Abstract
BackgroundIn Australia’s Northern Territory, most Aboriginal people primarily speak an Aboriginal language. Poor communication between healthcare providers and Aboriginal people results in adverse outcomes including death. This study aimed to identify remediable barriers to utilisation of Aboriginal Interpreter services at the Northern Territory’s tertiary hospital, which currently manages over 25,000 Aboriginal inpatients annually.MethodsThis is a multi-method study using key stakeholder discussions, medical file audit, bookings data from the Aboriginal Interpreter Service 2000–2015 and an online cross-sectional staff survey. The Donabedian framework was used to categorise findings into structure, process and outcome.ResultsSix key stakeholder meetings each with approximately 15 participants were conducted. A key structural barrier identified was lack of onsite interpreters. Interpreter bookings data revealed that only 7603 requests were made during the 15-year period, with completion of requests decreasing from 337/362 (93.1%) in 2003–4 to 649/831 (78.1%) in 2014–15 (p < 0.001). Non-completion was more common for minority languages (p < 0.001). Medical files of 103 Aboriginal inpatients were audited. Language was documented for 13/103 (12.6%). Up to 60/103 (58.3%) spoke an Aboriginal language primarily. Of 422 staff who participated in the survey, 18.0% had not received ‘cultural competency’ training; of those who did, 58/222 (26.2%) indicated it was insufficient. The Aboriginal Interpreter Service effectiveness was reported to be good by 209/368 (56.8%), but only 101/367 (27.5%) found it timely. Key process barriers identified by staff included booking complexities, time constraints, inadequate delivery of tools and training, and greater convenience of unofficial interpreters.ConclusionWe identified multiple structural and process barriers resulting in the outcomes of poor language documentation and low rates of interpreter bookings. Findings are now informing interventions to improve communication.
Highlights
In Australia’s Northern Territory, most Aboriginal people primarily speak an Aboriginal language
Key findings obtained via these key stakeholder discussions, relevant to the ‘structure’ category in the evaluation model, comprised knowledge about existing policies, tools and training available for healthcare providers, and mechanisms for accessing interpreters
We ascertained that Royal Darwin Hospital does not employ on-site interpreters; the Aboriginal Interpreter Service is located a 20-min drive away and provides an on-demand service via a bookings system plus a rostered service whereby one language interpreter is seconded to the hospital four hours per weekday
Summary
In Australia’s Northern Territory, most Aboriginal people primarily speak an Aboriginal language. Poor communication between healthcare providers and Aboriginal people results in adverse outcomes including death. When cultural difference or language discordance is present between healthcare providers and clients, poor communication can occur, with major adverse consequences [1, 2]. In Australia’s Northern Territory (NT), Indigenous people comprise 30% of the population, and an estimated 60% speak an Indigenous language at home [11]. Documented adverse outcomes include: refusing treatment due to misunderstanding, resulting in death; [2] consenting to surgery without knowing what the operation entails; [18] fundamental misunderstanding, confusion and frustration; [12, 19] unnecessarily prolonged admission; [18] taking leave from hospital against medical advice [20, 21] and distrust of healthcare providers with the belief that information is being deliberately withheld [14, 16]
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