidence was mixed as to the level of importance attributable to language when access to care is considered; however, non-English-speaking status was a marker of a population at risk for decreased access. Solid evidence showed that language barriers can adversely affect quality of care. Health care practitioners are recommended to devise an effective strategy to bridge language barriers in their setting. National laws and policies are discussed; practical guidelines and resources for providing language access in health care are provided. This article is intended to supply basic knowledge for providers and institutions in devising effective strategies for bridging the language barrier.