Impacts of an interpretation fee on immigrants' access to healthcare: Evidence from a Danish survey study among newly arrived immigrants

In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. Little is known about who is affected and how immigrants experience impacts of the fee. Using survey data from 2021 (n = 486), we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had impacted their access to healthcare. In the study population, 19% (n = 95) reported interpretation needs. Refugees and their families (OR: 10.2) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.86), low income (OR: 2.63) or poor self-perceived health (OR: 3.18), adjusted for gender, age, region of residence and length of stay. among immigrants needing interpretation, 42% (n = 69) reported having refrained from seeking healthcare due to the fee, 73% (n = 119) using ad hoc interpreters, and 77% (n = 126) trying to learn Danish faster. Findings suggest that the policy aim of incentivizing host country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care for a substantial group. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants' access to healthcare.

Interpreter services and effect on healthcare - a systematic review of the impact of different types of interpreters on patient outcome

Background

Utilization of interpreters to facilitate communication between health care providers and non-native speaking patients is essential to provide the best possible quality of care. Yet use and policy on the subject vary widely, as does knowledge on the effect of different types of interpreters. This paper systematically reviews the literature on use of interpreters in the medical setting to evaluate their effects on the quality of care.

Material and methods

We conducted a literature search of PubMed and Embase, supplemented with references from relevant previous literature. We included any report in a medical setting comparing one type of interpretation to any other, including no interpretation and measuring a patient outcome. No limit was set on time or language. Risk of bias was assessed using the Evidence Project Risk of Bias assessment tool and the CASP checklist for qualitative studies. Results were synthesized using REDCap and presented in tables.

Results

We identified 29 reports represented by five types of studies. Types of interpreter intervention examined were professional, ad hoc, relational, any and no interpreter. Outcomes measured were satisfaction, communication, utilization and clinical outcomes. Results were indicative of in-person professional interpreter resulting in highest satisfaction and communication, reaffirming that any interpreter is better than none and relational interpreters can be a valuable interpreter resource for patients in the private practice setting. To be able to further differentiate on outcome for interventions of ad-hoc or relational interpreters, further data is needed.

Discussion

In-person Professional interpreter is the interpreter type resulting in greatest satisfaction and best communication outcome for the patients. This review is limited by most data originating from one country, interpretation from mainly Spanish to English and in one cultural setting.

Funding

No funding was provided for this review.

Language Access and Orofacial Pain

Clear and effective communication is vital to quality patient care. More than 66 million Americans (21.5%) speak a language other than English at home, with more than 25 million (8.2%) speaking English "less than very well." Addressing language differences in the orofacial pain setting is of utmost importance to care quality, treatment outcomes, and overall health equity. In the case presented, language-related communication challenges affect the diagnosis and management of a patient with orofacial pain. This case highlights the significance of language discordance in the clinical setting and demonstrates the need for greater language access in the orofacial pain field.

The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: A retrospective case note review

BACKGROUND

Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services.

METHODS

In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services.

FINDINGS

Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care.

INTERPRETATION

Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement.

FUNDING

National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands.

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation

BACKGROUND

Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers' health. Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study's objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.

METHODS

The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.

RESULTS

The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.

CONCLUSIONS

The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.

Informing physician strategies to overcome language barriers in encounters with pediatric patients

OBJECTIVES

To describe physician perceptions of differences in limited English proficient (LEP) pediatric encounters and the behavioral adaptations they make to provide quality care to LEP pediatric patients.

METHODS

We conducted 30min, semi-structured interviews with 6 family physicians and 5 pediatricians in one health system. Audiotapes from each interview were transcribed verbatim then coded using content analysis.

RESULTS

Multiple aspects of the LEP pediatric encounter were perceived by physicians as different from other encounters: trust and relationship between physician and LEP child/child's family, continuity of care, encounter's structure and flow, patient assessment, and communication barriers. Within each of these themes, physicians identified how they adapt their behavior to improve the quality of care provided to LEP children and families.

CONCLUSIONS

Physicians' made both positive and negative adaptations in LEP pediatric encounters that may impact the quality of care provided to these patients.

PRACTICE IMPLICATIONS

By identification of specific positive and negative behavioral adaptations, this study emphasizes intervention targets, such as demonstrating interest in an LEP pediatric patient's family story and individuality and using common niceties in conversations with LEP children.

Telephone triage utilization among patients with limited English proficiency

BACKGROUND

Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP.

METHODS

This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP.

RESULTS

Call volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001).

CONCLUSION

Patients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.

Utilization of a mental health collaborative care model among patients who require interpreter services

Background

Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice.

Methods

This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not.

Results

Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]).

Conclusions

Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.

Limited English proficient Hmong- and Spanish-speaking patients' perceptions of the quality of interpreter services

BACKGROUND

Language barriers are a large and growing problem for patients in the US and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients' perceptions of these interpreter services.

OBJECTIVE

To examine Hmong- and Spanish-speaking patients' perceptions of interpreter service quality in the context of receiving cancer preventive services.

METHODS

Twenty limited English proficient Hmong (n=10) and Spanish-speaking participants (n=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis.

RESULTS

The two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters' ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients.

CONCLUSIONS

Our study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services.