Breaking down language barriers. The NHS needs to provide accessible interpreting services for all

Language barrier as a risk factor for obstetric anal sphincter injury - A case-control study

INTRODUCTION

The incidence of grade 3-4 perineal tears, also known as obstetric anal sphincter injury (OASI), is reported to be between 0.5 and 2.5%. Beyond the medico-economic burden, the consequences of OASI on a woman's emotional, psychological, sexual, and physical wellbeing are considerable. Among the various risk factors of OASI, few data are available about the impact of a language barrier on its incidence.

MATERIAL AND METHODS

We conducted a case-control study to evaluate the effect of language barriers on the risk of OASI comparing 171 women with OASI and 163 matched controls. The matched criteria included ethnicity, age, previous vaginal delivery, delivery mode, prophylactic episiotomy and birthweight. Patients' characteristics were compared and crude ORs and 95% CIs estimated using unadjusted logistic models. Multivariate analysis was performed with recognized potential confounders.

RESULTS

All of the cases had grade 3 tears. Language barrier was a determinant factor of OASI with an OR of 3.32 [1.36-8.90], p = 0.01. Other risk factors were occipito-posterior delivery, African origin and prolonged labor duration (OR 6.33, 95% CI: 2.04-27.78, p = 0.004, OR 1.85, 95% CI: 1.08-3.19, p = 0.03 and OR 1.03, 95% CI: 1.01-1.05, p = 0.004, respectively).

CONCLUSION

Our data suggest that language barrier is an independent risk factor of OASI. Physicians and midwives should attempt to identify patients with a language barrier during prenatal visits. Education about simple terms used during delivery could decrease the incidence of this complication.

Current status of stroke in Qatar: Including data from the BRAINS study

BACKGROUND

Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce.

METHOD

We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients.

RESULTS

Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians.

CONCLUSION

The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.

Challenges in the Delivery of E-Government through Kiosks

Kiosks are increasingly being heralded as a technology through which governments, government departments and local authorities or municipalities can engage with citizens. In particular, they have attractions in their potential to bridge the digital divide. There is some evidence to suggest that the citizen uptake of kiosks and indeed other channels for e-government, such as web sites, is slow, although studies on the use of kiosks for health information provision offer some interesting perspectives on user behaviour with kiosk technology. This article argues that the delivery of e-government through kiosks presents a number of strategic challenges, which will need to be negotiated over the next few years in order that kiosk applications can be successful in enhancing accessibility to and engagement with e-government. The article suggests that this involves consideration of: the applications to be delivered through a kiosk; one stop shop service and knowledge architectures; mechanisms for citizen identification; and the integration of kiosks within the total interface between public bodies and their communities. The article concludes by outlining development and research agendas in each of these areas.

Survey of family physicians' perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs

OBJECTIVE

Immigrants in Canada form a significant portion of the population and have unique and complex health needs. This study was undertaken to evaluate family physicians' perspectives on the care of this population.

METHODS

Questionnaires were distributed to family physicians in Montreal (n=598). The main outcomes of interest were attitudes of family physicians to care of immigrants including barriers perceived, resources and strategies used to accommodate immigrant patients, as well as physicians' training in immigrant care.

RESULTS

Family physicians find communication difficulties to be the key barrier and would like to see the access to interpreters improved. Very few physicians make use of professional interpreters. Only a minority of physicians have received specific cross-cultural competence training but those who have seem to provide better quality of care.

CONCLUSIONS

Knowledge of physician perspectives is an essential element on which to base interventions to improve the quality of care to this population.

PRACTICE IMPLICATIONS

Physicians should be reminded of the importance of using professional interpretation services in multi-lingual encounters. Cross-cultural training should be further advanced in Canadian medical curricula.

The unmet need for interpreting provision in UK primary care

Background

With increasing globalisation, the challenges of providing accessible and safe healthcare to all are great. Studies show that there are substantial numbers of people who are not fluent in English to a level where they can make best use of health services. We examined how health professionals manage language barriers in a consultation.

