Language barriers in healthcare delivery
A focus on expatriate healthcare providers in Ghanaian hospitals
Keywords:communication accommodation, convergence, expatriate doctors, healthcare, language barrier, multilingualism
The relevance of language for quality healthcare delivery cannot be overemphasised. Within the framework of communication accommodation theory, this paper discusses language barriers in expatriate doctor–patient communication in three state-owned hospitals in Ghana, and the strategies employed by the medical personnel to bridge communication gaps. The study design is qualitative and the data were obtained through semi-structured interviews with 16 expatriate doctors, three nurses and three patients. Furthermore, observation of five patient–doctor interactions was undertaken and notes taken. Both datasets were then analysed using the qualitative conventional content analysis approach. The findings revealed that the expatriate doctors employed convergence strategies such as ad hoc interpreters, gestures, picture charts and electronic dictionaries to deal with language barriers. The study is expected to stimulate further research into innovative ways of dealing with language barriers in expatriate doctor–patient interactions.
Anane, Akosua A. (2015) Doctor-Patient Communication in the Consulting Room: A Study of Two University Health Facilities in Ghana. Unpublished MPhil. dissertation, University of Education, Winneba, Ghana
Baker, David W., Risa Hayes and Julia Puebla B. Fortier (1998) Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Medical Care 36 (10): 1461–1470. https://doi.org/10.1097/00005650-199810000-00004
Benjamin, Ereshia, Leslie Swartz, Bonginkosi Chiliza and Linda Herring (2016) Language barriers in health: Lessons from the experiences of trained interpreters working in public hospitals in the Western Cape. South African Health Review 2016 (1): 73–81.
Bowen, Sarah (2001) Language Barriers in access to Healthcare. Ottawa: Health Canada.
Chui, Tina (2003) Longitudinal Survey of Immigrants to Canada. Ottawa: Statistics Canada.
Doyle, Louise, Catherine McCabe, Brian Keogh, Annemarie Brady and Margaret McCann (2019) An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing 24 (8): 443–455. https://doi.org/10.1177/1744987119880234
Elderkin-Thompson, Virginia, Roxane Cohen Silver and Howard Waitzkin (2001) When nurses double as interpreters: A study of Spanish-speaking patients in a US primary care setting. Social Science &Medicine 52 (9): 1343–1358. https://doi.org/10.1016/S0277-9536(00)00234-3
Escarce, Jose? and Kanika Kapur (2006) Access to and quality of health care. In Marta Tienda and Faith Mitchell (eds) National Research Council (US) Panel on Hispanics in the US, 410–446. Washington, DC: National Academies Press.
Flores, Glenn (2005) The impact of medical interpreter services on the quality of healthcare: A systematic review. Medical Care Research and Review 62 (3): 255–299. https://doi.org/10.1177/1077558705275416
Gallois, Cindy and Howard Giles (1998) Accommodating mutual influence in intergroup encounters. In M. T. Palmer and G. A. Barnett (eds) Mutual Influence in Interpersonal Communication: Theory and Research in Cognition, Affect and Behaviour, 135–162. Progress in Communication Science 14. Stamford, CT: Ablex.
Gasiorek, Jessica and Howard Giles (2013) Accommodating the interactional dynamics of conflict management. Iranian Journal of Society, Culture and Language 1 (1): 10–21.
Ghana Health Service (2002) The Patients’ Charter. Available online: https://www.ghanahealthservice.org/ghs-subcategory.php?cid=2&scid=46
Ghana Health Service (2017) The health sector in Ghana, facts and figures. Available online: https://www.ghanahealthservice.org/ghs-item-details.php?cid=5&scid=55&iid=128
Ghana Statistical Service (2010) Population and Housing Census. Accra: Ghana Statistical Service. Available online: https://statsghana.gov.gh/gssmain/storage/img/marqueeupdater/Census2010_Summary_report_of_final_results.pdf
Giles, Howard, Anthony Mulac, James J. Bradac and Patricia Johnson (1987) Speech accommodation theory: The first decade and beyond. Annals of the International Communication Association 10 (1): 13–48. https://doi.org/10.1080/23808985.1987.11678638
Giles, Howard and Tania Ogay (2007) Communication accommodation theory. In Bryan B. Whaley and Wendy Samter (eds) Explaining Communication: Contemporary Theories and Exemplars, 293–310. Mahwah, NJ: Lawrence Erlbaum.
Griffin, Em (2009) A First Look at Communication Theory (7th edition). San Francisco, CA: McGraw-Hill.
