Language Discrepancies in Medical Care

Introduction

Barriers to the provision of effective, as well as equitable healthcare to patients can be due to language differences between healthcare providers and patients, especially when the healthcare providers and their patients are using a second language. Increasingly in the UK, most healthcare professionals include migrants, and in most cases, their first language is not a common language (Ali & Watson, 2018). It is also evident that there is an increasing number of patients who are also linguistic minority migrants, and have no option but to use a second language in the course of their healthcare encounters, or rather, depend on the availability of language interpreters, to enhance accuracy in communication. In this regard, it is worth noting that there is a rapidly growing number of patients who use the healthcare system of a country, yet do not share the same language with their healthcare providers and vice versa (Komaric et al., 2012). Notably, language discrepancies often result into increased rate of psychological stress, and also significant errors in communication for patients who are already anxious, and this something to which various patients who experience language-congruent encounters are less vulnerable (Ferguson & Candib, 2002). Of importance noting, is that not just language can results into barriers against the provision of equitable healthcare (Barnett et al., 2004). This is owing to the fact that inequalities that are inherent within the social dynamic of the encounter of the patient and their practitioner are also well documented and such kind of inequalities often occurs, independent of whether a common language is shared (David & Rhee, 1998). This then proves the fact that comprehending language based on a medical encounter then poses to be critical for understanding various problems, which may occur when patients and their healthcare providers speak different languages (Ali & Watson, 2018).

Moreover, it is clear that whilst communicating various significant details regarding treatment or even diagnosis, it is vital conveying accurately and appropriately, the likelihood of the occurrence of associated risk factors. In this regard, it is evident that failure in communicating appropriately the seriousness of such kind of risks could result into negative consequences whereby, patients may fail in complying with significant instructions or could ignore certain life-saving potential treatment (Messias et al., 2009). However, much information has been published regarding communication barrier, which causes potential risk between healthcare providers and patients in various healthcare situations, this paper will significantly focus primarily on various language-congruent situations. Notably, it is never clear how various health-related risks are appropriately and also accurately conveyed to patients, especially when their first language differs with that of the healthcare practitioner and the entire community (Anoosheh et al., 2009). Evidence exists, which makes it clear that miscommunication most likely occurs when healthcare providers have no option but to use inadequately mastered second language and as such, the information they give to their patients are not correctly conveyed, and thus, can result into certain nuances of risks, as well as uncertainties whilst providing health care. Moreover, in complicating the matter father, it is notable that most people from varied cultural groups often describe their pains, as well as distresses quite differently (Schyve, 2007). For instance, using culturally specific terms, metaphors, and even expressions could be difficult navigating, even in an instance where the competence in language is high (Messias et al., 2009). Additionally, when healthcare providers do not have the linguistic, as well as the cultural skills that they need and their interpreters are also not available, then patients may only depend on medically inexperienced, non-medical staff, as well as bilingual relations, thereby, compromising the quality of healthcare that they receive, which consequently, could worsen their health outcomes, especially for migrant communities.

Research purpose

Miscommunications whilst providing healthcare to patients could be life-threatening (Yeo, 2004). In line with this, it is evident that the increasing rise in the number of migrant patients, as well as foreign-trained staff in the UK implies that communication errors between patients and healthcare practitioners, where one or both of them are speaking their second language is likely increasing (Komaric et al., 2012). This paper primarily purposes to outline a significant hospital-based study, which examines the interactions between healthcare providers and their patients, in situations where their patients share their first language with them or when they do not share. In this regard, of particular interest to this paper is the nature, as well as efficacy of communication, especially in language-discordant conversations, and also the degree to which certain health risks are communicated (Keers-Sanchez, 2003; cited in Boi, 2000). Overall, this paper makes it worth noting that comprehending the role, which language plays in the creation of barriers onto healthcare is critical for various healthcare systems that experience an increase in culturally, as well as linguistically diverse population existing amongst healthcare practitioners and patients. In this regard, the data that will be derived in this study will purpose to inform policy, as well as practical solutions that would significantly enhance communication training, thus providing a relevant agenda meant for future research, as well as extended theory in terms of health communication. This paper thus, brings forth the following research aim, and research questions.

