Challenges in overcoming communication barriers when treating non-Swedish-speaking patients

University of GothenburgOct 26 2010

The healthcare system faces a challenge in overcoming communication barriers when treating non-Swedish-speaking patients, reveals a thesis from the University of Gothenburg, Sweden.

The thesis showed that communication difficulties have meant that war-wounded refugees have found it hard to gain access to the disability support and rehabilitation help they are entitled to. Interpreters were sometimes assigned on the basis of a patient's nationality instead of ethnicity and mother tongue, which resulted in inadequate communication.

"The refugees also felt afraid during formal contact with the authorities," says Nabi Fatahi, nurse radiologist at Sahlgrenska University Hospital and researcher at the Sahlgrenska Academy. "The interpreters' neutrality and professional confidentiality were doubly tested when refugees had suspiciousness and political persecution in their background."

One of the studies examined interpreters' experience of their relationship with patients and staff in primary care in Gothenburg. It emerged that they viewed themselves as part of the healthcare team, and that patients also viewed them more as staff. The healthcare staff did not, however, always view the interpreters as a natural part of the team, which resulted in a conflict of roles for the interpreters. The interpreters emphasised the difficulties of their role as neutral intermediaries, who could be influenced both by patients, who sometimes addressed the interpreter in the first instance, and by doctors, who could also focus too much on the interpreter.

"The meeting between doctor and patient could easily end up on the backburner," says Fatahi. "Other problems included a lack of time for the interpreters in consultations, which resulted in stress and incomplete communication of information."

Healthcare professionals' views on communication through interpreters were studied through interviews with general practitioners in Gothenburg's primary care and radiology staff at Sahlgrenska University Hospital. The result showed that the healthcare professionals attached considerable importance to the interpreter's ability to balance proximity and distance to patients so that they could then translate what was actually being said without adding in extras or leaving things out.

"A key skill that healthcare professionals looked for in interpreters was cultural expertise, and they also wanted continuity of interpreter contact. They felt that the patient's needs must determine which interpreter was chosen. But they also had other important suggestions, such as training in cultural diversity for staff and interpreters working in healthcare, as well as permanent posts for interpreters working in the most common languages encountered by healthcare professionals."