Hemsley, Bronwyn, Susan Balandin and Linda Worrall (2012) Nursing the patient with complex communication needs: Time as a barrier and a facilitator to successful communication in hospital. Journal of Advanced Nursing 68 (1): 116-26. https://doi.org/10.1111/j.1365-2648.2011.05722.x
Hsieh, Hsiu-Fang and Sarah E. Shannon (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15 (9): 1277–1288. https://doi.org/10.1177/1049732305276687
Hull, Melodie (2016) Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk. International Journal of Nursing Studies 54: 158–172. https://doi.org/10.1016/j.ijnurstu.2015.02.015
Jain, Parul and Janice L. Krieger (2011) Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters. Patient Education and Counseling 84 (1): 98-104. https://doi.org/10.1016/j.pec.2010.06.022
Janssen, Anna L and Roderick D. MacLeod (2010) What does care mean? Perceptions of people approaching the end of life. Palliative and Supportive Care 8 (4): 433–440. https://doi.org/10.1017/S1478951510000301
Karliner, Leah S., Elizabeth Jacobs, Alice H. Chen and Sunita Mutha (2007) Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Service Research 42 (2): 727–754. https://doi.org/10.1111/j.1475-6773.2006.00629.x
Kropp-Dakubu, Mary E. (2015) The Languages of Ghana. London: Routledge. https://doi.org/10.4324/9781315683393
Lagacé, Martine, Annick Tanguay, Marie-Lyse Lavallée, Joelle Laplante and Sarah Robichaud (2012) The silent impact of ageist communication in long term care facilities: Elders’ perspectives on quality of life and coping strategies. Journal of Aging Studies 26 (3): 335–342. https://doi.org/10.1016/j.jaging.2012.03.002
Levin, Michael E. (2006) Language as a barrier to care for Xhosa-speaking patients at a South African pediatric teaching hospital. South African Medical Journal 96 (10): 1076–1079.
Lopez, Mark H., Manuel J. Krogstad and Jeffrey S. Passel (2019) Who is Hispanic? Washington, DC: Pew Research Centre FactTank. Available online: https://www.pewresearch.org/fact-tank/2019/11/11/who-is-hispanic/
Osae-Larbi, Judith A. (2016) Bridging the language gap in the health of multicultural societies: A report of a proposed mobile phone-based intervention using Ghana as an example. Springerplus 5 (1): Art. 900. https://doi.org/10.1186/s40064-016-2602-x
Passel, Jeffrey S. and D’Vera Cohn (2008) U.S. Population Projections: 2005-2050. Washington, DC: Pew Research Centre.
Republic of Ghana (1992) Constitution of Ghana. Available online: https://www.wipo.int/edocs/lexdocs/laws/en/gh/gh014en.pdf
Saulse, Bernice (2010) Interpreting within the Western Cape Healthcare Sector: A Descriptive Overview. Unpublished MPhil. dissertation, University of Stellenbosch, South Africa.
Sandelowski, Margarete J. (2000) Whatever happened to qualitative description? Research in Nursing and Health 23 (4): 334–340. https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
Schiaffino, Melody K., Mona al-Amin and Jessica R. Schumacher (2014) Predictors of language service availability in U.S. hospitals. International Journal of Health Policy Management 3 (5): 259–268. https://doi.org/10.15171/ijhpm.2014.95
Senayah, Ebenezer A. (2016) Barriers to Healthcare: The Case of Students at Ashanti School for the Deaf, Jamasi. Unpublished MSc dissertation, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Schlemmer, Arina and Bob Mash (2006) The effects of a language barrier in a South African district hospital. South African Medical Journal 96 (10): 1084–1087.
Shapiro, Johanna and Eleanor B. Saltzer (1981) Cross-cultural aspects of physician-patient communication patterns. Urban Health 10 (10): 10–15.
Simons, Gary F. and Charles D. Fennig (eds) (2018) Ethnologue: Languages of the World (21st edition). Dallas, TX: SIL International. Available online: http://www.ethnologue.com
South African Government (1996) Constitution of the Republic of South Africa, 1996. Available online: https://www.gov.za/documents/constitution-republic-south-africa-1996
South African Government (2004) National Health Act, 2003. Government Gazette 469 (26595). Available online: https://www.gov.za/sites/default/files/gcis_document/201409/a61-03.pdf
Sparks, Beverley and Victor J. Callan (1992) Communication and the service encounter: The value of convergence. International Journal of Hospitality Management 11 (3): 213–224. https://doi.org/10.1016/0278-4319(92)90019-R
Timmins, Caraway L. (2002) The impact of language barriers on the healthcare of Latinos in the US. Journal of Midwifery and Women’s Health 47 (2): 80–96. https://doi.org/10.1016/S1526-9523(02)00218-0
United States Census Bureau (2018) Hispanic Heritage Month 2018. Profile America Facts for Features CB 18-FF.07. Washington, DC: Department of Commerce United States Census Bureau. Available online: https://www.census.gov/content/dam/Census/library/visualizations/2018/comm/hispanic-fff-2018.pdf
United States Office of Civil Rights (2016) Nondiscrimination in health programs and activities: Final rule. Federal Register 81 (96): 31376–31473.
Van den Berg, Violet L. (2016) Still lost in translation: Language barriers in South African healthcare. South African Family Practice 58 (6): 229–231. https://doi.org/10.1080/20786190.2016.1223795
Watson, Bernadette and Cynthia Gallois (1999) Communication accommodation between patients and health professionals: Themes and strategies in satisfying and unsatisfying encounters. International Journal of Applied Linguistics 9 (2): 167–183. https://doi.org/10.1111/j.1473-4192.1999.tb00170.x
Wright, Pa?draig, Julian Stern and Michael Phelan (2012) Clinical examination of psychiatric patients. In Pa?draig Wright, Julian Stern and Michael Phelan (eds) Core Psychiatry, 501–510. Edinburgh: Saunders. https://doi.org/10.1016/B978-0-7020-3397-1.00033-1
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