Aim

This research is designed, with the aim of exploring on the fact that communication barrier hinders effective healthcare to patients, especially when healthcare providers and patients are using their second language across various in-and-out patient departments in hospitals. In this regard, the primary aim of the study is as provided below:

To explore on communication barrier, as a potential barrier in a healthcare communication setting, across in-and-out patient departments in hospitals

Research questions

How does language barrier impact negatively on the provision of effective healthcare to patients?

How do cultural differences affect the relationship between healthcare practitioners and patients in terms of provision of healthcare?

What are the alternative communication channels that can be used in instances where healthcare providers and patients are using their second language?

Methodology

Research design

This paper will primarily adopt the use of qualitative analysis. This is owing to the opinion that qualitative research provides a great freedom of expression, whereby, the participants will be allowed to freely give their opinions. In this regard, it is evident that the responses they will give will be authentic, as they will not be influenced by any group. Moreover, qualitative research will be preferred to any other method of data collection as the responses, which the participants will give will rely entirely on their perceptions, as well as opinions (Glesne, 2016). In this context, it is evident that the data that will be collected will depend on the observations, as well as personal experiences of the participants. It should also be noted that, qualitative research provides a forum for open-ended research, thus making the entire process much fluid and can easily be followed. In line with qualitative research, this study will use semi-structured interviews to seek for various details from the participants. Notably, semi-structured interviews will not require the researcher to follow a formalized list of the presented questions. In this regard, the researcher will ask the participants questions, which are more open-ended, thus allowing the interviewer and the interviewees to have a forum for discussion, instead of engaging with straight-forwards questions. Essentially, this will bring forth a two-way form of communication, thereby, allowing the participants to give their heart-felt opinions of certain subjects (Silverman, 2016).

Participants

This research will involve a total of 24 participants, inclusive of both healthcare practitioners and patients. The selection of the participants will be enhanced through a broad consultation with various directors of nursing, with the assistance of Nurse Unit Managers (NUMs) in various in-and-out patient departments. The participants to be included in the study will be patients and healthcare practitioners who can speak either English or any other language as their first language. The participants will be sampled from two hospitals in the UK and from different in-and-out patient departments. Only the participants who will be willing to participate will be involved in this study. Other than English as a first language, other languages will be used without any form of discrimination, owing to the fact that most patients in the UK hospitals speak varied languages as their first languages. Finally, it should be noted that the healthcare practitioners will be recruited for the study, from multiple professions and this will include clinical nurses, pharmacists, as well as midwives, in order to allow the evaluation, based on a range of various conversational dynamic. On the other hand, the patients to be involved will be patients suffering from any kind of illness.

Data collection procedure

This research will be conducted in two hospitals in the UK. In this regard, the selected hospitals will have to be of large sizes, with comprehensive ranges of departments. Various naturalistic conversations occurring between healthcare providers and patients during hospital appointments will be recorded and this will happen in various in-and-out patient departments, with the aim of obtaining a varied selection of health-related problems, in line with different patient risk levels. Notably, the departments, which will be regarded as appropriate for the collection of data will include various facilities for audio recording and will be to be quiet and private environments. All of the participants will be required to fill up a language background questionnaire and thereafter, they will be required to respond to a short survey, which will detail out the effectiveness of their interactions (interactions between healthcare practitioners and patients). The healthcare practitioners will be recorded with two patients each, wherefore, one patients will be sharing the same first language (English) with the healthcare practitioner. On the other hand, the other patient will not be sharing a first language with the healthcare practitioner. It is anticipated that most of the conversations, which the participants (patients and healthcare providers) will have will be specifically in English. However, there is a likelihood that either the healthcare practitioner or the patient may resort to using their first language, which will be incongruent with their counterpart, in an instance whereby, they have no option but resort to a language, which facilitates their communication. Moreover, various communications that will be aided by an interpreter will as well be recorded. Significant to note, the optimum length for all interactions between the healthcare provider and their patient will be around 15-20 minutes. Additionally, similar number of interactions will also be recorded between healthcare providers who share the same firs language with their patients. Overall, these interactions will be recorded, in order to assess the impacts of linguistic ability onto the interaction quality, as well as communication of various health-related information. The recordings will then be put through qualitative analysis, in order to determine various language elements, which may particularly be problematic and also examine the extent to which language discordance or concordance impacts on the quality of healthcare, which healthcare practitioners give to their patients.

