Language and cultural discordance in healthcare communication
The overarching objective of this Special Interest Group (SIG) is to foster a coherent interdisciplinary and interprofessional approach to researching and training in language and cultural discordance in healthcare communication. Multiculturalism and multilingualism have become a norm in Europe. Language barriers are known to be related to inequality in health care. The experiences of people whose first language is not the same as that of the healthcare service they attend can result in poorer health outcomes (Divi et al 2007). Whilst this may be related to a number of complex social and cultural factors it is evident that language difficulties are a major communication problem (Quesada et al 1976). A set of indicators suggest that the use of interpreters is more likely to lead to better communication outcomes (Bonacruz Kazzi and Cooper 2003, Diamond et al 2008, Karliner et al 2007, Karliner 2004). These triadic interpreted consultations require the use of specific skills which many health care professionals feel they lack (Hale 2007). There is also evidence that communication problems may occur even when interpreters are used (Hsieh 2007). Insufficient training for both healthcare professionals and medical interpreters might be one of the reasons behind the less effective collaboration between the two professionals (Tribe and Raval, 2013), which might ultimately lead to less optimal communication outcomes. Most of the curricula on clinical communication skills have so far relied on language concordance between healthcare providers and patients, do not allow much space for a language gap (Fung et al 2010) and therefore do not seem to attend to a wider set of intricacies inherent in interpreter-mediated communication. More empirical research on this matter is needed (Pérez-Stable and Karliner 2012, Angelelli 2008) in order to inform clinical practice and professional training (Segalowitz and Kehayia 2011; Angelelli 2008).
A large part of the available research reports on professional interpreters. While there is also an emerging body of research on ad hoc interpreting (Gray, Hilder, and Donaldson 2011, Li et al 2010) and cultural mediators, research in this area is still rare (Meeuwesen and Ani 2011; Meyer, Pawlack, and Ortun 2010). In addition, language barriers emerge when no interpreter is present, either because none was deemed necessary (e.g., the health care professional and patient share a lingua franca or the patient’s language proficiency is deemed “good enough”) or because the immediate situation precludes involving an interpreter for practical reasons (e.g., the patient’s needs are urgent). To be clinically relevant, knowledge is needed to uncover effective practice in the many real life situations health care professionals and patients face. This SIG is intended as an umbrella to address these and other situations involving a language barrier. Policies regarding using professional interpreters vary from country to country. Some officers of this SIG currently organise interprofressional training in Ghent and in London which have yielded research papers (Pype et al. 2016, Krystallidou et al 2016).We hope that this SIG can deliver research findings that can inform both training (possibly through tEACH) and policy making (possibly through pEACH).
- To conduct empirical research in order to advance the knowledge of language and cultural discordance in healthcare communication, and to conduct translational research to enhance professional practice and training;
- To build an international network for all stakeholders in order to support interdisciplinary research, interprofessional training and clinical practice;
- To contribute to improving quality of care and well-being of patients and clinicians in the super-diverse society
Three Year Plan
In the next 3 years, this SIG will focus on:
- Identify and apply for funding to develop research in the identified focal research areas.
- Establish an international network for collaborative research in the remit of the SIG.
Establish meaningful working relationships with other SIGs within EACH, such as tEACH.
- SIG: A co-authored paper introducing SIG and research agenda: http://www.pec-journal.com/article/S0738-3991(17)30255-0/fulltext
- Svennevig, J., Gerwing, J., Jensen, B.U. & Allison, M. (in press) Pre-emptive strategies in second language conversation – do they help? Applied Linguistics. https://doi.org/10.1093/applin/amx021
- Skjeggestad, E., Gerwing, J., & Gulbrandsen, P. (2017) Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues. Patient Education and Counseling, 100, 1466-1472. http://dx.doi.org/10.1016/j.pec.2017.03.007
- Landmark, A.M.D., Svennevig, J., Gerwing, J. & Gulbrandsen, P. (2017) Patient involvement and language barriers: problems of agreement or understanding? Patient Education and Counseling, 100, 1092-1102. http://dx.doi.org/10.1016/j.pec.2016.12.006
- SIG: searching for funding to develop research in the three areas as described in previous section.
- S Li, A Llopis, ES Martinez. An interdisciplinary approach to incorporating patient-centred communication in medical interpreting education
- J Liu, S Li. A case study of how medical students develop their cultural competence
- Krystallidou, D., Theys, L., Salaets, H., Wermuth, C., Pype, P. (2017-2021) EmpathicCare4All: The development of an educational intervention for medical and interpreting students on empathic communication in interpreter-mediated medical consultations. A study based on the Medical Research Council (MRC) framework phases 0-2. (Funded by the University of Leuven)
Future planned projects
- Establish an international network for collaborative research and supporting research
- Establish working relationship with other EACH groups.
- Organizing meetings have been challenging as all the members are in different countries and time zones.
- Funding application is challenging. The amount of funding has reduced in most countries. Funding for international collaboration has a lot of limitations.
- Reaching out to other scholars is done in an ad hoc manner. We would like to make use of the EACH website more.
How can EACH help?
- We wish to see new functions built on EACH website which to allow SIG to communicate SIG updates to EACH members, and use the website to build network.
- We wish to receive support from senior members regarding funding application—information on funding opportunities that suit our purpose, and strategies in composing application.
Angelelli, CV. (2008). The role of the interpreter in the healthcare setting: A plea for a dialogue between research and practice. Valero-Garcés, Carmen & Anne Martin (eds) (2008). Crossing Borders in Community Interpreting. Definitions and dilemmas. Amsterdam/Philadelphia: Benjamins, 147-164.
Bonacruz Kazzi G, Cooper C. Barriers to the use of interpreters in emergency room paediatric consultations. Journal of Paediatrics and Child Health. 2003 May 1;39(4):259-63. DOI: 10.1046/j.1440-1754.2003.00135.x
Fung CC, Lagha RR, Henderson P, Gomez AG. Working with interpreters: how student behavior affects quality of patient interaction when using interpreters. Medical Education online. 2010 Jun 1;15. DOI: 10.3402/meo.v15i0.5151
Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. Journal of General Internal Medicine. 2009 Feb 1;24(2):256-62. DOI: 10.1007/s11606-008-0875-7
Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. International Journal for Quality in Health Care. 2007 Apr 1;19(2):60-7. DOI: http://dx.doi.org/10.1093/intqhc/mzl069 60-67
Gray B, Hilder J, Donaldson H. Why do we not use trained interpreters for all patients with limited English proficiency? Is there a place for using family members?. Australian Journal of Primary Health. 2011 Sep 26;17(3):240-9. doi: 10.1071/PY10075
Quesada GM. Language and communication barriers for health delivery to a minority group. Social Science & Medicine (1976). 1976 Jun 30;10(6):323-7. doi:10.1016/0037-7856(76)90078-0
Hale S (2007) Community Interpreting. Palgrave McMillan.