Methods and Findings

This was a cross-sectional study in 41 UK general practices . Health professionals completed a proforma for a randomly allocated consultation session.

Seventy-seven (63%) practitioners responded, from 41(59%) practices. From 1008 consultations, 555 involved patients who did not have English as a first language; 710 took place in English; 222 were in other languages, the practitioner either communicating with the patient in their own language/using an alternative language. Seven consultations were in a mixture of English/patient's own language. Patients' first languages numbered 37 (apart from English), in contrast to health practitioners, who declared at least a basic level of proficiency in 22 languages other than English. The practitioner's reported proficiency in the language used was at a basic level in 24 consultations, whereas in 21, they reported having no proficiency at all. In 57 consultations, a relative/friend interpreted and in 6, a bilingual member of staff/community worker was used. Only in 6 cases was a professional interpreter booked. The main limitation was that only one random session was selected and assessment of patient/professional fluency in English was subjective.

Conclusions

It would appear that professional interpreters are under-used in relation to the need for them, with bilingual staff/family and friends being used commonly. In many cases where the patient spoke little/no English, the practitioner consulted in the patient's language but this approach was also used where reported practitioner proficiency was low. Further research in different setting is needed to substantiate these findings.

GPs' perceptions of the service needs of South Asian people with chronic pain: a qualitative enquiry

This qualitative study describes GPs' experiences of and needs for management of people from a South Asian community who have chronic pain. Semi-structured interviews were conducted with 18 GPs from practices in two PCTs in Leicester. The data was analysed using grounded theory. The results indicate that managing patients from a South Asian community with chronic pain can be challenging due to differing pain expression and presentation. Emerging themes refer to shortages of services for these patients including the need for CBT, counselling, community support and GP education and training. Potential implications of the results for service provision are discussed.

Translating genetics leaflets into languages other than English: lessons from an assessment of Urdu materials

Genetic counselors frequently counsel clients whose first language is not English, relying on interpreters and on supplementary translated written material. This paper highlights factors that counselors need to consider before using or commissioning translated leaflets. It is based on an assessment of leaflets translated into Urdu, the national language of Pakistan, which are available through U.K. genetics clinics for use with Pakistani-origin clients. The 2 authors, who know Urdu as their 2nd and 1st languages respectively, independently read each leaflet, checking for accuracy of information, ease of reading and understanding, cultural sensitivity, and contact details for Urdu-speaking professionals. There were factual errors and confusing or very difficult text in all leaflets; some leaflets also contained culturally insensitive messages that could alienate users of genetics services. The paper discusses the reasons for these pitfalls and makes recommendations to guide the future production of translated genetics leaflets.

Strengthening Cultural Sensitivity in Children’s Disaster Mental Health Services

During and following natural or man-made disasters, relief efforts have a long history of initially focusing on basic survival needs, then restoring community stability. Disaster mental health is a relatively new aspect of relief efforts, particularly in regard to children’s needs. After reviewing objectives of major relief organizations and summarizing current research in light of practitioners’ input, suggestions and resources are offered to strengthen cultural sensitivity in school-based disaster mental health services.

Ischemic Stroke in South Asians

Background and Purpose— Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group.

Summary of Review— A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural–urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent.

Conclusions— This review emphasizes the importance of further research into ischemic stroke for South Asians given their higher cardiovascular disease burden and necessity for targeted healthcare approaches.

Understanding, testimony and interpretation in psychiatric diagnosis

Psychiatric diagnosis depends, centrally, on the transmission of patients' knowledge of their experiences and symptoms to clinicians by testimony. In the case of non-native speakers, the need for linguistic interpretation raises significant practical problems. But determining the best practical approach depends on determining the best underlying model of both testimony and knowledge itself. Internalist models of knowledge have been influential since Descartes. But they cannot account for testimony. Since knowledge by testimony is possible, and forms the basis of psychiatric diagnosis, its very existence is a factor in support of an externalist model of knowledge in general. Internalist and externalist models of knowledge also suggest different ways of responding to the practical challenges of basing psychiatric diagnosis on testimony. Thus the argument in favour of externalism also supports a potentially empirically testable hypothesis about interpretation of non-native speakers for accurate psychiatric diagnosis: interpretation of non-English speakers should be as transparent and unhindered by specialised medical knowledge as possible.

