Language and cultural discordance in healthcare communication

The overarching objective of this Special Interest Group (SIG) is to foster a coherent interdisciplinary and interprofessional approach to researching and training in language and cultural discordance in healthcare communication. Multiculturalism and multilingualism have become a norm in Europe. Language barriers are known to be related to inequality in health care. The experiences of people whose first language is not the same as that of the healthcare service they attend can result in poorer health outcomes (Divi et al 2007). Whilst this may be related to a number of complex social and cultural factors it is evident that language difficulties are a major communication problem (Quesada et al 1976). A set of indicators suggest that the use of interpreters is more likely to lead to better communication outcomes (Bonacruz Kazzi and Cooper 2003, Diamond et al 2008, Karliner et al 2007, Karliner 2004). These triadic interpreted consultations require the use of specific skills which many health care professionals feel they lack (Hale 2007). There is also evidence that communication problems may occur even when interpreters are used (Hsieh 2007). Insufficient training for both healthcare professionals and medical interpreters might be one of the reasons behind the less effective collaboration between the two professionals (Tribe and Raval, 2013), which might ultimately lead to less optimal communication outcomes. Most of the curricula on clinical communication skills have so far relied on language concordance between healthcare providers and patients, do not allow much space for a language gap (Fung et al 2010) and therefore do not seem to attend to a wider set of intricacies inherent in interpreter-mediated communication. More empirical research on this matter is needed (Pérez-Stable and Karliner 2012, Angelelli 2008) in order to inform clinical practice and professional training (Segalowitz and Kehayia 2011; Angelelli 2008).

A large part of the available research reports on professional interpreters. While there is also an emerging body of research on ad hoc interpreting (Gray, Hilder, and Donaldson 2011, Li et al 2010) and cultural mediators, research in this area is still rare (Meeuwesen and Ani 2011; Meyer, Pawlack, and Ortun 2010). In addition, language barriers emerge when no interpreter is present, either because none was deemed necessary (e.g., the health care professional and patient share a lingua franca or the patient’s language proficiency is deemed “good enough”) or because the immediate situation precludes involving an interpreter for practical reasons (e.g., the patient’s needs are urgent). To be clinically relevant, knowledge is needed to uncover effective practice in the many real life situations health care professionals and patients face. This SIG is intended as an umbrella to address these and other situations involving a language barrier. Policies regarding using professional interpreters vary from country to country. Some officers of this SIG currently organise interprofressional training in Ghent and in London which have yielded research papers (Pype et al. 2016, Krystallidou et al 2016).We hope that this SIG can deliver research findings that can inform both training (possibly through tEACH) and policy making (possibly through pEACH).

Aims

  • To conduct empirical research in order to advance the knowledge of language and cultural discordance in healthcare communication, and to conduct translational research to enhance professional practice and training;
  • To build an international network for all stakeholders in order to support interdisciplinary research, interprofessional training and clinical practice;
  • To contribute to improving quality of care and well-being of patients and clinicians in the super-diverse society

2017 Annual Report

In the last 12 months (Sept 2016 to Sept 2017), the SIG have held three Skype meetings, one face-to-face meeting during ICCH, monthly email correspondences among all committee members. As a newly formed group, we managed to publish a jointly-authored paper in PEC (May 2017: Link: http://www.pec-journal.com/article/S0738-3991(17)30255-0/fulltext ) to introduce the SIG and raise our research agenda in social research, clinical and intercultural practice and training. This paper is a milestone of the group showing its determination and capacity of working as a team. The team have jointly submitted a Seed Award Application to Wellcome Trust in the UK for establishing a network, which unfortunately was unsuccessful. Core members of the SIG have been working in their own countries to extend their networks within their expertise and research interest. Under the remit of language and cultural discordances in healthcare communication, we identify three main areas as current focus: interactional studies of interpreter mediated clinical consultations, interprofessional training between medical students and interpreting students, communication with LGBTQ patients (a new focus). An invitation to becoming members of our SIG will soon be sent to colleagues who we have identified as required experts in our focused research areas. Members are looking for funding opportunities in their own countries which can fund member’s own research interest but can also support international collaboration.

For 2018 ICCH, the SIG has submitted a proposal for a pre-conference workshop on translating research into clinical education. This is under consideration by rEACH Committee. A proposal for a symposium on emotions and emotional communication is in preparation by SIG members with their external collaborators. Core members will also submit their own projects to the conference for workshops or presentations.

Three Year Plan

In the next 3 years, this SIG will focus on:

  1. Identify and apply for funding to develop research in the identified focal research areas.
  2. Establish an international network for collaborative research in the remit of the SIG.

Establish meaningful working relationships with other SIGs within EACH, such as tEACH.

