Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety

Disparities in Healthcare Accessibility and Discrimination Faced by Black Quebecers: a Race and Language Perspective

The Black population in Canada is characterized by its long-established history and diversity. The present study aims to expand our current understanding of the relation between discrimination and disparities in healthcare by including race and language as determinants of health. We recruited 531 Black adults who are currently living in Quebec, Canada, to complete a survey measuring socio-demographic characteristics, mental and physical health, accessibility to healthcare, and experiences of discrimination. Results showed that being a racialized and linguistic minority population in Quebec, English-speaking Black participants experienced more discrimination, fewer healthcare providers, less access to COVID-19 information during the COVID-19 pandemic, and were more dissatisfied with the healthcare system than French-speaking Black participants. Furthermore, the negative impacts of healthcare access associated with being a racialized and linguistic minority population in Quebec (e.g., the English-speaking Black population) were shown to be mediated by experiences of discrimination and dissatisfaction with the healthcare system.

An analysis of metaphor in COVID-19 TV news in English and Spanish

BACKGROUND

Latinxs lack equitable access to science-based, accessible, trustworthy, and bilingual health information and rely heavily on TV news as a source of health information. This study examines how TV news media convey COVID-19 health- and safety-related information to the public, focusing on communications that target Latinxs in the US, a group disproportionately affected by COVID-19.

METHOD

To understand how information targets Latinxs, we analyzed conceptual metaphors used in Spanish and English descriptions of the COVID-19 pandemic using TV news archive. Metaphor is an integral part of daily communication that can help people explain what is abstract in terms of what is concrete. Our analysis focused on prominent COVID-19 metaphors in both languages: war, journey, and natural disaster.

RESULTS

Similar to previous studies, we found that war metaphors were pervasive in English, for instance, as in 'Diagnostic testing is the only weapon that allows you to fight COVID-19' and 'a 15-day battle with COVID-19.' A new finding was that war metaphors were even more common in Spanish than in English. The journey metaphor had similar rates of use in both languages, while the natural disaster metaphors were more common in English than in Spanish.

CONCLUSIONS

Our work provides novel insights into how TV news reports use metaphor to convey information about COVID-19 to viewers in English and Spanish. We also offer implications on using culturally informed language and conclude with directions for future research to guide health communications serving linguistic minority communities such as Latinxs.

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

The Interplay of Race, Ethnicity, and Language in Caregiver Health: Insights from the National Social Life, Health, and Aging Project

Background

Recent socio-demographic shifts in the United States have underscored the growing importance of informal caregiving and raised concerns about caregivers' health and well-being. This study aims to deepen our understanding of the health dimensions of caregivers, considering their diverse backgrounds.

Objective

To examine five key health dimensions (physical, cognitive, mental, social, and sexual health) of caregivers, and to identify potential disparities based on ethnoracial and linguistic differences.

Methods

Using data from the National Social Life, Health, and Aging Project (NSHAP), this study explores the interconnections among the specified health dimensions of caregivers and their ethnoracial (Black, Hispanic, White, and others) and linguistic (Spanish, English) backgrounds, in addition to their social networks (N=1,309). Regression analysis was employed to discern the patterns and associations.

Results

The findings indicate that White caregivers generally report better physical, cognitive, and social health compared to their Black and Hispanic counterparts, but exhibit less favorable outcomes in sexual health than Hispanic caregivers. Spanish-speaking caregivers, while having lower cognitive and self-rated mental health than English-speaking caregivers, show stronger social health and greater relationship satisfaction. Notably, these correlations persist irrespective of the size of social networks, pointing to intrinsic links with health outcomes.

Conclusion

The study underscores the necessity of a comprehensive health evaluation for caregivers, acknowledging the intricate interplay between their health and various socio-demographic factors. It advocates for the development of targeted policies and interventions that address the complex health needs of caregivers, with an emphasis on their ethnoracial and linguistic contexts and social environments.