Access to interpreting services in England: secondary analysis of national data

BACKGROUND

Overcoming language barriers to health care is a global challenge. There is great linguistic diversity in the major cities in the UK with more than 300 languages, excluding dialects, spoken by children in London alone. However, there is dearth of data on the number of non-English speakers for planning effective interpreting services. The aim was to estimate the number of people requiring language support amongst the minority ethnic communities in England.

METHODS

Secondary analysis of national representative sample of subjects recruited to the Health Surveys for England 1999 and 2004.

RESULTS

298,432 individuals from the four main minority ethnic communities (Indian, Pakistani, Bangladeshi and Chinese) who may be unable to communicate effectively with a health professional. This represents 2,520,885 general practice consultations per year where interpreting services might be required.

CONCLUSION

Effective interpreting services are required to improve access and health outcomes of non-English speakers and thereby facilitate a reduction in health inequalities.

Experiences of refugees and asylum seekers in general practice: a qualitative study

BACKGROUND

There has been much debate regarding the refugee health situation in the UK. However most of the existing literature fails to take account of the opinions of refugees themselves. This study was established to determine the views of asylum seekers and refugees on their overall experiences in primary care and to suggest improvements to their care.

METHODS

Qualitative study of adult asylum seekers and refugees who had entered the UK in the last 10 years. The study was set in Barnet Refugee Walk in Service, London. 11 Semi structured interviews were conducted and analysed using framework analysis.

RESULTS

Access to GPs may be more difficult for failed asylum seekers and those without support from refugee agencies or family. There may be concerns amongst some in the refugee community regarding the access to and confidentiality of professional interpreters. Most participants stated their preference for GPs who offered advice rather than prescriptions. The stigma associated with refugee status in the UK may have led to some refugees altering their help seeking behaviour.

CONCLUSION

The problem of poor access for those with inadequate support may be improved by better education and support for GPs in how to provide for refugees. Primary Care Trusts could also supply information to newly arrived refugees on how to access services. GPs should be aware that, in some situations, professional interpreters may not always be desired and that instead, it may be advisable to reach a consensus as to who should be used as an interpreter. A better doctor-patient experience resulting from improvements in access and communication may help to reduce the stigma associated with refugee status and lead to more appropriate help seeking behaviour. Given the small nature of our investigation, larger studies need to be conducted to confirm and to quantify these results.

Communication between South Asian patients and GPs: comparative study using the Roter Interactional Analysis System

BACKGROUND

The UK South Asian population has poorer health outcomes. Little is known about their process of care in general practice, or in particular the process of communication with GPs.

AIM

To compare the ways in which white and South Asian patients communicate with white GPs.

DESIGN OF STUDY

Observational study of video-recorded consultations using the Roter Interactional Analysis System (RIAS).

SETTING

West Yorkshire, UK.

METHOD

One hundred and eighty-three consultations with 11 GPs in West Yorkshire, UK were video-recorded and analysed.

RESULTS

Main outcome measures were consultation length, verbal domination, 16 individual abridged RIAS categories, and three composite RIAS categories; with comparisons between white patients, South Asian patients fluent in English and South Asian patients nonfluent in English. South Asians fluent in English had the shortest consultations and South Asians non-fluent in English the longest consultations (one-way ANOVA F = 7.173, P = 0.001). There were no significant differences in verbal domination scores between the three groups. White patients had more affective (emotional) consultations than South Asian patients, and played a more active role in their consultations, as did their GPs. GPs spent less time giving information to South Asian patients who were not fluent in English and more time asking questions. GPs spent less time giving information to South Asian patients fluent in English compared with white patients.

