How Are Language Barriers Bridged in Acute Hospital Care? the Tale of Two Methods of Data Collection

Article excerpt

Abstract

Objective: To explore language service provision in a pilot hospital study with two methods of data collection.

Methods: This mixed mode study design comprises a multilingual telephone survey followed by a medical records audit, undertaken at Liverpool Hospital in 2004-05.

Results: Two hundred and fifty-eight patients responded from 360 patients representing nine language groups. About a third of patients with limited English proficiency had used a professional interpreter in hospital. Concordance between the multilingual telephone survey and the medical records audit was apparent, although the telephone survey mostly showed non-significant, higher rates than the audit. While the methods showed high agreement (76%) for frequency of interpreter usage, kappa indicated only fair agreement (PABAK 0.40). Forty-eight percent of the patients preferred relatives as interpreters and 51% felt that their inability to speak English negatively affected their hospital stay.

Conclusions: Professional interpreter usage is lower than desirable in the hospital, especially in the Emergency Department. Relatives frequently interpret. Under-reporting on the medical record is suggested, implying a need for improved documentation, while possible over-reporting in the telephone survey may relate to recall bias and social acquiescence.

Aust Health Rev 2008: 32(4): 755-765

LANGUAGE IS INTEGRAL to social, cultural, and institutional integration, provides an ongoing link with a person's background, history and identity,1-2 and contributes significantly to a patient's construction of illness.3 Being unable to speak the dominant language excludes a person from institutional interaction, thereby disempowering them.4 Language facilitators, including professional interpreters, family, or bilingual staff, provide an essential communication and empowerment bridge. However, health care language service provision is fraught with issues associated with accessibility, confidentiality, trust, linguistic accuracy, cultural accuracy, bias related to cultural, political or familial affiliation, and concerns regarding the health care provider's legal and ethical duty of care.5-6

Language barriers decrease equity in health care by reducing access to primary care, including emergency department care; reduce patient understanding and involvement in decision making; and decrease adherence to treatment, including medications.7-10 Poor English ability is associated with poorer health outcomes.11-12 Use of professional interpreters for patients has been associated with increased satisfaction, improved understanding, greater participation, high levels of compliance, improved access, and fewer medical errors.13-17 Use of professional rather than "ad hoc" interpreters in health care has been recommended to ensure quality, safety, positive health outcomes, and to reduce health disparities and discrimination.5,14,16,18-22 There is little Australian evidence regarding the most common methods of facilitating communication in health care with people who do not speak English. The dual purposes of this paper were to identify interpreter usage patterns in an acute hospital and to explore two methods of data collection, a multilingual telephone survey (MTS) and a medical records audit (MRA).

Methods

A mixed mode design was used to compensate for the limitations of the use of a single methodology.23 The MTS was followed by the MRA. The questions asked in the MTS are included in the Appendix.

Approval to undertake this study was provided by the local Human Research Ethics Committee. Verbal consent was obtained from patients through the Bilingual Research Officers.

Data collection

Study participants comprised a convenience sample of patients aged over 65 years and identified on their medical record as speaking a language other than English, who attended the ED of the hospital or had been an inpatient of general medical and surgical wards between June and November 2004. …