Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada

Danielle de Moissac, Sarah Bowen, Danielle de Moissac, Sarah Bowen

Abstract

Introduction: The risks to patient safety and quality of care faced by members of linguistic minority groups have been well-documented. However, little research has focused on the experience of official language minorities in Canada.

Methods: This multiple method study (online and paper-based surveys combined with semi-structured individual interviews with patients and interpreters-health navigators) explored the experience of minority Francophones living in 4 Canadian provinces.

Results: Patients and interpreters-navigators described experiences where language barriers contributed to poorer patient assessment, misdiagnosis and/or delayed treatment, incomplete understanding of patient condition and prescribed treatment, and impaired confidence in services received. Reliance on Google Translate and ad hoc, untrained interpreters are commonly reported, in spite of evidence highlighting the risks associated with such practice.

Conclusion: Increased awareness that the risks of language barriers apply to official language minorities is essential.

Keywords: language barriers; linguistic minority; patient safety; patient satisfaction; quality of care.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Canadian Institute for Health Information. Measuring Patient Harm in Canadian Hospitals: Technical Report. Ottawa, ON, Canada: Canadian Institute for Health Information; 2016.
    1. Kingston-Riechers J, Ospina M, Jonsson E, Childs P, McLeod L, Maxted J. Patient Safety in Primary Care. Edmonton, AB, Canada: Canadian Patient Safety Institute and BC Patient Safety & Quality Council; 2010.
    1. Bauer AM, Alegria M. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatr Serv. 2010;61:765–73.
    1. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62:255–99.
    1. Jacobs E, Chen AH, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in health care: a proposed research agenda. Milbank Q. 2006;84:111–33.
    1. Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42:727–54.
    1. Bowen S. The Impact of Language Barriers on Patient Safety and Quality of Care. Ottawa, ON, Canada: Société Santé en français; 2015.
    1. World Health Organization, World Alliance for Patient Safety Taxonomy. The Conceptual Framework for the International Classification for Patient Safety version 1.1. Geneva, Switzerland: World Health Organization; 2009.
    1. Nelson AR, Stith AY, Smedley BD. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.
    1. Farmer SA, Roter DL, Higginson IJ. Chest pain: communication of symptoms and history in a London emergency department. Patient Educ Couns. 2006;63:138–44.
    1. Garra G, Albino H, Chapman H, Singer AJ, Thode HC., Jr The impact of communication barriers on diagnostic confidence and ancillary testing in the emergency department. J Emerg Med. 2010;38:681–5.
    1. Detz A, Mangione CM, Nunez de Jaimes F, Noguera C, Morales LS, Tseng CH, et al. Language concordance, interpersonal care, and diabetes self-care in rural Latino patients. J Gen Intern Med. 2014;29:1650–6.
    1. Lakhanpaul M, Bird D, Manikam L, Culley L, Perkins G, Hudson N, et al. A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children. BMC Public Health. 2014;14:403.
    1. Flynn PM, Ridgeway JL, Wieland ML, Williams MD, Haas LR, Kremers WK, et al. Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study. J Gen Intern Med. 2013;28:386–91.
    1. Granek L, Krzyzanowska MK, Tozer R, Mazzotta P. Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract. 2013;9:e129–35.
    1. Holdgate A, Shepherd SA, Huckson S. Patterns of analgesia for fractured neck of femur in Australian emergency departments. Emerg Med Australas. 2010;22:3–8.
    1. Bowen S. Language Barriers within the Winnipeg Regional Health Authority: Evidence and implications. Winnipeg, MB, Canada: Winnipeg Regional Health Authority; 2004.