CONCLUSIONS

These findings were expected between patients fluent and non-fluent in English but do demonstrate their nature. The differences between white patients and South Asian patients fluent in English warrant further explanation. How much of this was due to systematic differences in behaviour by the GPs, or was in response to patients' differing needs and expectations is unknown. These differences may contribute to differences in health outcomes.

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services

OBJECTIVES

This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group.

REVIEW

Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers.

CONCLUSIONS

The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.

Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective

We report a qualitative study of accounts of interpreted consultations in UK primary care. The study sought to explore how three Habermasian tensions between (a) system and lifeworld, (b) communicative and strategic action, and (c) interpersonal and macropolitical spheres played out in the triadic consultation between clinician, interpreter and patient. In a total of 69 individual interviews and two focus groups, we collected narratives from service users (through interpreters or bilingual researchers), interpreters and doctors and other staff in general practice. We recorded, transcribed and analysed these, taking the story as the main unit of analysis. Our data suggest that the preconditions for communicative action are rarely met in the interpreted consultation. The interpreter's presence makes a dyadic interaction into a triad, adding considerable complexity to the social situation and generating operational and technical challenges. Lack of trust, intense pressure of time, mismatch of agendas (biomedical versus lifeworld), firm expectations of a specific outcome (e.g. referral, prescription) and profound power imbalances all promote strategic action (i.e. speech that seeks consciously or unconsciously to manipulate an outcome) rather than communicative action (i.e. sincere efforts to achieve understanding, and reach consensus) by all parties. In consultations interpreted by family members (an option traditionally seen as 'second best' by policy makers), the social situation is very different. Family members are generally trusted, share the lifeworld agenda, and shift the power balance in the patient's favour. The interpreter occupies multiple social roles, including translator, interpersonal mediator, system mediator, educator, advocate, and link worker. The essence of professionalism in interpreting is shifting judiciously between these potentially conflicting roles. We discuss the implications of our findings for communication with limited English speakers in healthcare consultations and for realizing contemporary policy goals such as concordance, shared decision-making, empowerment, and choice.

Patients' experiences and expectations of general practice: a questionnaire study of differences by ethnic group

BACKGROUND

Research has highlighted variations in morbidity, mortality and health needs by ethnic group, and suggests that some ethnic groups may receive a poorer service.

AIM

To explore the impact of ethnic group on patients' experiences and expectations of their general practice consultation.

DESIGN OF STUDY

Cross-sectional survey.

SETTING

One general practice in a multicultural area of London.

METHOD

A total of 604 consecutive patients attending their general practice (response rate = 60.4%) who described their ethnic group as white British, black African, black African Caribbean or Vietnamese completed a measure relating to their experiences and their expectations of the general practice consultation in terms of treatment, communication, patients' agenda, patients' choice and doctor consistency.

RESULTS

No differences were found for the black African or black African Caribbean patients. The Vietnamese patients reported better experiences of communication, more focus on their agenda and more attention to their choices than the white British patients. However, they also reported expecting lower levels of communication, less focus on their own agenda and reported wanting less GP consistency than the other ethnic groups.

CONCLUSION

Vietnamese patients state that they are receiving better standards of care in general practice than other ethnic groups. However, they also state that they expect less. This may illustrate a problem with assessing experiences of primary care. Higher scores of experience may not illustrate better consultations as such, but only better when compared with a lower level of initial expectation. A lower expectation is easier to fulfil.

Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral

The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.

Bilingual young people's experiences of interpreting in primary care: a qualitative study

BACKGROUND

Young people are often used as interpreters for family members in the primary healthcare setting.

AIM

To explore bilingual young people's accounts of interpreting for family or friends in primary care settings.

DESIGN OF STUDY

Qualitative study using in-depth interviews.

SETTING

Community and youth groups in London.

