Kyle Baird and Laura Smith, German and Russian
Previous research has examined the provider-patient relationship and the effect of different first languages and culture on such relationship (1,2,3). Most studies conducted in the United States have focused primarily on the interactions between English-speaking health care providers and Spanish-speaking patients. Such studies found a relationship between quality of communication and quality of care received by patients, (2,3). When the patient is minimally proficient in English the divide increases and patients receive less information. Similarly, the provider’s proficiency in the patient’s language correlates with the quality of communication and care. The purpose of this study was to investigate a broader range of languages, cultures and contexts in both North America and German-speaking countries. In particular, we examine how providers, patients and translators view the effectiveness of communication as well as how confident and comfortable they feel about the patient-provider relationship across cultural and linguistic barriers. The results will allow us to answer three questions: 1) to what extent does the country in which the interaction takes place play a role in the communication, 2) to what extent do the culture and language of providers and patients play a role in the communication, and 3) does the use of a translator help facilitate higher quality communication?
Respondents: 106 respondents completed a survey. Respondents were separated into three categories: health care providers (n=23), patients (n=66), and translators (n=17). All had experience in cross-language communication within the health care field.
Survey: Three different versions of the survey were created and directed at each of the target groups; each was available in English, Spanish, and German. Surveys consisted of multiple choice and free-response questions that examined patients’ and providers’ ability to understand one another, comfort and confidence levels of each group, and cultural barriers and biases. Quantitative and qualitative data were analyzed from each category.
Results Survey responses showed that both patients and providers in German-speaking countries rated themselves and each other as having higher levels of understanding than their US counterparts. This included understanding each other while using a translator, while communicating in their own native language, and while communicating in the native language of the other party. Three fourths of providers in Germany reported using a lingua franca to communicate with patients, whereas only 17 % reported doing the same in the US. Two thirds of those who report using a lingua franca in Germany reported preferring that form of direct communication over using a translator, compared to 50% in the US. Translators in Germany rated patient understanding about the same as translators in the US, however, translators in the US rated provider understanding higher than translators in Germany. For all patient categories, language was the largest factor affecting both comfort-level and level of understanding the diagnosis communicated by the provider, followed by culture. Comments from respondents suggest that cultural factors may play a larger role in comfort than understanding the communication with the provider.
1.To what extent does the country in which the interaction takes place play a role in the communication? Results suggest that both patients and providers understand each other better in German-speaking countries than in the US. One contributing factor could be the lower foreign language ability of US providers in comparison to German-speaking providers. US providers rated themselves and their patients much lower than their German-speaking counterparts in terms of understanding when attempting to communicate directly with patients. Our limited sample size for German-speaking providers could be a limitation in drawing this conclusion. Patients in the US rated themselves as feeling more comfortable than patients in German-speaking countries. This discrepancy could, however, be skewed by the fact that most of the patients in German-speaking countries were from the US—comparing their German health care experience to the high standards of health care in the US. On the other hand, patients in the US were from various parts of the globe and therefore compared their experience to potentially less-advanced health care systems. Several respondents suggested this. A more varied sample of patients in German-speaking countries could help answer this question.
2.To what extent do the culture and language of providers and patients play a role in communication? According to our results, language plays a much larger role in both patient understanding and comfort level than does culture. Language is less important for comfort than understanding.
3.Does the use of a translator help facilitate higher quality communication? According to understanding ratings by both patient groups (in the US and in German-speaking countries), using a translator gave average scores understanding between “half” and “most” of the provider’s diagnosis. Use of a translator increased understanding ratings for US providers, however German-speaking providers scored better while speaking directly to their patients. This suggests that using direct communication may be the most effective option when possible; however, using a translator may be the best option when both parties have low foreign language skills. A larger sample size would be needed to prove this.
Our study showed that the L2 ability of the patient and the provider are the most important factors affecting the quality of multilingual communication in healthcare. Our results also show that patients and providers with a different L1 in German-speaking countries are better able to communicate than those in the US. This seems to be due to the higher L2 proficiency of providers in German-speaking countries. Future studies are needed further examine this difference in provider language ability and actions could be taken in order to improve provider L2 proficiency in the US.
- Ferguson, W.J., and L.M. Candib. (2002). “Culture,language and the doctor-patient relationship.” FMCH Publications and Presentations, Paper 61.
- Fernandez, A., D. Schillinger, K. Grumbach, A. Rosenthal, A.L. Stewart, F. Wang, and E.J. Perez-Stable. (2004) Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. Journal of General Internal Medicine, 19, 167-174.
- Wilson, E. A.H. Chen, K. Grumbach, F. Wang, A. Fernandez. (2005). “Effects of limited English proficiency and physician language on health care comprehension.” Journal of General Internal Medicine 20.9, 800-806.