A Case Study of the Impact of Language Concordance on Patient Care, Satisfaction, and Comfort with Sharing Sensitive Information During Medical Care

Linguistic barriers continue to be a source of difficulty and inappropriate treatment in our healthcare system. Several studies have shown the importance of language concordance, which leads to increased trust and higher patient satisfaction. The aim of this is study is to determine patients' satisfaction and comfort levels with sharing sensitive information in Spanish with either the health care provider or an interpreter, respectively, and to compare the results to find out if there is an option that patients prefer. There were two different groups of participants in the study. The experimental group was directly seen by Spanish-speaking student doctors while the control group was seen by English-speaking student doctors that had the aid of an interpreter. Several questions were asked to participants via survey in order to measure their comfort levels during the encounter. The results of this study demonstrate that having Spanish-speaking healthcare providers providing health care to Hispanic patients can raise patients' comfort levels and satisfaction in contrast to having the aid of an interpreter. Providing second language training to student doctors can potentially improve patient care and reduce health inequities facing LEP patients. Given the small sample size of our study, future projects should expand the study to include more participants.

Ethnic identity and barriers for using mental health services among Arab-Bedouin women coping with emotional distresses

The study aimed to explore barriers to mental health service attainment among Bedouin women living in different residential environments in southern Israel. We hypothesized that emotional distress and the utilization of mental health services would be influenced by the living environment and ethnic identity factors. The sample included 376 Arab-Bedouin women, 126 Arab-Bedouin women from the recognized and unrecognized villages, and 250 Arab-Bedouin women from the central localities. Quantitative methods were used, including emotional distress (GHQ12), ethnic identity scale (EIS), mental health literacy (MHLS), and barriers to mental health services attainment (BACE). Results indicated that participants from the central localities demonstrated a greater inclination to seek and utilize mental health services. Furthermore, higher rates of affirmation of ethnic identity were also found to be a predictive factor for the willingness to attain mental health services. These findings further support the role of residential environment and ethnic identity in shaping mental health service utilization patterns. Current research explored barriers to mental health services seek and attainment for Arab-Bedouin women in different residential environments in southern Israel. Ethnic identity factors and barriers such as stigma and access to resources predicted the tendency to seek help. Findings emphasize the need to address barriers to seeking help and the role of ethnic identity in mental health service attainment for Arab-Bedouin women.

Establishing a baseline for multilingual capabilities of medical students at the Michigan State University College of Osteopathic Medicine

CONTEXT

The language proficiencies of Michigan State University College of Osteopathic Medicine (MSUCOM) medical students are unknown. As of 2015, approximately 8% (or roughly 25 million) of the US population over the age of five were considered "limited English proficient". Research indicates, however, that it is valuable to patients to be able to communicate in their primary language with their primary care physician. If medical students' language proficiencies were known, the medical school curriculum could be adapted to leverage or enhance a student's language proficiencies, preparing students to serve in communities where their patients language proficiencies align.

OBJECTIVES

The aim of this pilot study was to survey MSUCOM medical students in order to assess their language proficiencies with two goals in mind: first, to develop medical school curriculum that would leverage student's language proficiencies, and second, to encourage student placement within diverse communities throughout the state of Michigan where these physicians-in-training speak or understand the primary language of the local community to better serve patients.

METHODS

For this cross-sectional descriptive pilot study, a short, author-created survey was sent to 1,226 osteopathic medical students (OMS-I to OMS-IV) at MSUCOM. Participants were asked questions pertaining to language proficiency, number of languages spoken, prior exposure to education abroad, and demographic information. All participant data were only reported in grouped, collective, de-identified terms. Descriptive statistical analyses (frequencies, percentages) were calculated utilizing SPSS Version 25 software.

RESULTS

Over the course of several months, 698 (58.7%) current MSUCOM medical students participated in the study. Of those students, 382 (54.7%) responded that they were multilingual. The top three second languages reported spoken were: English 332 (47.6%), Spanish 169 (24.2%), and Arabic 64 (9.2%). In addition, 249 (37.2%) said they had prior exposure to education abroad, and 177 (26.4%) said they had lived in another country for more than 6 months.