METHODS

Young people aged nine to 18 years old (n = 77) were purposively sampled to include those from established and recently arrived groups and were from Vietnamese, Kurdish, Bangladeshi or Eastern European backgrounds. Participants were interviewed one-to-one or with a friend, and interview transcripts were analysed to identify key themes.

RESULTS

Young people were used for interpreting because of deficiencies in services, and also by choice. They identified advantages and disadvantages in their experiences. The majority of healthcare encounters were regarded as unproblematic. Three factors contributed to less successful encounters: healthcare professionals' or patients' communication skills; young people's own language skills, and the nature of the healthcare problem.

CONCLUSION

This study identifies ways in which primary care professionals could facilitate better communication in encounters where young people are used as interpreters.

A problem of communication? Diabetes care among Bangladeshi people in Bradford

People of Bangladeshi origin in the UK continue to experience poorer health and poorer healthcare than other sections of the community. Although communication with medical and nursing staff has long been recognised as key to the provision of effective healthcare services, efforts to overcome communication problems have often been minimal: many practitioners and patients rely on informal interpreters, usually family members, to assist them, despite the shortcomings of these arrangements. The present paper examines the experiences of 12 Bangladeshi people in Bradford, obtained during the course of a wider evaluation of diabetes services. All but one of the in-depth interviews were carried out in Sylheti and explored respondents' experiences of diabetes and local services. Software-assisted analysis of the transcripts followed a framework approach. It was found that, in the absence of alternatives, informal interpreting support was a necessity for many people: making appropriate arrangements frequently involved disruption to family members' routines and responsibilities, yet access to healthcare was often not possible without them. Despite the acknowledged problems, informal arrangements were often preferred: the benefits included greater privacy, support in the consultation, and a shared understanding of advice and instructions. Many patients nonetheless received poor quality care, although this appeared to be related less to language difficulties than to professional attitudes and methods of working.

Reflections on communicating with non-English-speaking patients

Nursing patients who speak no English has ethical, legal and professional implications for patients, relatives and healthcare staff. Appropriate communication between a patient and members of the healthcare team demonstrates respect, and empowers the patient to make healthcare decisions. Without appropriate translation, the patient who speaks no English is extremely vulnerable. Healthcare professionals have a duty to provide appropriate care for all patients, irrespective of nationality and ability to speak English. Issues such as empowerment, advocacy and confidentiality need to be considered in relation to caring for non-English-speaking patients. The author of this article reflects on her lecturer exchange at the University of Barcelona, Spain, and how her limited ability to speak Spanish gave rise to considering the needs of non-English-speaking patients in the medical directorate at the Royal London Hospital. This reflection gave rise to working with clinical and university colleagues in an attempt to improve communication with non-English-speaking patients, thus combining the author's role as a nurse, ethics lecturer and link lecturer. Working with clinical and university colleagues gave rise to the development of an advocacy/translation box file for use in clinical practice, and the formation of a staff-student liaison committee working party to review the possibility of student nurses becoming volunteer translators for non-English-speaking patients.

Community voices: views on the training of future doctors in Birmingham, UK

The United Kingdom (UK) population is diverse with nearly 6% minority ethnic communities. Both patients and doctors experience difficulties when dealing with someone from a different ethnic group. Medical education has failed to keep pace with the changing needs of the diverse population. We report a project in which 12 established (religious/cultural and specific interest) community groups expressed their views on what future doctors should learn about serving diverse populations. Data were obtained by group discussion and through the media using a structured format. Fifteen themes emerged which were grouped under three broad themes: firstly, the identification by group members of their perception of the 'differences' in social and cultural beliefs and behaviours of their individual community; secondly, the identification of characteristics of a culturally sensitive doctor; and lastly, recommendations for changes in medical training. New teaching has been introduced to the medical curriculum that incorporates the themes raised by the communities and which reflects consciousness raising and communication issues.

