Impacts of language barriers on healthcare access and quality among Afaan Oromoo-speaking patients in Addis Ababa, Ethiopia

Abstract

Background Ethiopia is a multilingual and multinational federation with Addis Ababa serving as both the capital city of Oromia regional state and the seat of the Ethiopian federal government. Nevertheless, only Amharic is considered as the working language of the city and federal offices, including hospitals. As a result, Afaan Oromoo-speaking patients may be facing language barriers in the healthcare settings in Addis Ababa. Language barriers have the capacity to affect patients’ experience of care and treatment outcomes. This study, hence, examined the impacts of language barriers on the healthcare access and quality for the Afaan Oromoo-speaking patients in public hospitals in Addis Ababa. Methods In-depth interviews with patients (N = 27) and key informant interviews with healthcare providers (N = 9) were conducted in six public hospitals found in Addis Ababa. All the interviews were audio-taped and transcribed verbatim. A thematic analysis technique was employed to address the study objectives. Results The study participants indicated the widely existing problem of language discordance between patients and healthcare providers. The impacts of language barriers on the patients include preventable medical errors, low treatment adherence, low health-seeking behavior, additional treatment cost, increased length of hospital stays, weak therapeutic relation, social desirability bias, less confidence, and dissatisfaction with the healthcare. For the healthcare providers, language barriers are affecting their ability to take patient history, perform diagnoses and provide treatment, and have also increased their work burden. The use of ad hoc interpreters sourced from bilingual/multilingual patients, patient attendants, volunteer healthcare providers, and other casual people has been reported to deal with the problem of language barriers. Conclusion A significant number of Afaan Oromoo-speaking patients are facing language barriers in accessing quality healthcare in public hospitals in Addis Ababa, and this constitutes structural violence. As a way out, making Afaan Oromoo an additional working language of the public hospitals in Addis Ababa, the assignment of professional interpreters, and a hiring system that promotes the recruitment of qualified multi-lingual healthcare providers are suggested.

“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

“…[28] In accordance with the informants worry regarding making incorrect clinical judgements and assessments, previous research has found that dementia indeed is associated with decreased accuracy of the older patient presenting illness, [29] and that communication barriers pose risks for patients. [13,[15][16][17][18] Specifically for PLwD, whose ED visits are associated with adverse outcomes including functional decline, hospitalization, and mortality, [3,10,11,30,31] with one of the found reasons for adverse outcomes being communication barriers. [11] Indeed, PLwD are less likely to comprehend their discharge diagnosis and instructions.…”

“…For healthcare providers, language barriers were found to affect their ability to take patient history, diagnose the patient, provide treatment, and resulted in an increased work burden. [13] In Denmark, a country with fewer Informed consent was obtained from all subjects involved in the study.…”

“…[2] Language barriers and communication barriers are known to increase the risk for patients and cause an increased work burden and moral distress for the healthcare provider. [13,[15][16][17][18] Moral distress describes the feelings of unease that arise in situations when someone knows the morally correct action to take but is constrained in some way from taking this action. It is related to malpractice, reduced quality of care, and poor communication, negatively affecting the patient.…”

“…For healthcare providers, language barriers were found to affect their ability to take patient history, diagnose the patient, provide treatment, and resulted in an increased work burden. [ 13 ] In Denmark, a country with fewer foreign-born compared to Sweden, [ 14 ] a study found that language barriers frequently affected communication, which in turn negatively affected the clinical assessment and certainty of decision-making. [ 2 ]…”

Multidimensional Reflections on the Foreign Communication and Translation of Xinjiang Minority Cultures

“…In addition, the current political environment and social issues in the Xinjiang region, such as ethnic relations, religious conflicts, and terrorist attacks, may also have some impact and difficulty on cultural transmission and foreign communication. There is a need to focus on the understanding of historical and political backgrounds in foreign communication and translation, and to strengthen policy support and cultural propaganda so as to promote better dissemination and understanding of minority cultures in Xinjiang [11].…”