    1. Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services. J Gen Intern Med. 2007;22:294–9.
    1. Betancourt JR, Jacobs EA. Language barriers to informed consent and confidentiality: the impact on women’s health. J Am Med Womens Assoc. 2000;55:294–5.
    1. Dick T. Betrayal. Protecting people’s privacy on scene. EMS World. 2011;40:16.
    1. Dilworth TJ, Mott D, Young H. Pharmacists’ communication with Spanish-speaking patients: a review of the literature to establish an agenda for future research. Res Social Adm Pharm. 2009;5:108–20.
    1. Samuels-Kalow ME, Stack AM, Porter SC. Parental language and dosing errors after discharge from the pediatric emergency department. Pediatr Emerg Care. 2013;29:982–7.
    1. Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5:276–82.
    1. Regalbuto R, Maurer MS, Chapel D, Mendez J, Shaffer JA. Joint commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions? J Card Fail. 2014;20:641–9.
    1. Gallagher RA, Porter S, Monuteaux MC, Stack AM. Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013;29:579–83.
    1. Lion KC, Rafton SA, Shafii J, Brownstein D, Michel E, Tolman M, et al. Association between language, serious adverse events, and length of stay among hospitalized children. Hosp Pediatr. 2013;3:219–25.
    1. Shah BR, Khan NA, O’Donnell MJ, Kapral MK. Impact of language barriers on stroke care and outcomes. Stroke. 2015;46:813–8.
    1. Joint Commission. Sentinel event data: root causes by event type. 2013. Retrieved May 12, 2013, from: .
    1. Wasserman M, Renfrew MR, Green AR, Lopez L, Tan-McGrory S, Brach C, et al. Identifying and preventing medical errors in patients with limited English proficiency: key findings and tools for the field. J Health Qual. 2014;36:5–16.
    1. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19:60–67.
    1. Cohen AL, Christakis DA. Primary language of parent is associated with disparities in pediatric preventive care. J Pediatr. 2006;148:254–8.
    1. Meuter RFI, Gallois C, Segalowitz NS, Ryder AG, Hocking J. Overcoming language barriers in healthcare: a protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Serv Res. 2015;15:371–6.
    1. Komaric N, Bedfort S, van Driel ML. Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC Health Serv Res. 2012;12:322–5.
    1. Battaglini A, Chomienne MH, Plouffe L, Torres S, van Kemenade S. La santé des immigrants au Canada: état des connaissances, interventions et enjeux. Global Health Prom. 2014, 21:40–45.
    1. Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27:1294–9.
    1. Andrulis D, Goodman N, Pryor C. What a Difference an Interpreter can Make: Health Care Experiences of Uninsured with Limited English Proficiency. Boston, MA: The Access Project; 2002.
    1. Jimenez N, Jackson DL, Zhou C, Ebel BE. Postoperative pain management in children, parental English proficiency, and access to interpretation. Hosp Pediatr. 2014;4:23–30.
    1. Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med. 2012;60:545–53.
    1. Kilian S, Swartz L, Dowling T, Dlali M, Chiliza B. The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital. Soc Sci Med. 2014;106:159–67.
    1. Healthcare Interpretation Network. National Standard Guide for Community Interpreting Services. Toronto, ON, Canada: Healthcare Interpretation Network; 2007.
    1. Office of the Commissioner of Official Languages. Understanding Your Language Rights. Ottawa, ON, Canada: Government of Canada; 2017.
    1. Statistics Canada. Le français, l’anglais et les minorités de langue officielle au Canada, Recensement de 2016. Ottawa, ON, Canada: Government of Canada; 2016.
    1. Bouchard L, et Desmeules M. Minorités de langue officielle du Canada: Égales devant la santé? Québec: Presses de l’Université du Québec, 2011: 120.
    1. de Moissac D, Giasson F, Roch-Gagné M. Accès aux services sociaux et de santé en français: l’expérience des Franco-Manitobains. Min Ling Soc. 2015;6:42–65.