Knowledge and attitudes in multicultural health care

Health professionals' knowledge of ethnic minority cultures and lifestyles was assessed to determine whether the respondents' cultural background and experience of working with ethnic minorities affected the health care delivered by them and to assess the need for training. Improving access to health services for ethnic minorities requires continuing education and training of all health professionals.

Providing health care for refugee children and unaccompanied minors

The health of refugee children must be considered beyond ensuring access to health care to include issues such as housing and education. Refugees require support in using services, and their culture and religious background must be taken into account. Asylum seeking children have the same rights to health as any other children, yet non-eligibility for welfare foods may have implications for their nutrition. Providing for 15-18 year olds presents particular problems. It is important to arrange access to appropriate care for unfamiliar diseases and to recognize emotional health problems, particularly when they are related to past experiences of violence.

Informed choice in genetic screening for thalassaemia during pregnancy: audit from a national confidential inquiry

OBJECTIVE

National audit of informed choice in antenatal screening for thalassaemia.

DESIGN

Audit from the UK Confidential Enquiry into Counselling for Genetic Disorders.

SETTING

Thalassaemia module of the UK Confidential Enquiry into Counselling for Genetic Disorders.

SUBJECTS

138 of 156 couples who had had a pregnancy affected by a major beta thalassaemia from 1990 to 1994.

MAIN OUTCOME MEASURES

How and when genetic risk was identified for each couple, and whether and when prenatal diagnosis was offered.

RESULTS

Risk was detected by screening before or during the first pregnancy in 49% (68/138) of couples and by diagnosis of an affected child in 28% (38/138) of couples. Prenatal diagnosis was offered in 69% (274/400) of pregnancies, ranging from 94% (122/130) for British Cypriots to 54% (80/149) for British Pakistanis and from 90% in the south east of England to 39% in the West Midlands. Uptake of prenatal diagnosis was 80% (216/274), ranging from 98% (117/120) among British Cypriots in either the first or second trimester to 73% (35/48) among British Pakistanis in the first trimester and 39% (11/28) in the second trimester. A demonstrable service failure occurred in 28% (110/400) of pregnancies, including 110 of 126 where prenatal diagnosis was not offered and 48 of 93 that ended with an affected liveborn infant.

CONCLUSION

Although antenatal screening and counselling for haemoglobin disorders are standard practices in the United Kingdom, they are delivered inadequately and inequitably. An explicit national policy is needed, aiming to make prenatal diagnosis in the first trimester available to all couples and including ongoing national audit.

Questionnaire survey of interpreter use in accident and emergency departments in the UK

OBJECTIVE

To determine the support for a national telephone interpreter service from accident and emergency (A&E) departments across the UK, and the factors that may influence that support. To determine the nature of interpreter needs for these departments.

METHODS

Postal questionnaire survey of 255 A&E departments in the UK.

RESULTS

A total of 197 replies were received, a response rate of 77.3%. Altogether 186 respondents answered the question on support for a national telephone interpreter service and 124 (66.7%) would support one. Those departments in favour were no more likely to have required an interpreter in the last seven days (chi 2 = 0.16, df = 1, p = 0.69), be in the inner city (Fisher's exact test, two sided probability, p = 1), have predominantly local population needs compared with tourist needs (chi 2 = 0.65, df = 1, p = 0.42), or be current users of a telephone interpreter service (chi 2 = 0.01, df = 1, p = 0.93). Seventy-nine of 180 (42.9%) departments had used some form of interpreter in the seven days preceding completion of the survey. Seventy-six of 86 (88.4%) of those departments using face to face interpreters had experienced difficulty obtaining an interpreter out of hours. Nationally, the following proportion of all A&E departments listed the named language as occurring among the three most common languages requiring interpretation: French 0.46 (95% confidence interval 0.42 to 0.50), Urdu 0.30 (0.26 to 0.34), and German 0.24 (0.21 to 0.27).

CONCLUSIONS

There is widespread need and support for a national telephone interpreter service that would match the requirements of 24 hour emergency health care provision.