Communication and health in a multiethnic society

Abstract

By Mark Robinson. The Policy Press, 2002, £15.99(pb), 240 pp. ISBN 1-86134-341-8 Mark Robinson has produced a useful book for those involved in developing health services. This should be of interest to academics, policy-makers, managers and professionals in the health care field. This book has a role in helping health professionals find ways to increase health care access to minorities or to empower them. It aims to inform practice and service development, and to identify the most pressing research issues. His book is an assessment of some of the relevant research literature. The author clearly lays out his review methodology and he clarifies issues surrounding ethnic and cultural diversity, racism and communication. He has presented 25 studies in a simple, understandable format. For each study, he describes the research and then critically evaluates it. It soon becomes obvious that there are very few good evidence-based studies in this area. Hopefully this review will help others design studies in the future and it gives a perspective of what evidence is available at present. Interestingly, not all the studies produce results that one would intuitively expect. Although I think the book is most useful in the context of the UK, there are points raised that apply to all developed countries about the possible pitfalls of interpretation services and communication methods. The context of all the studies is that of a developed country aiming to deliver health care in a multiethnic society. Most of the studies are UK-based but there are some from USA, Canada and Australia. A lot of the studies from the UK are based on the South Asian population. Although the title of the book is ‘Communication and health in a multiethnic society’ the book includes more than just language issues. Some of the studies are very context-specific but useful general points can be taken from them nonetheless. The first part of the book covers barriers to communication in terms of process and structural barriers. Barriers exist in a multiethnic society at interpersonal, organizational and cultural levels. The book includes examples of studies that show community consultation, gathering and use of information about individual patients' needs, bilingual support and practitioner evaluation. The author highlights the difficulty of communicating health information to ethnic minority clients in an effective and targeted way and the scarcity of studies about the training of health professionals. The second part of the review covers intervention studies in a wide range of communication areas, some at the structural and organizational levels. These include an evaluation of external audit as an agent of change in ethnically sensitive general practice; evaluation of bilingual services in mental health; evaluation of an interpreter training project; an evaluation of an innovation in ethnic monitoring; studies comparing outcome measures for bilingual services that use interpreters, link-workers or advocates; and impact studies about health education programmes. The book touches on the area of public participation in health care, for example, it describes one interesting study that involves community participation in health-needs assessment and service development. In this study, residents were trained to conduct qualitative research and contribute to service commissioning. Overall Mark Robinson gives a good account of the limitations of the present state of research in this area and indicates that effective strategies to overcome ‘communication barriers’ require context-sensitive, needs-led initiatives. He also indicates that effective long-term strategies must address the organizational mechanisms and process aspects of communication barriers within a health service.