Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives

Strategies to address perceived barriers to timely kidney transplantation in the Netherlands: A qualitative study from a stakeholders' perspective

Objective

We present strategies to perceived barriers to access to kidney transplantation (KT) in the Netherlands.

Methods

This qualitative study (N = 70) includes nephrologists, social workers, surgeons, nurses, patients, former living kidney donors, policy employees, and insurance representatives. Interviews were conducted both in focus groups and individually and coded with NVivo.

Results

Participants proposed strategies within five domains. 1.Policy: Making KT guideline more visible. 2.Medical: Increase access and transparency to KT medical eligibility criteria (e.g., age, BMI) for patients and healthcare providers. 3.Psychological: Support patients who continue to use dialysis because of social interaction opportunities associated with dialysis settings to find such interaction elsewhere. Link kidney patients with fears for KT to experienced experts or trained professionals. 4.Social: Support patients with language barriers with interpreters and visual explanations. Support patients using social media, e.g. Facebook, to identify potential donors. Better expectation management to reduce reports of inadequate aftercare for living donors. 5.Economical: Solving negative economic incentives for KT by changing incentives.

Conclusion

Stakeholders see strategies for barriers in the entire care pathway.

Innovation

This large qualitative study gives an important overview which strategies stakeholders see improving access to KT. Some strategies offer opportunities to solve barriers in the short-term.

Understanding Professional Medical Interpreters' Perspectives on Advancing Accurate and Culturally Informed Patient-Provider Communication for Filipinos in Hawai'i: Qualitative Analysis

One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.

Effective communication with linguistically diverse patients: A concept analysis

OBJECTIVE

Effective communication is essential to providing high-quality healthcare. For linguistically diverse patients, communication remains a barrier to receiving equitable healthcare throughout the globe. It is necessary to examine the concept of effective communication with linguistically diverse patients.

METHODS

The Walker and Avant method was used to analyze the concept.

RESULTS

We define effective communication with linguistically diverse patients as any verbal or written communication between two or more individuals who do not speak the same language that utilizes accurate translation techniques to reach a shared message or understanding, where all parties involved are listened to and actively engaged. The antecedents, attributes, consequences, and empirical referents are mapped.

CONCLUSION

Effective communication with linguistically diverse patients is limited by a lack of access to professional language assistance, structural racism/discrimination, and policy barriers.

PRACTICE IMPLICATIONS

Healthcare workers hold the power to provide language assistance to patients and should therefore receive training in cultural competency, cultural humility, and how to work with professional medical interpreters and language access programs. Institutions should invest in multimodal approaches to provide equitable healthcare to linguistically diverse patients.

Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis

WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issues National mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communities Several barriers exist for people from CALD communities in Victoria to access and utilise mental health services Improving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and services Various challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in Australia The data generated on the beliefs about mental health issues and consequent help-seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The information from the study can be adapted for quality improvement and culturally responsive practices The strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakers The findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice.

ABSTRACT

INTRODUCTION: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023).

AIM

This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi-method research project.

METHOD

A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis.

RESULTS

The themes and sub-themes identified were: Settling issues; Perceptions of understanding of mental health issues (help-seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio-cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals.

DISCUSSION

Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria.

IMPLICATIONS FOR PRACTICE

The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice.

Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting

OBJECTIVES

In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia.

METHODS

An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed.

RESULTS

The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop.

CONCLUSION

Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.

Scoping the needs, roles and implementation of bilingual community navigators in general practice settings

This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system.

Healthcare Professionals' Views of Working with Medical Interpreters in a Cancer Setting: an Exploratory Study

Australia, like many other nations, continues to become more culturally and linguistically diverse. Medical interpreters play a key role in bridging the linguistic gap between healthcare professionals (HCPs) and patients. Little research exists from the HCP's perspective about working with interpreters. This study aimed to explore the views of HCPs regarding working with interpreters in a cancer setting. This exploratory study utilised a cross-sectional, qualitative design, involving focus groups and semi-structured interviews. HCPs from the Oncology and Palliative Care units were invited to participate and were asked about their experiences of working with interpreters in a cancer setting. Interviews were audio-recorded and transcribed. An inductive thematic analysis of qualitative data derived an understanding of attitudes and beliefs which may affect the way in which HCPs interact with interpreters and patients. Twenty-five participants were recruited. Five key themes emerged from the data: (1) communication practices and preferences, (2) training and supports, (3) alternative methods for translation, (4) challenges faced by HCPs and interpreters, and (5) limitations of translation. Communication with non-English-speaking patients using interpreters could be significantly improved with further training and support for both HCPs and interpreters, and a greater appreciation for the challenges each party faces.