Research Materials

The healthcare practitioners, as well as patients who will be participating in this study will be given information sheet, consent form and language background questionnaires, in advance, for the purpose of the audio recording. In this regard, the patients who will be language discrepant or concordant will easily be identified in easier ways. Firstly, the NUMs will search the health system, in order to identify the patients who will be having upcoming appointments, and who will have identified themselves to be speaking other languages, other than English as their first language. This will enable easy introduction of the researcher to the patients when they will arrive for their appointments, thereby aiding in seeking their consent to participate in the study. Secondly, there will be poster advertising in the two hospitals that will be identified, in order to inform both the patients and the healthcare providers regarding the research and thus, request that they kindly get in touch when they would be vising the hospital. Thirdly, all the information, consent, as well as questionnaire forms will be made available in choices of English, and other languages, thus allowing both patients and healthcare providers to select the language, which they preferred. Finally, it should be noted that basic language, as well as second language proficiency background information will as well be obtained by use of the Language Background Questionnaire (this will include a self-rate proficiency for first language and second language) for patients and healthcare practitioners.

Exclusion/inclusion criteria

The participants who will be included in this study will be patients, as well as health practitioners who either speak English or any other second language. In this regard, the participants will either have English as their first language or other languages as their first languages or vice versa. This study will also include participants who will request for interpreter assistance, wherefore, they will be recorded, but only in when they will have consent to the recording. Moreover, this study will only include participants who will be willing to participate in the study However, there will be no audio recording of appointments, especially where the patients will be expected to receive physical examination by the healthcare practitioner.

Data analysis

The data collected from the semi-structured interviews will be transcribed and later prepared for qualitative analysis. In this regard, the transcripts will significantly be developed into thematic analysis, whilst focusing on the extent to which various communicative requirements were met. Significant to note, thematic analysis aids in expounding on various significant concepts and themes derived from the data and it will enable the researcher to investigate various ways in which the expression of certain risks will be achieved, and also the extent to which they will be linked to various changes in convergent. Moreover, some paralinguistic features like tempo and pitch will be used in the analysis. For instance, the convergence in register i.e. the extent to which the healthcare providers and the patients pitched their communication whilst interacting. Moreover, significant data derived from the Language Background Questionnaire (for instance, the second language proficiency and the language of training) and the healthcare practitioner or the patients’ conversation will also be utilized in informing various metric derived from the thematic analysis. The themes derived from the conversations will be used in comparing with the Language Background Questionnaire, as well as the outcome measured gotten from the presented post-appointment questionnaire for the qualitative analysis. Notably, the qualitative analysis will focus on accommodation and target the occurrence of various specific adverb phrases, and the manner in which they operate whilst handling the discussion of health risk.

Ethics

This study will follow the ethical guideline, wherefore, the participant will seek the participants’ consent to participate in this study. Moreover, the participants will be kept anonymous and confidentiality will highly be accorded to the study, whereby, no third party will be allowed to access the filled semi-structured interviews and once the data analysis will have been completed, the filled questionnaire will be discarded. Moreover, any participant will be allowed to withdraw their participating if they presented their wish to the researcher. Finally, request to conduct this study in two hospitals in the UK will be presented to the hospitals to seek their approval to conduct the study within the premises of the hospital and to involve some health practitioners and patients in various in-an-out patient departments.

References

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