Communication barriers and use of interpreter

What strategies to address communication barriers for refugees and migrants in health care settings have been implemented and evaluated across the WHO European Region?


Communication barriers

Migrants and refugees are more likely to have challenges with communication in healthcare settings. Communication barriers are a serious issue which can lead to health inequities due to:

  • Insufficient knowledge among migrants about availability of healthcare services (and migrants’ entitlements to them)
  • Negative experiences about approaching healthcare services due to language differences leading to underutilization of healthcare services
  • Increased clinical errors due to incomplete information exchange during consultations
  • Non-compliance with treatment and lack of opportunities for health promotion and prevention due to limited understanding of information provided by healthcare providers.

There are different strategies proven to be effective in reducing communication barriers for migrants and refugees:

  • Interpreters
  • Cultural mediators
  • Translation of health information
  • Examples of interventions providing guidance and training for health care providers to improve communication during the health encounter

Evaluations of these strategies in settings where they were implemented have shown positive results for improved knowledge, health behavior, accessibility and utilization of healthcare services. However, implementation can often be challenging, and both interpretation and cultural mediation services often have issues with accessibility and quality because of implementation challenges.

There is also confusion about the role of interpreters and cultural mediators, and that they are often lumped together. Interpreters solely translate the content of the information into another language, whilst cultural mediators facilitate understanding between groups by interpreting as well as providing advice about cultural behaviors to both parties.

Why use an interpreter?

Interpreters are used to improve the accessibility and quality of health care for migrants and refugees, by reducing linguistic barriers.

What is the role of the interpreter in health care?

The unique role of interpreter is to translate language. If the communication barrier goes beyond language issues and has cultural aspects, such as different expectations of healthcare, health literacy, or trust in staff, one should ask for an intercultural mediator instead of an interpreter.

How to use an interpreter?

There are different types of suitable interpreters:

  • Professional interpreters
  • Bilingual healthcare staff

Family members are unsuited to provide an ad hoc informal solution to communication barriers. There are many issues with the use of family members as translators and hence this is not recommended. These include:

  • Lack of confidentiality
  • Some elements being lost in translation as the informal translator is unlikely to have the precise medical vocabulary
  • No certainty that the entirety of the conversation is being translated accurately
  • If the translator is the patient’s child, this can cause additional problems as the parent’s authority can be compromised, or the child may miss school in order to accompany their parents to healthcare visits

An interpreting session can be held face-to-face with the interpreter physically in the room, over the telephone or through video call. The advantages of face-to-face interpretation is that non-verbal communication such as body language can be picked up. However, telephone interpreters can remain anonymous, which is valuable especially during physical consultations or when discussing sensitive matters. They are also more easily available.

Practical advice when using an interpreter during a healthcare encounter:

  • Inform the patient about the availability of professional translators, about their entitlement to this service, and about the benefits of using professional interpretation such as accuracy and confidentiality.
  • Involve the patient (and their families) in the decision process about the type of interpreter to be used (phone or face-to-face).
  • The interpreter should be treated as a colleague, but not as a co-diagnostician, whose neutrality and integrity should be supported. They should be able to read and understand written information and understand the healthcare system.
  • Choose an appropriate calm room where you will not be disturbed during the interpretation session and be aware of your own behavior, appearance and attitude during the interpretation session.
  • Create a comfortable atmosphere where all parties involved (patient and family members, healthcare provider and interpreter) feel able to ask questions. Avoid interrupting others during interpretation.
  • Make eye contact with the patient, not with the interpreter. Always speak directly to the patient and not to the interpreter. Please observe that it is you and the patient who are talking to each other.
  • Adapt your level of language and speak slowly. Avoid as much as possible the use of specialist terminology, which often does not translate well. Everything that is said in the room must be interpreted.
  • If the patient does not understand, you need to reformulate by simplifying.
  • Avoid, as far as possible, turning privately to the interpreter, and avoid the interpreter and the patient ending up in discussions with each other during the interpretation session.
  • Respect the working methods and professional ethics of the interpreter. Do not ask for the interpreter’s personal opinions or advice concerning the content of the dialogue. However, it is possible to talk to the interpreter before and/or after the interpretation session in order to discuss the situation, any reactions during the conversation or questions that might have arisen during the interpretation.

References:

Hadziabdic, E., & Hjelm, K. (2013). Working with interpreters: practical advice for use of an interpreter in healthcare. International Journal of Evidence-Based Healthcare, 11(1), 69–76. https://doi.org/10.1111/1744-1609.12005

Mcgarry Orla, Ailish|, Maria, H., De Almeida, M., Santino, Soorej Severoni, … Macfarlane Anne. (2018). What strategies to address communication barriers for refugees and migrants in health care settings have been implemented and evaluated across the WHO European Region? 50. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0006/380229/who-hen-62.pdf

Hadziabdic, E., Heikkilä, K., Albin, B., & Hjelm, K. (2011). Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare. Nursing Inquiry, 18(3), 253–261. https://doi.org/10.1111/j.1440-1800.2011.00542.x

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