Providing Care by Telephone to Refugees and Asylum Seekers: An Evaluation of Telephone Mode-of-Care in Monash Health Refugee Health and Wellbeing Clinic in Victoria, Australia

An evaluation of accessibility, appropriateness, acceptability and efficiency of telephone consultations, implemented at Monash Health Refugee Health and Wellbeing (MH RHW) throughout the COVID-19 pandemic, was conducted. A convergent mix-methods design was used, with both patients (n = 50) and clinicians (n = 11) participating in a survey, and two focus groups (n = 14) involving clinicians being conducted. Service utilization data was sourced from the MH RHW database. During May to December 2020, 61% (n = 3012) of the consultations were conducted by telephone, 42% (n = 11) of these required interpreters in a 3-way conversation Most patients were satisfied with telephone as a medium for providing care and with the quality of telephone-based care. Similarly, clinicians considered telephone consultations to be an acceptable mode-of-care for most patients during the pandemic, however, expressed caution in relation to certain patient cohort. Finally, the provision of care by telephone was considered no more efficient than face-to-face service provision, as reflected in the time required for each consultation, with some clinicians reporting adverse workload outcomes. This study highlighted the benefits and challenges of telephone consultations from patient and clinician perspectives. It also highlighted the types of patients that may not be suited to telephone consultations. Overall, this study showed that telephone service delivery is a feasible option in providing care to people of refugee background and should be considered in future decisions as an ongoing Medicare (Australia’s universal healthcare insurance scheme) billing item. However, clinical discretion should prevail in determining the most appropriate means of delivering care.

Challenges and chances by involving community interpreters in the regular health care of pregnant women and young mothers from third countries with language barriers. A qualitative study within the project RundUm – Transcultural network in the care of pregnancy and birth / Herausforderungen und Chancen bei der Hinzuziehung von Sprach- und Integrationsmittlerinnen in die Regelversorgung von Schwangeren und jungen Müttern aus Drittstaaten. Eine qualitative Erhebung im Rahmen des Projektes RundUm – Transkulturelles Netzwerk zur Begleitung bei Schwangerschaft und Geburt

Einleitung

Zur sprachlichen Verständigung und Partizipation an den Versorgungsstrukturen des Sozial- und Gesundheitswesens bei Menschen mit Sprachbarrieren und einem Migrations- oder Fluchthintergrund entwickelte sich der Tätigkeitsbereich der Sprach- und Integrationsmittler/-in in Abgrenzung zum/zur Dolmetscher/-in. Im Rahmen des Forschungsprojektes RundUm begleiteten Sprach- und Integrationsmittlerinnen des Sprachmittlerdienstes SprInt in Essen Schwangere und junge Mütter zu Terminen der Regelversorgung im Gesundheitswesen. Die Chancen und Herausforderungen innerhalb der geburtshilflichen Versorgung aus Sicht der Sprach- und Integrationsmittlerinnen sind Gegenstand der vorliegenden Studie.

Methode

Im Rahmen von qualitativen Experteninterviews wurden 14 Sprach- und Integrationsmittelnde des Sprachmittlerdienstes SprInt in Essen befragt. Die Transkripte wurden inhaltsanalytisch ausgewertet.

Ergebnisse

Herausforderungen zeigen sich in der Kontaktaufnahme zu den Klientinnen und in Aspekten der Zusammenarbeit mit professionellen Fachkräften und dem Verhältnis zwischen professionellen Akteuren/-innen der Regelversorgung und ihren Patientinnen/Frauen. Fehlende sprachliche Kompetenzen der Sprachmittlerin im Themengebiet der geburtshilflichen Versorgung, die Konfrontation mit interkulturellen Unterschieden und eine Unsicherheit der professionellen Akteure/-innen im Umgang mit Sprach- und Integrationsmittlung beeinflussen die Tätigkeit. Daneben bieten unterschiedlich praktizierte Rollenverständnisse der SprInterinnen Chancen und Konfliktpunkte in der Zusammenarbeit im Versorgungsnetzwerk Schwangerer und junger Mütter.

Diskussion

Die Bedeutung der Arbeit der Sprach- und Integrationsmittlerinnen für eine bedarfsgerechte geburtshilfliche Versorgung von Frauen mit Sprachbarrieren bietet Chancen für eine öffentliche Diskussion um die Anerkennung des Tätigkeitsprofils. Anpassung und Ausbau von themenspezifischen Qualifikationsmaßnahmen können dabei helfen, Kompetenzen zur Übernahme einer Brücken- und Lotsenfunktion im Sprachund Integrationsmittlungsprozess zu entwickeln und nachfolgend zu praktizieren. Dies impliziert abgesicherte Finanzierungsmöglichkeiten für die Hinzuziehung von Sprach- und Integrationsmittlerinnen in die Regelversorgung von Schwangeren und jungen Müttern und eine Implementierung in interprofessionelle Netzwerkstrukturen.