    1. Ngwakongnwi E, Hemmelgarn BR, Musto R, Quan H, King-Shier KM. Experiences of French speaking immigrants and non-immigrants accessing health care services in a large Canadian city. Int J Environ Res Public Health. 2012;9:3755–68.
    1. Schwei RJ, Del Pozo S, Agger-Gupta N, Alvarado-Little W, Bagchi A, Chen AH, et al. Changes in research on language barriers in health care since 2003: a cross-sectional review study. Int J Nurs Stud. 2016;54:36–44.
    1. Ramisetty-Mikler S, Mikler A, O’Neill M, Komatz J. Conceptual framework and quantification of population vulnerability for effective emergency response planning. J Emerg Manag. 2015;13:227–38.
    1. Winnipeg Regional Health Authority. Language Access Interpreter Services. n.d. Retrieved August 19, 2015, from: .
    1. Silversides A, Laupacis A. Interpretation services in health care. Healthy Debate, 2013. Retrieved March 27, 2018, from: .
    1. Accueil francophone de Thunder Bay. Au service des francophones du Nord-Ouest de l’Ontario; n.d. Retrieved August 19, 2015, from: .
    1. Canadian Volunteers United in Action. Programmes. n.d. Retrieved August 19, 2015, from: .
    1. Médecins francophones du Canada. Formation continue; 2010. Retrieved August 19, 2015, from: .
    1. Drolet M, Savard J, Savard S, Arcand I, Savard S, Lagacé J, et al. Health services for linguistic minorities in a bilingual setting: challenges for bilingual professionals. Qual Health Res. 2014;24:295–305.
    1. Regroupement des intervenantes et intervenants francophones en santé et en services sociaux de l’Ontario. Trousse d’appui RH: Vers un service bilingue. Toronto, ON, Canada: RIFSSSO; 2012.
    1. de Moissac D, Bowen S. Impact of language barriers on access to healthcare for official language minority Francophones in Canada. Health Manage Forum. 2017;30:207–12.
    1. Quinn PM. Qualitative Research and Evaluation Methods. 3rd ed California, EU: Sage Publications Inc; 2002.
    1. Thomas DR. A general inductive approach for evaluating qualitative evaluation data. Am J Eval. 2006;27:237–46.
    1. Falconer J, Quesnel-Vallée A. Les disparités d’accès aux soins de santé parmi la minorité de langue officielle au Québec [Disparities in access to health care among official language minorities in Quebec]. Recherches Sociographiques. 2014;55:511–29.
    1. Sheldon LK, Barrett R, Ellington L. Difficult communication in nursing. J Nurs Scholarsh. 2006;38:141–47.
    1. Forrest C. Working with ‘difficult’ patients. Primary Health Care. 2012;22:20–22.
    1. Guo J. Is Google Translate adequate for facilitating instrument translation from English to Mandarin? CIN. 2016;34:377–83.
    1. Patil S, Davies P. Use of Google Translate in medical communication: evaluation of accuracy. BMJ. 2014;349:7392.
    1. Irvine F, Robert GW, Jones P, Spencer LH, Baker CR, Williams C. Communicative sensitivity in the bilingual healthcare setting: a qualitative study of language awareness. J Adv Nurs. 2006;53:422–34.
    1. Société Santé en français. L’Organisation de normes en santé et la Société Santé en français mettent au point un programme de reconnaissance et des normes de communication en situation de langue minoritaire. 2017. Retrieved July 23, 2017, from: .
    1. Arsenault E, Arseault M, Kickham M. Améliorer l’accès aux services en français dans le système de santé de l’.Î-P.-É In: Deuxième Colloque scientifique: La santé des communautés de langue officielle en situation minoritaire. Ottawa, ON, Canada, February 27-28, 2017.
    1. Desaulniers J, Manseau J. Démonstration de la valeur ajoutée de la collecte de l’identité linguistique: projet pilote de la variable linguistique francophone en Ontario In: Deuxième Colloque scientifique: La santé des communautés de langue officielle en situation minoritaire. Ottawa, ON, Canada: February 27-28, 2017.

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