Language barriers are a recurring reality in clinical practice in public health care centers across Catalonia. They negatively affect the relationship between health care personnel and patients who are not fluent in any of the official languages: Catalan, Aranese or Spanish. There is a lack of resources and protocols to manage these situations, and therefore professional and stable coordinated policies are needed that can guarantee interpreting and mediation services across the country to prevent inequalities.
This is the conclusion reached in a report published by researchers at the Universitat Autònoma de Barcelona (UAB) working on the project “CIMAS: Comunicació Intercultural Mediada a l’Àmbit Sanitari.” The results of the project were presented at a conference held at the UAB Teaching Unit of Vall d’Hebron Hospital.
The study was conducted by researchers from the group Mediació i Interpretació: Recerca en l’Àmbit Social (MIRAS) in the Department of Translation and Interpreting and East Asian Studies. Researchers and health care professionals from Rovira i Virgili University, Vall d’Hebron Hospital and Mútua de Terrassa Hospital also participated.
“In Catalonia, where according to IDESCAR data 16.3% of the population has a migrant background, the efforts in these past three decades on behalf of health care services and the administration have not been enough to reduce these communication barriers. The report we present offers an overall perspective on the current situation, which until now has been studied in a very fragmented way,” explain Anna Gil-Bardají and Gema Rubio, coordinators of the report.
1,400 health care professionals surveyed
The report includes a pilot study in which 1,390 health care professionals and some 40 professional language mediators were surveyed, as well as a qualitative analysis of the attitudes and perceptions of all groups involved: health care professionals and community health agents, patients, professional interpreters, and accompanying adults and minors.
The survey results reveal that language difficulties have a large impact on 85% of health care workers and interfere a lot or quite a lot with their professional practice, while 29% experience communication difficulties at least once a week and 9% experience them daily.
Interpreters and intercultural mediation services are clearly insufficient to cover real needs, and this often forces professionals to turn to informal solutions, such as communicating through the patient’s relatives or friends, even when they are minors. Aside from this option, machine translation is the second most-used resource among health care professionals, while very few (1.5%) use the phone interpreting services offered through the public health helpline, 061.
Communication problems entail a high emotional load for all those involved, with consequences that affect the quality and equity of patient care, including misunderstandings, informed consent, adherence to treatment and information confidentiality.
Risks and limitations of machine translations
The report shows that machine translation technologies are already part of everyday health care practices and warns of the limitations and risks they represent, as they can generate a false sense of understanding and make important communication problems invisible.
According to the research team, the problem is not just whether the translation is linguistically correct, but the tendency to assume that communication has already occurred simply because a machine translation has been used. Furthermore, these tools may work relatively well in the most common languages but have many more limitations in less represented languages or in those with great dialectal diversity.
Moreover, the use of these tools can increase the workload of health care personnel and affect the efficiency of the system, since consultations require more time, more reformulations and more effort to verify understanding.
Job insecurity and regional gaps
The report points to an absence of planning and coordinated public policies, which leads to significant gaps in different regions (Barcelona and the metropolitan area versus other places in the provinces of Lleida and Tarragona), as well as externalization and job insecurity for professional interpreters. All of this causes erosion in the quality of the service and limited use of mediation, subordinated to epidemiological control logics that have distanced patients from the right to health care.
“We hope that the study will serve to advance toward stable public policies across Catalonia that can better train, fund and deploy language and cultural mediation throughout the Catalan health care system,” the authors of the report conclude.
The research team used the results to create a list of clinical practice recommendations and design specialized training courses for health care professionals.
Key medical concepts
Clinical categories
The content is provided for information purposes only.