Developing interprofessional collaboration between clinicians, interpreters, and translators in healthcare settings: outcomes from face-to-face training

Interprofessional collaboration between clinicians, interpreters, and translators is crucial to providing care for consumers with limited English proficiency. Interprofessional training for these professions has been overlooked outside of the medical field. This study investigated whether face-to-face training for speech pathologists, interpreters, and translators improved their knowledge, confidence, practice, and attitudes to engage in interprofessional collaboration. It also examined whether single-profession training for speech pathologists can produce similar training outcomes when delivered to multiple healthcare professions. Thirty interpreters and translators (30 training), 49 speech pathologists (27 training, 22 control), and a mixed group of 24 clinicians from eight professions (16 training, 8 control) completed surveys before, after, and two months after their respective training event. Training outcomes were similar across cohorts. Knowledge and confidence improved and were maintained after two months. Attitudes toward interprofessional collaboration were positive despite perceptions of challenge, and this was largely unchanged after training. Intent to implement optimal practices after training was greater than self-reported practices two months later. While years of professional experience did not affect training outcomes for clinicians, knowledge improvement for interpreters was associated with having less professional experience. Findings highlight the need to reevaluate service planning, policy, and workforce development strategies alongside foundation level training to deliver effective interprofessional education for clinicians, interpreters, and translators in healthcare settings.

The professional interpreter's effect on empathic communication in medical consultations: A qualitative analysis of interaction

OBJECTIVE

To investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it.

METHODS

We coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters.

RESULTS

We identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor.

CONCLUSION

In IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction.

PRACTICE IMPLICATIONS

Doctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other's communicative goals.

Interpreters in healthcare: Nursing perspectives

PURPOSE

This study explored nursing experiences using interpreters in primary healthcare settings.

METHODS

Eight nurses in southern Sweden were subjected to semistructured interviews. The responses were divided into three categories using content analysis: interpreter influence, challenges, and strategies.

RESULTS

Despite using an interpreter to minimize language barriers, nurses do not achieve the same level of person-centered care as those who speak the same language as their patients, but translation services remain a useful communication tool for patient care.

CONCLUSION

Communication through an interpreter is an inevitability for healthcare professionals, and formal education is recommended to improve nurses' utilization of these services.

Clinical communication and the 'triangle of care' in mental health and deafness: Sign language interpreters' perspectives

Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters. Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis. Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled. Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people. Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware.

Implementing a digital communication assistance tool to collect the medical history of refugee patients: DICTUM Friedland - an action-oriented mixed methods study protocol

Background

Language barriers play a decisive role in determining the outcomes of medical consultations between healthcare providers and their foreign patients. This issue is a significant challenge to the German healthcare system, especially with the rising number of refugees in recent years. The communication gap between healthcare professionals and their non-German speaking patients sometimes leads to unnecessary medical re-admission, insufficient medical history, incorrect diagnosis, and treatment plans. In this study, we aim to assess the usability and accuracy of a novel digital translation tool in collecting medical history from patients in their native language and to check its effects on healthcare outcomes.

Methods

The study aims to monitor the implementation of a new digital communication assistance tool (DCAT) and to investigate its impact on the mutual understanding between refugee patients and their German general practitioners (GPs). In the first study phase, an action-oriented approach is used to implement DCAT. In the second study phase, DCAT use will be evaluated with a mixed methods design.

The main outcome assesses the re-consultation rates of patients before and after using DCAT. Secondary outcomes include the usability of the tool, its acceptance and perceived quality by patients, the accuracy of the information collected as determined from analysing the reasons for the consultation (ICPC-2 codes), and diagnosis (ICD-10 codes). The acceptance by patients, socio-demographic factors and native language are also taken into account.

The research designs for both study phases include questionnaires, semi-structured interviews, non-participant observation and analysis of collected patients’ data.

All the collected data is pseudonymised.

Discussion

The DCAT study is one of the new research projects in primary healthcare investigating the usability, accuracy, and acceptance of digital translation tools during medical encounters. We aim to eliminate significant communication errors and misunderstandings in medical consultations, thereby improving the quality of healthcare outcomes. By applying an action research design, we will attain a more comprehensive evaluation of DCAT scopes and limits. The results of this study are expected to give an in-depth understanding of possible applications and benefits of digital translation tools for patient care.

Trial registration

German Clinical Trials Register DRKS00013076, 29/09/2017.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3928-1) contains supplementary material, which is available to authorized users.