Language barriers to health care

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In addition to a myriad of barriers to health care faced by migrants, such as the eligibility of health benefits, level of poverty and education, inconvenient hours, lack of transportation, cultural differences, etc., language is one of the most evident barrier to accessing health services. This is especially true in case of newcomers, who have none or elementary knowledge of the language spoken in the host country.

Language barriers can have deleterious effects on health, as they compromise the quality of care and increase costs and inefficiencies. People who face linguistic barriers are less likely to search medical attention, follow the exact medical regimens, adhere to medication, go to follow-up appointments, or receive preventive services. In case of patients with psychiatric conditions, those who encounter language barriers are more likely to be diagnosed with a severe psychopathology or leave the hospital against medical advice.

In order to overcome this barrier, it is imperative that free interpreting services are made available to patients with none or limited knowledge of the dominant language. In many cases involving ad hoc interpreters, such as family members or relatives, untrained medical staff or even strangers found in waiting rooms is not the best way to provide care, since they are more likely to commit translation errors or to filter information and assume the role of the decision maker. Moreover, the presence of family members or relatives who act as interpreters may inhibit discussions regarding sensitive issues such as domestic violence, substance abuse, undesired pregnancy, psychiatric illnesses, or sexually transmitted diseases. The use of professional interpreters for patients with none or limited proficiency of the host language has been proved to improve access to health care and understanding, increase satisfaction, rise the levels of compliance and participation, and diminish the amount of medical errors. Free interpreting services may be cost effective, since the provision of these services could save health care money by preventing unnecessary tests, hospitalisations and treatments, or by avoiding potential lawsuits [1].

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Another way to overcome language barriers is to recruit skilled bilingual staff members who reflect the cultural diversity of the community served and provide them additional training in interpretation, cultural competency, and ethics. Bilingual staff, acting either as healthcare providers or interpreters, create a welcoming environment for the migrant patients, thus increasing the patient’s satisfaction and trust in the quality of received medical care.

Bilingual staff is also more likely to be cultural aware. Culture influences the way a community sees the world and it creates a certain pattern of accepted values, beliefs and behaviours.  When linked to health, culture influences people’s lifestyle choices, their perception of ‘illness’ and its causes, their reaction to certain diseases, the choice of treatment, among others. For example, culture may constrain some patients from speaking about ‘cultural taboo’ topics or may discourage a wife from speaking freely in front of her husband. This is where the bilingual and bicultural staff can step in and provide information about health or suggest different treatments in a way that does not shock patients from migrant or ethnic communities.

As for the medical information delivered in writing (informed-consent forms, discharge forms, preventive screening brochures, etc.), they should be provided in several languages, so that patients with limited knowledge of the dominant language could be informed of their treatment options, screenings, and other services provided by the healthcare facilities.

[1]Quan, Kelvin et al. (2010). The High Costs of Language Barriers in Medical Malpractice. University of California, Berkley.

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