Life is peppered with unexpected events...
Life is peppered with unexpected events, tête-à-têtes with bureaucracies, hospital admissions, not to mention parking tickets (so many parking tickets…). If you’ve ever been presented with a legal contract of any kind, a consent form, or a notice from a landlord, then you are well aware of how perplexing and unfamiliar the language often is. Maybe you can read the words (“decoding” in linguistic studies) but that doesn’t equal understanding (comprehension). Companies often count on this barrier; how many mobile phone contracts have you signed without reading the small print?
“Language barriers have been identified as being the primary obstacle in providing effective, equitable and patient-safe care to patients with limited proficiency in a country’s majority language.”
Evidence suggests that non-English speakers can experience anxiety simply by speaking to native speakers, let alone by finding themselves in unpredictable circumstances or needing to follow unfamiliar procedures. Combine this with literacy and/or vision issues and the barrier to comprehension rises higher and higher. When communicating with low literacy clients and non-English speakers, it is the duty of responsible organisations to be hyper-vigilant in their care and communication, in order to reduce inequity and the risk of causing unintended harm.
Mind the Language Gap –
lack of access to, and understanding the importance of professional interpreter services
“Professional interpreters are the most skilled in medical interpretation, the least likely to make errors, and the only type of interpreter associated with overall improvement of care for patients with limited English proficiency.”
(Schenker, Lo, Ettinger & Fernandez, 2017)
Our immigrant population is steadily growing. 1 in 4 Australians are now born overseas, and over 300 languages are spoken in Australia, including Indigenous languages. The addition of a strong skilled migration program, supporting a booming international student body (with majority of students hailing from non-English speaking countries) the use of professionally qualified interpreters is increasingly relevant in service delivery across multiple categories (civic, health, education and legal services being just a few). In 2015 there were over 11,000 judicial hearings (across Federal Court and Review Tribunals, for example), which involved interpreters (Perry & Zornada, 2015). Coupled with statistics around low literacy (14%-46% of Australians), language services play a vital role in establishing understanding and consent, and even “ensuring that justice is in fact done” (Perry & Zornada, 2015).
But unfortunately (and there is always a but), a slew of factors obstruct the institutional use of interpreters, creating concerning scenarios for non-English speakers that, in the worst-cases, may be life threatening.
“Family members often have inadequate l anguage skills, resulting in higher rates of clinically significant errors … and may interpret selectively to fit their own beliefs.”
(Schenker, Lo, Ettinger & Fernandez, 2017)
Take a situation where the non-English speaker is a patient in a hospital where rapid decisions need to be made – an extremely confronting and stressful experience for both patient and family. Research from Sweden and America tells us that the quality, availability of, and access to interpreters varies widely amongst institutions (Schenker, Lo, Ettinger & Fernandez, 2017) (Jungner, 2018). Within the medical field there is a concerning belief that using family members or untrained bilingual staff is an adequate means of communication. Alarming estimates suggest that 20% of Australian GPs do not consider it necessary to use a qualified interpreter to gain informed consent (Promoting the Engagement, 2013).
In the federal court system where there is a necessity for a high professional standard, there is a preference for NAATI-accredited interpreters. Unfortunately they are not always available, resulting in the use of interpreters who may not have the adequate skills to interpret and reconstitute legal jargon (Perry & Zornada, 2015).
The risk of miscommunication, the risk of a lack of parity of meaning, is significant in both of these scenarios, and certainly applies to other fields including welfare, aged care, and government service delivery. When the non-qualified interpreter does not have adequate certifications, and lacks the ability to convey terminology or procedure, or where a cultural barrier exists which inhibits them from discussing certain topics, there is a worrying potential for severe ethical issues, and inequity of outcome.
“In one documented case, a child of 10 years, suffered a severe post-traumatic stress reaction that saw her hospitalised for eight months; one of the triggers was being used as an interpreter between her family and medical staff for her younger sibling, who died of renal failure at the age of 13 months.”
Promoting the Engagement of Interpreters in Victorian HealthServices, 2013.
“Equity is the absence of preventable differences among groups of people”
(World Health Organization, 1948).
Closing the gap for the linguistically diverse
In cases such as these, pre-recorded audio can be more effective than written communications, and is more efficient than engaging an interpreter (whose abilities are better suited to two-way conversation). Furthermore audio is fundamental when there is poor literacy and/or vision impairment).
Multilingual messaging services such as LiME are paving the way for equitable service delivery, by delivering pre-recorded audio across multiple communication channels.
According to some studies, there is a clear correlation between the lack of adequate translation and increased healthcare costs (Jungner, 2018). Through the combination of qualified and accredited interpreters and pre-recorded audio messaging, civic, medical and judicial institutions can not only help reduce the stress, anxiety faced by non-English speakers, but also resolve their discrepancies in access and outcome, while also reducing the occurrence of costly mistakes.
Consider the impact of using audio recordings to inform patients of pre-operative procedures, or medication side effects, or lawyers using this approach to ensure their clients fully understand their rights. Where professional interpreter services cannot be used, or there are benefits to adopting other technologies, organisations may look towards cross-platform approaches to prevent repetition and improve efficiencies. The consensus amongst the experts is that communication practices have to change in Australia if we are to make navigating increasingly complex systems, and achieving positive outcomes, accessible to all.
What can you do to create equity for your customers from non-English speaking backgrounds?
- Schenker, Y., Wang, F., Selig, S.J. et al. J GEN INTERN MED (2007) 22(Suppl 2): 294. https://doi.org/10.1007/s11606-007-0359-1
- Granhagen Jungner, Johanna. 2018-12-14. Communication over language barriers in paediatric oncology care : a prerequisite for equity in care.
- Schenker Y, Lo B, Ettinger KM, Fernandez A. Navigating Language Barriers under Difficult Circumstances. Ann Intern Med. ;149:264–269. doi: 10.7326/0003-4819-149-4-200808190-00008
- Foundation House. Promoting the engagement of interpreters in Victorian health services. June 2013
- The Hon. Justice Melissa Perry, Kristen Zornada. (13-14 March 2015, Sydney) Panel on Working with Interpreters. Working With Interpreters: Judicial Perspectives. AIJA Cultural diversity and the law conference