CONCLUSIONS

The majority, 382 (54.7%), of the MSUCOM students who participated in the survey have some degree of multilingual capabilities. The student population at MSUCOM may benefit from completing primary care rotations in diverse communities within the state of Michigan. Likewise, the communities throughout Michigan may benefit from having bilingual and multilingual medical students serve in their medical facilities. Further research on the efficacy of leveraging language skills in various communities, as well as broadening the population sample, is warranted to refine and validate the observed pilot study results.

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

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.

Descriptive phenomenology study of the reasons for the low uptake of free health service package among type II diabetic patients

BACKGROUND

Although several diabetes management and control programs are introduced in Iran, rate of using such cares in patients with Type II Diabetic in Ahvaz is low and they show no tendency for receiving free diabetes service package. The aim of this study was to identify reasons behind low uptake of free health service package among T2DM patients in Ahvaz, Iran.

METHODS

This descriptive phenomenology study based on semi-structured guided interviews of patients with Type II Diabetic in Ahvaz, was carried out in the year 2021. Through purposeful sampling, 495 patients with diabetics who not received health services package more than 6 months were interviewed until the data saturation. The gathered data were analyzed through conventional content analysis.

RESULTS

Reasons were categorized into three themes which include 13 subthemes and 57 codes. Themes included individual, accessibility, and structural factors. Besides, subthemes were lack of awareness, poor health literacy, adverse patients experience, difficulties to use services, verbal miscommunication cultural barriers, low trust, geographic barriers, time barriers, financial difficulties, lack of human resources, poor service delivery, and organizational factors were as barriers to participation.

CONCLUSION

Regarding individual level, there is a need for further training of diabetic patients. Besides, for accessibility and structural factors Iranian healthcare system needs a comprehensive integrated care for the management of diabetes, this underlines the collaboration for improving patients' uptake of free health service package.

Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers

Introduction

One of the most important factors affecting the increase of clients' satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP.

Method

This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16.

Findings

From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers (p < 0.05).

Conclusion

HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.

"I'm sorry, my English not very good": Tracking differences between Language-Barrier and Non-Language-Barrier emergency ambulance calls for Out-of-Hospital Cardiac Arrest

BACKGROUND

One-fifth of Australia's population do not speak English at home. International studies have found emergency calls with language barriers (LB) result in longer delays to out-of-hospital cardiac arrest (OHCA) recognition, and lower rates of bystander cardiopulmonary resuscitation (CPR) and survival. This study compared LB and non-LB OHCA call time intervals in an Australian emergency medical service (EMS).

METHODS

The retrospective cohort study measured time intervals from call commencement for primary outcomes: (1) address acquisition; (2) OHCA recognition; (3) CPR initiation; (4) telecommunicator CPR (t-CPR) compressions, in all identified LB calls and a 2:1 random sample of non-LB EMS calls from January to June 2019. Results for time intervals #1, 2, and 4 were benchmarked against the American Heart Association's (AHA) t-CPR minimal acceptable time standards. Patient survival outcomes were compared.

RESULTS

We identified 50 (14%) LB calls from a cohort of 353 calls. LB calls took longer than non-LB calls (n=100) for: address acquisition (median 29 vs 14 secs, p<0.001), OHCA recognition (103 vs 85 secs, p=0.02), and CPR initiation (206 vs 164 secs, p=0.01), but not for t-CPR compressions (292 vs 248 secs, p=0.12). Rates of OHCA recognition and 30-day-survival did not differ but smaller proportions of LB calls met the AHA standards.

CONCLUSION

Time delays found in LB calls point to phases of the call which need further qualitative investigation to understand how to improve communication. Overall, training call-takers for LB calls may assist caller understanding and cooperation during OHCAs.

The Social Lives of Infectious Diseases: Why Culture Matters to COVID-19

Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture-mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, transmission rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: (1) cross-society differences; (2) within-society communities and intergroup relations; and (3) individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions.

Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.