I heard “hunedresit?”: Uncovering Language Barriers Among Indonesian Diasporas in Glasgow

Background Communication is essential in the medical sector, particularly in the emergency departments (ED), to provide appropriate patient care. Lack of patient history and large patient numbers, cultural variations, inadequate health literacy, and language difficulties can impact effective communication. Aim This study aims to examine language and communication barriers experienced by ED physicians in Makkah, Saudi Arabia, as well as to determine the effect of language barriers on patient care and explore possible methods to deal with language and communication barriers. Methods This cross-sectional study was conducted from April 8 to June 6, 2023. A total of 136 responses were collected from ED physicians at the six Ministry of Health Hospitals (MOH) in Makkah through a validated online survey. The data analysis was implemented using RStudio (R version 4.1.1). Result In this study, 136 participants' data were examined. Of note, one-quarter of ED physicians (25%; n=34) under study stated that they always experienced language barriers, whereas 64.7% (n=88) of them sometimes experienced these difficulties. More than half of the ED physicians (54.4%; n=74) stated that their patients had poor outcomes because of poor communication. Among those who responded positively to poor outcomes, EDphysicians' suggestions to improve communication with patients included providing labels of the common scientific terminologies in different languages (59.6%; n=81) and providing courses to communicate in foreign languages (48.5%; n=66). Conclusion Exposure to language barriers among ED physicians in Makkah was slightly high. This may impact the patient's outcomes. Therefore, strategies to improve patient-physician communication are needed.

This paper evaluates the cause, extent, and effects of language and cultural barriers within the Saudi Arabia healthcare system that have an indirect or direct effect on both the patient's perceived quality of care and the actual quality of care delivered. A systematic search of different databases (Google Scholar, PubMed, ProQuest, MEDLINE, and ScinceDirect.) was conducted. Using the following search terms language barrier’ AND ‘health’ AND ‘Saudi Arabia’. Additionally, the search terms ‘safety’ AND ‘quality’. The findings illustrate that the Saudi Arabian healthcare system is subject to significant impacts due to poor communication as a result of evident language barriers. Accordingly, it is proposed that individual level and an overall strategy for enhancing language and communication in healthcare across the Kingdom are implemented, including both technological solutions and organisational and human resource-based solutions. A proposed timeline for implementing these various strategies has been provided. Keywords: language barriers, Saudi Arabia healthcare system, language and communication in healthcare

IntroductionDespite evidence from other healthcare settings that language barriers negatively impact patient outcomes, the literature on language barriers in emergency medical services (EMS) has not been previously summarized. The objective of this study is to systematically review existing studies of the impact of language barriers on prehospital emergency care and identify opportunities for future research.MethodsA systematic review with narrative synthesis of publications with populations specific to the prehospital setting and outcome measures specific to language barriers was conducted. A four-prong search strategy of academic databases (PubMed, Academic Search Complete, and Clinical Key) through March 2015, web-based search for gray literature, search of citation lists, and review of key conference proceedings using pre-defined eligibility criteria was used. Language-related outcomes were categorized and reported as community-specific outcomes, EMS provider-specific outcomes, patient-specific outcomes, or health system-specific outcomes.ResultsTwenty-two studies met eligibility criteria for review. Ten publications (45%) focused on community-specific outcomes. Language barriers are perceived as a barrier by minority language speaking communities to activating EMS. Eleven publications (50%) reported outcomes specific to EMS providers, with six of these studies focused on EMS dispatch. EMS dispatchers describe less accurate and delayed dispatch of resources when confronted with language discordant callers, as well as limitations in the ability to provide medical direction to callers. There is a paucity of research on EMS treatment and transport decisions, and no studies provided patient-specific or health system-specific outcomes. Key research gaps include identifying the mechanisms by which language barriers impact care, the effect of language barriers on EMS utilization and clinically significant outcomes, and the cost implications of addressing language barriers.ConclusionThe existing research on prehospital language barriers is largely exploratory, and substantial gaps in understanding the interaction between language barriers and prehospital care have yet to be addressed. Future research should be focused on clarifying the clinical and cost implications of prehospital language barriers.

