Moving beyond the ‘language problem’: developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters

Abstract

Health systems internationally are dealing with greater diversity in patient populations. However the focus on 'the language problem' has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health. Sur le plan international, des systèmes de santé font face à une diversité croissante dans ses populations de patients. Cependant, l'accent sur 'le problème de langue' se traduit dans une manque d'attention à la diversité à l'intérieur même et entre des populations des migrants; et la façon par laquelle des variables migratoire, ethnique et sociodémographique influencent elles-mêmes des consultations interprétées. Notre analyse des expériences des patients, des professionnels fournissant de soins de santé et des interprètes offre des preuves du besoin de dépasser le problème de langue. Et en faisant cela, nous adressons des multiples inégalités, souvent cachées dans des contextes de soins de santé, dans les milieux clinique et domicile. Nous proposons un programme de recherche basé sur la pratique, qui favorise la communication culturelle dans des milieux clinique et domicile, et qui reconnait le statut d'immigration comme un déterminant social de la santé.

Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework

“…Additionally, interpreters may require additional training to work with AS&R and clinicians in what may be challenging consultations. Piacentini et al [63] have previously highlighted the need for more training measures that move beyond diversity and/or race awareness, and which use a more holistic approach to understanding how different social identities and multi-dimensional markers of difference come to be produced and reproduced in interpreter-mediated healthcare encounters with migrant populations. They argue that these social identities and markers of difference include language, culture, ethnicity, age, gender, and also immigration status.…”

Ethical Issues of Decision Making and Communication in Health Care: An Intercultural and Interfaith Perspective

“…There are many reasons for such a delay. Among them are lack of registration and fear of being deported or repatriated (Rodriguez, 2019;Schumann, 2016), poor language skills, inability to explain the problem or fear of being misunderstood (Piacentini et al, 2019, Periyakoil et al, 2016, differences in religion, and mistrust to treatment methods that contradict one's native culture (Walker & Lovat, 2017). The problems of medical communication are encountered not only by migrants but also by medical tourists (Hanefeld et al, 2017).…”

“…As a consequence of globalization, many newly created religions have appeared. Thus, among the population of any country, there are representatives of various faiths (Piacentini et al, 2019;Safonov, 2020). Each religion has its own beliefs.…”

“…Ignorance of these peculiarities brings a number of difficulties in doctor-patient communication if they both are carriers of different cultures and faiths. For example, a lack of understanding makes the medical care process impossible (Piacentini et al, 2019). In this perspective, the problem of doctor-patient interaction is not limited only to the language barrier.…”

Medical Interpreting In The Migration Discourse: Problems And Didactics

“…The inequality of roles and positions increases when the customers are from another country: foreign students, migrants, etc., who find themselves in a more unequal position towards doctors due to their ignorance of language and cultural conventions and the mediated nature of communication (Piacentini, O'Donnel, Phipps, Jackson, & Stack, 2019). Language and cultural barriers affect the care of patients with limited English proficiency (Clarke, Jaffe, & Mutch, 2019;Rosse, Bruijne, Suurmond, Essink-Bot, & Wagner, 2016) and can lead to abuse of authority due to failure to provide appropriate services (Jacobs et al, 2018).…”