"It's the First Barrier" - Lack of Common Language a Major Obstacle When Accessing/Providing Healthcare Services Across Europe.

Florence Samkange-Zeeb,Lucy Doos,Rachel Humphris,Silja Samerski,Hannah Bradby,Beatriz Padilla

doi:10.3389/fsoc.2020.557563

Abstract

International migration is shaping and changing urban areas as well as impacting on healthcare access and provision in Europe. To investigate how residents of superdiverse neighborhoods put together their healthcare, we conducted qualitative interviews with 76 healthcare providers and 160 residents in four European cities - Bremen, Germany; Birmingham, UK; Lisbon, Portugal and Uppsala, Sweden, between September 2015 and April 2017. A common theme arising from the data was language and communication obstacles, with both healthcare providers and users experiencing language difficulties, despite all four countries having interpretation policies or guidelines to address language barriers in healthcare. Official interpreter services were seen to be unreliable and sometimes of poor quality, leading to a reliance on informal interpretation. Some coping strategies used by both service providers and users led to successful communication despite the lack of a common language. Where communication failed, this led to feelings of dissatisfaction and frustration among both users and providers. Language difficulties came up across all participating countries even though this was not prompted by interview questions, which highlights the widespread nature of language barriers and communication barriers and the need to address them in order to promote equal accessibility to good quality healthcare.

Highlights

Despite the extensive literature on how the lack of a common language impairs access to quality healthcare provision (Flores, 2005; Bauer and Alegria, 2010), on-going globalized migration makes it imperative that this topic be revisited
In this article we report on how language emerged as one of the main barriers to healthcare access and provision in our research: a qualitative content analysis of semi-structured interviews conducted with healthcare users and providers in a study conducted in four superdiverse European cities during and after the refugee crisis of 2015/16
The study from which this analysis is drawn did not focus on language barriers and sampled for the range of groups in the neighborhood, the issue of language, communication and interpretation, in relation to trust, came through as a key issue across our interviews

Summary

Introduction

Despite the extensive literature on how the lack of a common language impairs access to quality healthcare provision (Flores, 2005; Bauer and Alegria, 2010), on-going globalized migration makes it imperative that this topic be revisited. Language skills and the ability to articulate a problem in consultations are crucial to accessing healthcare (Dixon-Woods et al, 2005). Without such skills, people are prevented from accessing the necessary services, and from receiving appropriate care (Ahmad and Walker, 1997). To accommodate the language needs of different population groups, European national health services have taken several measures, including interpreter services, multi-lingual health information, training in working with interpreters and maintaining a register of staff language skills (Huddleston et al, 2015; McGarry et al, 2018). National Health Service (NHS) Trusts in the UK are obliged to ensure that ethnic minorities can understand healthcare information, and that patients and clinicians can communicate effectively. According to NHS guidance, rather than relying on family members or friends, healthcare professionals should offer a professional interpreter (Public Health England, 2014)

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Conclusion