Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia's Northern Territory

Anna P Ralph, Anne Lowell, Jean Murphy, Tara Dias, Deborah Butler, Brian Spain, Jaquelyne T Hughes, Lauren Campbell, Barbara Bauert, Claire Salter, Kylie Tune, Alan Cass, Anna P Ralph, Anne Lowell, Jean Murphy, Tara Dias, Deborah Butler, Brian Spain, Jaquelyne T Hughes, Lauren Campbell, Barbara Bauert, Claire Salter, Kylie Tune, Alan Cass

Abstract

Background: 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. 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.

Methods: This 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.

Results: Six 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.

Conclusion: We 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.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Human Research Ethics Committee (HREC), Northern Territory Department of Health and Menzies School of Health Research (HREC-2015-2465). Patient consent was not required since no patients were directly approached by study investigators and the data used comprised only retrospective de-identified data from the Aboriginal Interpreter Service database, and medical file audit conducted by a clinical nurse practitioner then de-identified. Waiver of consent was approved by the approving HREC.

Consent for publication

Not applicable.

Competing interests

All authors have no competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of Aboriginal Interpreter Service bookings made by Top End Health Services, June 2000–June 2015, showing breakdown by main service areas
Fig. 2
Fig. 2
Outcome of requests for an Aboriginal interpreter
Fig. 3
Fig. 3
Outcome of interpreter booking according to language requested Numbers at tops of columns indicate total number of requests for that language
Fig. 4
Fig. 4
Staff perceptions of Aboriginal Interpreter Service accessibility, timeliness and effectiveness

References

    1. Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229–231. doi: 10.1056/NEJMp058316.
    1. Coroners Court Alice Springs. Inquest into the death of Kristelle Ruby Mulladad aka Oliver. FIndings of Mr Greg Cavanagh SM. 29 October 2010.
    1. Napier AD, Ancarno C, Butler B, Calabrese J, Chater A, Chatterjee H, Guesnet F, Horne R, Jacyna S, Jadhav S, Macdonald A, Neuendorf U, Parkhurst A, Reynolds R, Scambler G, Shamdasani S, Smith SZ, Stougaard-Nielsen J, Thomson L, Tyler N, Volkmann AM, Walker T, Watson J, Williams AC, Willott C, Wilson J, Woolf K. Culture and health. Lancet. 2014;384(9954):1607–1639. doi: 10.1016/S0140-6736(14)61603-2.
    1. Karliner LS, 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(2):727–754. doi: 10.1111/j.1475-6773.2006.00629.x.
    1. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Medical care research and review : MCRR. 2005;62(3):255–299. doi: 10.1177/1077558705275416.
    1. Betancourt JR, Green AR. Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Academic medicine : journal of the Association of American Medical Colleges. 2010;85(4):583–585. doi: 10.1097/ACM.0b013e3181d2b2f3.
    1. Wade P. B. B. Culture sensitivity training and counselor’s race: effects on black female client’s perceptions and attrition. J Couns Psychol. 1991;38:9–15. doi: 10.1037/0022-0167.38.1.9.
    1. Durand MA, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, Elwyn G. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9(4):e94670. doi: 10.1371/journal.pone.0094670.
    1. Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra. . 2016.
    1. Australian Institute of Health and Welfare. Mortality and life expectancy of Indigenous Australians 2008 to 2012. Cat. no. IHW 140. Canberra. , 2014.
    1. Australian Bureau of Statistics. Population Characteristics, Aboriginal and Torres Strait Islander Australians, Northern Territory, 4713.7.55.001. 2006. .
    1. Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between aboriginal patients and healthcare workers. Med J Aust. 2002;176(10):466–470.
    1. Lowell A. A review of two subprograms of the Cooperative Research Centre for Aboriginal and Tropical Health’s Indigenous Health and Education Research program. Communication and Cultural Knowledge in Aboriginal Health Care, 1998.
    1. Roman C. Making it clear : aboriginal perceptions of racism in mainstream health care. PhD thesis. Darwin, Northern Territory: Charles Darwin University; 2012.
    1. Cheng WY, Blum P, Spain B. Barriers to effective perioperative communication in indigenous Australians: an audit of progress since 1996. Anaesth Intensive Care. 2004;32(4):542–547.
    1. Lowell A, Maypilama E, Yikaniwuy S, Rrapa E, Williams R, Dunn S. "hiding the story": indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. International journal of speech-language pathology. 2012;14(3):200–208. doi: 10.3109/17549507.2012.663791.
    1. Shahid S, Finn LD, Thompson SC. Barriers to participation of aboriginal people in cancer care: communication in the hospital setting. Med J Aust. 2009;190(10):574–579.
    1. Mitchell AG, Lowell A, Ralph AP. Report on the patient educator service at Royal Darwin Hospital, 2001–2009: insights into inter-cultural communication in healthcare. 2016.
    1. Anderson K, Devitt J, Cunningham J, Preece C, Cass A. "all they said was my kidneys were dead": indigenous Australian patients' understanding of their chronic kidney disease. Med J Aust. 2008;189(9):499–503.
    1. Henry B, Dunbar T, Barclay L, Thompson R. Self-discharge against medical advice from northern territory hospitals: prevalence rates, experiences and suggestions, economic implications and recommended strategies for improvement. A Report Prepared for the Department of Health and Community Services: Charles Darwin University and Co-operative Research Centre for Aboriginal Health. 2007;
    1. Einsiedel LJ, van Iersel E, Macnamara R, Spelman T, Heffernan M, Bray L, Morris H, Porter B, Davis A. Self-discharge by adult aboriginal patients at Alice Springs hospital, Central Australia: insights from a prospective cohort study. Australian health review : a publication of the Australian Hospital Association. 2013;37(2):239–245. doi: 10.1071/AH11087.
    1. Howe PW, Condon JR, Goodchild CS. Anaesthesia for aboriginal Australians. Anaesth Intensive Care. 1998;26(1):86–91.
    1. Menzies School of Health Research and Charles Darwin University. The 'Communicate' Study. 2015 (accessed 27 May 2016.
    1. Donabedian A. Evaluating the quality of medical care. The Milbank Memorial Fund quarterly 1966; 44(3): Suppl:166-206.
    1. Northern Territory Government Department of Health. Annual Report 2013–14. 2015.
    1. Beach MC, Price EG, Gary TL, Robinson KA, Gozu A, Palacio A, Smarth C, Jenckes MW, Feuerstein C, Bass EB, Powe NR, Cooper LA. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356–373. doi: 10.1097/01.mlr.0000156861.58905.96.
    1. Hotez PJ. Blue marble health Redux: neglected tropical diseases and human development in the group of 20 (G20) nations and Nigeria. PLoS Negl Trop Dis. 2015;9(7):e0003672. doi: 10.1371/journal.pntd.0003672.
    1. Phillips CB, Travaglia J. Low levels of uptake of free interpreters by Australian doctors in private practice: secondary analysis of national data. Australian health review : a publication of the Australian Hospital Association. 2011;35(4):475–479.
    1. Yelland J, Riggs E, Szwarc J, Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S. Compromised communication: a qualitative study exploring afghan families and health professionals' experience of interpreting support in Australian maternity care. BMJ quality & safety. 2016;25(4):e1. doi: 10.1136/bmjqs-2014-003837.
    1. Gray B, Stanley J, Stubbe M, Hilder J. Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters. The New Zealand medical journal. 2011;124(1342):23–38.
    1. Hanssen I, Alpers L-M. Interpreters in intercultural health care settings: health professionals’ and professional interpreters’ cultural knowledge, and their reciprocal perception and collaboration. J Intercult Commun. 2010;23

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