Interpreter services for immigrants in European healthcare systems: a systematic review of access barriers and facilitators.

BACKGROUND: Language barriers have been identified as a key access barrier to healthcare services for immigrants. The aim of this study was twofold: to investigate immigrants' and healthcare professionals' experiences with barriers and facilitators of interpreter services, and to examine the influence of barriers to interpreter services on the quality of care from immigrant and healthcare professional perspectives. METHODS: We searched PubMed, Embase, The Cochrane Library, Scopus, SocINDEX and PsycINFO, resulting in 1425 studies. A total of 21 original quantitative, qualitative and mixed methods studies published between 1996 and 2021 were assessed as eligible for inclusion. RESULTS: Identified barriers included: lack of immediately available interpreter services, cost, lack of knowledge about availability, and attitude towards interpreter services. Facilitators included: a high number of interpreters in the requested language, awareness among healthcare professionals and patients of the patient's rights to interpreters, and a positive attitude towards use of interpreter services. Regarding quality of care, language barriers created safety risks for the patients, made patients feel unsafe, or delayed patient contact with the healthcare system. CONCLUSION: Immigrant patients and healthcare professionals experience barriers in using interpreter services due to restrictive policies regarding user fees and limitations to entitlement to interpreters, a limited number of qualified interpreters and lack of knowledge. Medical encounters with unaddressed language barriers can put patients at risk and reduce quality of care for immigrants, which calls for strengthening formal and informal access to interpreters.

Diversity competence training for health professionals in Europe: a modified delphi study investigating relevant content for short or online courses.

BACKGROUND: Diversity is a reality in our societies, requiring health professionals to adapt to the unique needs of all patients, including migrants and ethnic minorities. In order to enable health professionals to meet related challenges and reduce health disparities, long and demanding training courses have been developed. But due to busy schedules of professionals and often scarce resources, a need for shorter training courses exists. This study aims to investigate which topics and methods should be prioritised in designing basic diversity training courses that provide health professionals the opportunity to foster this competence. METHODS: The study provided an expert panel of 31 academic and clinical migrant health experts with the content and methods of an existing diversity training course. The panel was asked to prioritise training topics and teaching methods in a two-stage process, using an adapted Delphi method. In the first stage, experts rated 96 predefined items, commented on those items, provided answers to eight open-ended questions and suggested additional content for a short course. In the second stage, they commented on the ratings from Round 1, and rated new suggested content. Consensus for training topics was set to 80% and for teaching methods 70%. RESULTS: The entire panel deemed 'health effects of migration (pre-, during- and post-migration risk factors)' to be important or very important to include in a short/online, basic diversity training (100% consensus). Other high-scoring items and therefore topics to be included in trainings were 'social determinants of health' (97%) and 'discrimination within the healthcare sector' (also 97%). A general trend was to focus on reflective practice since almost all items regarding reflection reached consensus. 'Reflection on own stereotypes and prejudices' (97%) was the highest-rated reflection item. 'Opportunities and best practices in working with interpreters' was the highest-scoring skills item, both on consensus (96%) and mean value (5.77). CONCLUSIONS: Experts' prioritizations of teaching content and methods for diversity training can help the design of short (online) trainings for health professionals and reduce unnecessary course content, thereby fostering professional development and enabling diversity competence trainings to be implemented also when time and/or financial resources are limited.

General practitioners' experiences in consultations with foreign language patients after the introduction of a user's fee for professional interpretation: a qualitative interview study.

BACKGROUND: In 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter. METHODS: The study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis. RESULTS: The GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas. CONCLUSIONS: The GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.

Introduction of user fee for language interpretation: effects on use of interpreters in Danish health care.

Amendments to the Danish Health Act were introduced in 2018 that stated immigrant patients who have resided in Denmark for more than 3 years have to pay user fees for interpretation in health care. The aim of the study was to explore, how the use of interpreters was affected by the introduction of user fees for interpretation. Results showed a considerable decrease in interpretation services following the introduction of the fee. It is likely to assume that the reduced utilization of interpretation services is highly related to the fee. Further research is needed about the consequences of underutilization of interpretation services.

Quality of life and coping strategies among immigrant women living with pain in Denmark: a qualitative study.

OBJECTIVE: To examine quality of life and coping strategies among immigrant women living with chronic pain. DESIGN: Qualitative content analysis based on in-depth semistructured interviews. SETTING: A clinic specifically targeting immigrants at a larger university hospital in Copenhagen, Denmark. PARTICIPANTS: Non-western female immigrant patients suffering from chronic pain (n=13). MAIN OUTCOME MEASURES: Experiences of the impact of chronic pain on quality of life. RESULTS: Chronic pain was perceived to have an extensive, adverse effect on all aspects of quality of life, including physical health, mental well-being and social relations. This included the ability to maintain activities of daily living and the ability to work. Chronic pain was further experienced as a cause of emotional distress, depression and altered personalities, which all had great consequences on women's social interactions, causing change and loss of social relations. A variety of coping strategies were used to cope with the pain, manage its consequences, and restore a level of health that would enable women to function and fulfil social roles. Many participants coped with the pain by altering everyday life, keeping daily activities to a minimum and taking pain-killing drugs, offering temporary relief. Seeking healthcare was another coping strategy used as an active means to assert agency and as a temporary distraction from pain. However, accessing healthcare also involved a risk of disagreement and disappointments. CONCLUSIONS: Chronic pain had a severe negative impact on quality of life and necessitated alterations in everyday life and active health-seeking strategies. Implications for practice imply a need for a more holistic approach to immigrant women with chronic pain, including a family-centred approach. Further research is needed to explore similarities or differences in and between populations with diverse ethnic, socioeconomic and psychosocial backgrounds, and to assess how ethnicity and culture might influence the experiences of chronic pain.