Projects

Completed projects:

Current projects:

  • SIG: searching for funding to develop research in the three areas as described in previous section.
  • S Li, A Llopis, ES Martinez. An interdisciplinary approach to incorporating patient-centred communication in medical interpreting education
  • J Liu, S Li. A case study of how medical students develop their cultural competence
  • Krystallidou, D., Theys, L., Salaets, H., Wermuth, C., Pype, P. (2017-2021) EmpathicCare4All: The development of an educational intervention for medical and interpreting students on empathic communication in interpreter-mediated medical consultations. A study based on the Medical Research Council (MRC) framework phases 0-2. (Funded by the University of Leuven)

Future planned projects

  • Establish an international network for collaborative research and supporting research
  • Establish working relationship with other EACH groups.

Challenges

  1. Organizing meetings have been challenging as all the members are in different countries and time zones.
  2. Funding application is challenging. The amount of funding has reduced in most countries. Funding for international collaboration has a lot of limitations.
  3. Reaching out to other scholars is done in an ad hoc manner. We would like to make use of the EACH website more.

How can EACH help?

  1. We wish to see new functions built on EACH website which to allow SIG to communicate SIG updates to EACH members, and use the website to build network.
  2. We wish to receive support from senior members regarding funding application—information on funding opportunities that suit our purpose, and strategies in composing application.

Officers

Dr Shuāngyŭ Lĭ (Chair)
Lecturer in Clinical Communication
2.11 Shepherd’s House
King’s College London School of Medical Education
St Thomas’ St, London SE1 9RT, UK
Email: shuangyu.li@kcl.ac.uk
Tel: +44 (0)20 784 86387
Dr Demi Krystallidou (Co Chair)
Postdoctoral researcher
Interpreter-Mediated Communication trainer
Department of Translation, Interpreting & Communication, Ghent University, Groot-Brittanniëlaan 45, B-9000 Ghent, Belgium
Email: dimitra.krystallidou@ugent.be
Faculty of Arts (Campus Sint-Andries Antwerp)
KU Leuven, Sint-Andriesstraat 2
B-2000 Antwerp, Belgium
Email: demi.krystallidou@kuleuven.be
Tel: +32 (0)486 175 625
 20x20
Ms Angela Rowlands
Senior Lecturer Clinical Communication Skills
Robin Brook Centre, St Barts Hospital
West Smithfield, London EC1, UKEmail:
Tel: +44 (0)20 7882 8928
Dr Peter Pype
Postdoctoral researcher, communication skills trainer
Department of Family Medicine and Primary Health Care, Ghent University
De Pintelaan 185 – Building 6K3
B-9000 Ghent, BelgiumEmail: peter.pype@ugent.be
 20x20
Dr Jennifer Gerwing
Senior researcher
HØKH Health Services Research Centre
Akershus University Hospital
Mail drawer 1000
1478 Lørenskog, Norway
Email: jennifer.gerwing@gmail.com
Mr Antoon Cox
PhD researcher
VrijeUniversiteit Brussel
Department of Applied Linguistics and theBrussels Centre for Urban Studies
Pleinlaan 2, 1050 Elsene
BelgiumE-mail:antoon.cox@vub.ac.be
Mobile: + 32 (0)48 5120063
King’s College London
School of Medical Education and the Centre for Discourse and Communication
St Thomas’ St, London SE1 9RT, UK
Email: antoon.cox@kcl.ac.uk
Mobile: + 32 (0)48 5120063

References

Angelelli, CV. (2008). The role of the interpreter in the healthcare setting: A plea for a dialogue between research and practice. Valero-Garcés, Carmen & Anne Martin (eds) (2008). Crossing Borders in Community Interpreting. Definitions and dilemmas. Amsterdam/Philadelphia: Benjamins, 147-164.
Bonacruz Kazzi G, Cooper C. Barriers to the use of interpreters in emergency room paediatric consultations. Journal of Paediatrics and Child Health. 2003 May 1;39(4):259-63. DOI: 10.1046/j.1440-1754.2003.00135.x

Fung CC, Lagha RR, Henderson P, Gomez AG. Working with interpreters: how student behavior affects quality of patient interaction when using interpreters. Medical Education online. 2010 Jun 1;15. DOI: 10.3402/meo.v15i0.5151

Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. Journal of General Internal Medicine. 2009 Feb 1;24(2):256-62. DOI: 10.1007/s11606-008-0875-7
Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. International Journal for Quality in Health Care. 2007 Apr 1;19(2):60-7. DOI: http://dx.doi.org/10.1093/intqhc/mzl069 60-67
Gray B, Hilder J, Donaldson H. Why do we not use trained interpreters for all patients with limited English proficiency? Is there a place for using family members?. Australian Journal of Primary Health. 2011 Sep 26;17(3):240-9. doi: 10.1071/PY10075

Quesada GM. Language and communication barriers for health delivery to a minority group. Social Science & Medicine (1976). 1976 Jun 30;10(6):323-7. doi:10.1016/0037-7856(76)90078-0

Hale S (2007) Community Interpreting. Palgrave McMillan.