Background: Acute stroke is a time-critical emergency where diagnosis and acute management are highly dependent upon the accuracy of the patient’s history. We hypothesised that the language barrier is associated with delayed onset time to thrombolysis and poor clinical outcomes. This study aims to evaluate the effect of language barriers on time to thrombolysis and clinical outcomes in acute ischemic stroke. Concerning the method, this is a retrospective study of all patients admitted to a metropolitan stroke unit (Melbourne, Victoria, Australia) with an acute ischemic stroke treated with tissue plasminogen activator between 1/2013 and 9/2017. Baseline characteristics, thrombolysis time intervals, length of stay, discharge destination, and in-hospital mortality were compared among patients with and without a language barrier using multivariate analysis after adjustment for age, sex, stroke severity, premorbid modified Rankin Scale (mRS), and Charlson Comorbidity Index (CCI). Language barriers were defined as a primary language other than English. A total of 374 patients were included. Our findings show that 76 patients (20.3%) had a language barrier. Mean age was five years older for patients with language barriers (76.7 vs. 71.8 years, p = 0.004). Less non-English speaking patients had premorbid mRS score of zero (p = 0.002), and more had premorbid mRS score of one or two (p = 0.04). There was no statistically significant difference between the two groups in terms of stroke severity on presentation (p = 0.06). The onset to needle time was significantly longer in patients with a language barrier (188 min vs. 173 min, p = 0.04). Onset to arrival and door to imaging times were reassuringly similar between the two groups. However, imaging to needle time was 9 min delayed in non-English speaking patients with a marginal p value (65 vs. 56 min, p = 0.06). Patients with language barriers stayed longer in the stroke unit (six vs. four days, p = 0.02) and had higher discharge rates than residential aged care facilities in those admitted from home (9.2% vs. 2.3%, p = 0.02). In-hospital mortality was not different between the two groups (p = 0.8). In conclusion, language barriers were associated with almost 14 min delay in thrombolysis. The delay was primarily attributable to imaging to needle time. Language barriers were also associated with poorer clinical outcomes.

Lost in Translation: The Impact of Language Barriers on the Outcomes of Patients Receiving Coronary Artery Revascularization

Communication under language barriers

There are four sorts of communication barriers that are Attitudinal Barriers, Cultural Barriers, Language Barriers, and Emotional Barriers.People with opposing attitudes, ideals, and discrimination are major causes of workplace communication breakdown.Embracing differences allows us to draw on a greater spectrum of thoughts, ideas, experience, and expertise.The scope of this study is to explore the effects of cultural barriers, attitude barrier, language barriers and emotional barriers on job performance of workers in the organization.The method used in this study was a qualitative methodology using indepth interview method with 8 respondents who are among managers, executives, and clerks.This study found out that, Language barriers arise when persons do not speak the same language and dialect or do not have equal proficiency in a language, while emotional barriers are those who are frustrated with financial issue, increment, promotion, and compliment from employer.Besides that, attitude barrier happens when someone is overly self-centred and believes that their ideas, thoughts, and viewpoints are more valuable than those of others.Finally, culture barriers are people who live in a different way of lifestyle, clothes, mentality, beliefs and the way they interact with each other.This study provides implications and recommendations for future study.

Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators—family members/friends, case managers, or interpreters—who can communicate with healthcare providers in the AALWH’s native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.

