Language barriers in healthcare delivery

A focus on expatriate healthcare providers in Ghanaian hospitals

Authors

  • Mercy Akrofi Ansah University of Ghana
  • Mercy Adzo Klugah University of Ghana

DOI:

https://doi.org/10.1558/cam.39671

Keywords:

communication accommodation, convergence, expatriate doctors, healthcare, language barrier, multilingualism

Abstract

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.

Author Biographies

Mercy Akrofi Ansah, University of Ghana

Mercy Akrofi Ansah received her PhD in Linguistics from the University of Manchester, UK, and is currently a Senior Research Fellow at the Institute of African Studies, University of Ghana. Her research interests include description and documentation of less-studied languages, language use in multilingual contexts and biographical research. Her most recent book chapter is ‘Receiving justice in our mother tongue: The role of the court interpreter in Ghanaian law courts’ (2019, Sun Press). 

Mercy Adzo Klugah, University of Ghana

Mercy Adzo Klugah is a PhD candidate at the Institute of African Studies, University of Ghana and a Leiden ASA visiting fellow at the African Studies Centre, University of Leiden. She holds a Bachelor of Education in Arts and a Master of Philosophy in Ghanaian Languages and Linguistics from the University of Cape Coast, Ghana. Her research interests include language use in specific domains and language and culture. 

References

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

Published

2021-01-15

How to Cite

Ansah, M. A., & Klugah, M. A. (2021). Language barriers in healthcare delivery: A focus on expatriate healthcare providers in Ghanaian hospitals. Communication and Medicine, 16(3), 201–213. https://doi.org/10.1558/cam.39671

Issue

Section

Articles