Navigating the Language and Culture Barrier in Healthcare

Today more than ever, medicine knows no borders. In the United States, our citizenry continues to diversify representing the world—a reality that applies to both healthcare providers and their patients. The challenge is how to communicate in a way so that illness can be treated effectively, no matter the barriers.

For patients, there is fear plus whatever pain they’re dealing with and the struggle to understand complex science. For healthcare professionals, there are more patients and treatments every day, not to mention the need to remain objective. If differing language and culture are factored in, this puts additional strain on the system and the goal to cure. 

In 1964, in an effort to address the problem of language barriers, the Civil Rights Act established that it was a legal right for all individuals to have language assistance services when receiving health care. And in the ensuing 43 years, the industry has struggled to meet the need for the constantly-changing populace they serve. Per the November 2007, Journal of General Internal Medicine article, “linguistic diversity of the USA has burgeoned with more than 200 different languages now spoken across the country.” 

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To build a better bridge of communication, experts must continue to step back and assess how they align their resources to serve a wide variety of patients. Something as basic as how candidates are selected, for example, could be key. 

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In a community such as Washington, D.C, one outlet discovered that testing for new employees was done primarily in English, even when their patient population spoke several other languages. The reality of the disparity in what we do versus what we know plays out in communities throughout the country. Per a 2017 article in the Home Health Care News, “Despite the fact that Spanish is the second most spoken language in the U.S., only 13.1% of RN visits with Spanish speaking patients were language concordant, compared to 31.3% for Koreans, Russian 22.4% and Chinese speakers with 18.7%.” Part of the problem may be in how the industry brings on staff to help serve their patients.

Where there is confusion, there will be error in the delivery of services, and the patient will have a negative experience in care. The March 2020 Oman Medical Journal article cited data revealing that “many patients with limited local language proficiency experienced adverse health events that resulted in detectable physical harm (49.1% of patients)…or experienced some failure in communication with medical providers (52.4%).”

Language Challenge for Elders

Differing languages and cultures become uniquely problematic for elders faced with conditions of aging, particularly the loss of hearing. An older patient’s ability to understand a person speaking with an accent, even if it is in the patient’s native language, can become a significant impediment to care.

One of the frequent top-10 complaints of older patients is that they can’t understand the healthcare staff who work with them. The patient is forced to spend a great deal more effort listening, which creates stress.

Professional home health providers such as Home Health Companions understand that this is an issue for clients. We work with our staff in training to address the need to speak slowly, clearly, and face-to-face to assist in comprehension for both the patient and care provider.

Strategies to Break the Barrier

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Although language and culture differences continue to challenge the healthcare system, there are concepts, services and new technologies that can help, such as:

  • Acknowledge diversity. Our knee-jerk response as humans is to identify commonalities and quickly overlook how we are different, but this can also lead to inaccurate assumptions. 
  • Employ a culturally and linguistically diverse staff. Patients feel better when they experience a space with people they perceive to be similar to them. 
  • Provide new staff orientation and ongoing training regarding the subject of diversity to help cultivate a culture of acceptance of values, principles and practices that are different. 
  • Provide educational materials and signage in a variety of languages that is tested to be culturally and linguistically appropriate. 
  • Whenever possible, use on-site interpreters. Staff interpreters are especially important, even when the person brings in a family member (particularly a child). Candid information sharing between the patient and medical professional could be limited by the dynamic of any family member as the go-between. In addition, medical language requires the precision of an expert interpreter who can translate technical terms for the patient and physician in the situation. 
  • Use off-site phone interpreter services when staff interpreters are not available.  
  • Interpreter services indirectly increase the cost of health services and also tend to increase the length of treatment visits. Online translation tools have stepped in to try and mitigate these issues offering Google Translate and MediBabble as possible solutions. 

The disconnect that comes from the wall of misunderstanding due to language and culture will continue to be an issue for healthcare providers and their patients. Following these best practices to celebrate diversity and even use it to your advantage will create doors and windows in the wall to improve the healthcare system for everyone.

Bibliography:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150609/#:~:text=In%20the%20federal%20arena%2C%20the,right%20to%20language%20assistance%20services.

Language Barriers in Home Health Put Patient Outcomes at Risk

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/

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