Reducing language and cultural barriers in healthcare are significant factors in resolving health disparities. Qatar’s rapidly growing multicultural population presents new challenges to the healthcare system. The purpose of this research was to explore patients’ perspectives about language discordance, and the strategies used to overcome language barriers during patients’ visits. Participants were recruited and interviewed from four language groups (Arabic = 24, English = 20, Hindi = 20, and Urdu = 20), all of whom were living in Qatar and utilizing Hamad General Hospital-Outpatient Clinics as a source of their healthcare services. Using qualitative analysis procedures, relevant themes and codes were generated and data analyzed using Atlas-ti. As for results, most participants had experienced or witnessed language barriers during their outpatient clinics visits. Participants essentially were unfamiliar with professional medical interpreters and described their adaptive solutions, for example utilizing incidental interpreters, stringing together fragments of multiple languages, and using body language. Those not speaking mainstream languages of Hamad General Hospital (English and Arabic) were more vulnerable to health disparities due to language barriers. Despite the patient impetus to do something, patient-reported adaptive strategies could compromise patients’ safety and access to quality healthcare. Polices tackling the language barrier need to be reviewed in Qatar’s multicultural healthcare system and similar settings.

Amending Federal Regulations to Counteract Language Barriers in the Informed Consent Process

Objective. The objective of this study was to investigate the effect of language barriers during medical 9-1-1 calls, on the time to dispatch and level of medical aid (Basic or Advanced Life Support). Methods. All 9-1-1 medical calls to two large call centers during one week for each of the months of August, October, December 2010 and February 2011, were reviewed for a notation of language barrier (LB). Non-language barrier calls were identified from the same time period such that there were an equal proportion of LB and non-LB calls by dispatch code and dispatcher. A total of 272 language barrier calls were identified. The computer-assisted dispatch (CAD) reports for the LB and non-LB calls were abstracted by research staff using a standard form, including: Start time of call, time to dispatch of BLS, time to dispatch of ALS, dispatch code, interpretation service use, on-scene upgrade to ALS, and on-scene downgrade to BLS. 9-1-1 recordings were abstracted for LB calls only to obtain information about use of interpreter services. Difference between LB and English speakers in time to assignment of BLS and ALS was examined using linear mixed effects models with log time as the outcome; language barrier, call center and dispatch code as fixed effects and dispatcher as a random effect. Results. The effect of language barrier on time to BLS assignment was, on average, 33% longer (p < 0.001) and time to ALS assignment 43% longer (P = 0.008). A majority of the effect was due to the effect of interpreter use, which increased time to BLS by 82% and 125% for ALS, when compared to non-language barrier calls. Data from the 9-1-1 recordings showed an average of 49 seconds between connecting to the service operator and connecting to the language interpreter. Language barrier calls were more likely to be up- and down-graded, only statistically significantly so for on-scene downgrades. Conclusion. Language barriers increase time to dispatch and the accuracy of the level of aid dispatched during medical emergency calls. Decreasing the time to connecting to an actual interpreter when using an interpretation service could minimize existing delays.

OBJECTIVE: To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment. DESIGN: Cohort study. SETTING: Public hospital emergency department. PARTICIPANTS: English- and Spanish-speaking patients (N=714) presenting with nonemergent medical problems. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P=.05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P=.78). CONCLUSIONS: Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments.

To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment. Cohort study. Public hospital emergency department. English- and Spanish-speaking patients (N = 714) presenting with nonemergent medical problems. Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P =. 05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P =.78). Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments.

Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes. This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient's preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates. Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57-0.82; P<0.001). However, they were more likely to be discharged with a moderate-to-severe neurological deficit (65.9% versus 51.5%; OR, 1.25; 95% CI, 1.15-1.35). In-hospital complication rates did not differ, and quality of care indicators generally favored patients with language barriers. Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics.

Both communication and sexual and reproductive health knowledge play significant roles in family planning decisions. Individuals who face language barriers may struggle to access the education needed to make informed family planning decisions. This review seeks to describe the effects of language barriers on family planning outcomes in the United States. An integrative review conducted per Whittemore and Knafl using an intersectional feminist framework. Systematic searches in four databases generated 17 studies for review. Language barriers were associated with lower-frequency and lower-quality family planning counseling. Patients facing language barriers also likely face other oppressive forces like racism, discrimination, poverty, and intimate partner violence that further complicate their experiences. Language barriers have significant effects on family planning outcomes. By considering language barriers and addressing factors beyond interpreter use and language concordance, nurses can support improved outcomes.