Beyond translation: Engaging with culturally and linguistically diverse consumers

Abstract

Background:In the context of an effective consumer engagement framework, there is potential for health-care delivery to be safer. Consumers from culturally and linguistically diverse (CALD) backgrounds may experience several barriers when trying to engage about their health care, and they are not acknowledged sufficiently in contemporary strategies to facilitate patient engagement. Methods: Four focus group discussions were facilitated by bilingual fieldworkers inArabic, Mandarin, Turkish and Dari in a district of Sydney, Australia that has a high proportion of CALD consumers. Each group included 5-7 health-care consumers who, using a topic guide, discussed their experiences of barriers and facilitators when engaging with health-care services in Australia. Thematic analysis was undertaken to identify, analyse and report patterns in the data. Results:In all, 24 consumers participated. Six inter-related themes emerged: navigating the health system; seeking meaningful interpretation; understanding and managing expectations; respectful professional care; accessing services; and feeling unsafe. Conclusions:The incorporation of strategies such as professional interpreters and migrant health workers may go some way to addressing the needs of culturally or linguistically diverse consumers and facilitate communication, but do not sufficiently address the range of barriers to consumer engagement identified in this work.Understanding consumer experience in the context of the complex factors that may be associated with poor engagement and poor outcomes such as health literacy, cultural, educational and linguistic background, and health-care setting or condition, may contribute to better understanding about how to deliver quality health care to these patients. K E Y W O R D Sconsumer engagement, focus group research, health-care quality, migrants, patient engagement

The safety of health care for ethnic minority patients: a systematic review

“…The role of bilingual healthcare staff in positively addressing language and culture was identified in a number of studies [51,58,64]. Bilingual staff may improve communication and are highly valued by organisations and patients alike as they speak the patients' language and understand their culture context [25,77]. The evidence from the present review suggests that use of interpretation through a range of means is valuable in addressing some patient safety issues but may also leads to others.…”

“…The Australian Commission of Safety and Quality in Health Care (ACSQHC) identifies consumer engagement strategies as central to improved health and healthcare safety outcomes for consumers [21,81]. Recent studies has also highlighted the role of patient and carer engagement among ethnic minority populations as critical for enhanced healthcare [25,77]. Consumers can act as safety buffer by identifying when the care is not adequate or unsafe [82].…”

“…Strategies utilised by the wider patient population, such as checklists or consumer toolkits designed to assist in asking health professionals questions and raising concerns during their care, are under-utilised in ethnic minority populations [81]. Engagement strategies that take into account the nuance differences between ethnic minority consumers are lacking and involving ethnic minority consumers can help develop relevant engagement strategies [25]. Co-design approaches to adapt and develop suitable engagement strategies may be of value to address this gap.…”

“…In a mixed method study using interviews with consumers from four different ethnicities (n = 18), authors noted that the lack of communication between various departments within a hospital as well as with community practitioners such as general practitioners can impact on care such as ceasing a patient's medicines prescribed by a GP during hospitalisation [36]. This frequent change applies to all populations but potentially this is a greater threat to patients from ethnic minorities due to various other compounding factors, such as greater investment of time required to build relationships and engagement with ethnic minority consumers [25].…”

“…Patients from ethnic minorities continue to report feeling unsafe when receiving health care, with experiences of discrimination, not having appropriate interpreting services and having inadequate knowledge of healthcare settings [25]. Current policy guidelines in Australia and many countries internationally require use of trained interpreters, yet research to date highlights patients reliance on informal translating mediums to support their healthcare interactions [25]. Lack of sufficient systems support comprising inadequate policies and resource for mandatory use of trained interpreters may lead to poor quality interactions between patients, carers and professionals and exacerbate the risk of safety events [17].…”