Bischoff Alexander, Bovier Patrick A, Rrustemi Isah, Gariazzo Françoise, Eytan Ariel, Loutan Louis
Department of Community Medicine, Geneva University Hospitals,1211 Geneva 14, Switzerland.
Soc Sci Med. 2003 Aug;57(3):503-12. doi: 10.1016/s0277-9536(02)00376-3.
The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.
本研究的目的是确定筛查面谈期间的语言障碍是否会影响寻求庇护者健康问题的报告以及他们获得进一步医疗保健的转诊情况。回顾了1998年6月至12月期间护士在寻求庇护者进入日内瓦/瑞士时向其发放的723份标准筛查问卷，以及面谈期间语言使用的相关信息。通过考虑是否有口译员、口译员的类型（受过培训的、未受过培训的）以及护士对医疗面谈中使用语言的自我评估熟练程度，来评估护士与寻求庇护者之间的语言一致性。护士还记录了他们对面谈期间总体沟通质量的主观评估。超过一半的寻求庇护者来自欧洲，主要是巴尔干地区，三分之一来自非洲。大多数寻求庇护者是男性（72%）。年龄中位数为26.5岁，50%的人年龄小于25岁。19%的人报告有严重的身体和心理症状，63%的人报告有移民前的创伤性事件。护士将所有难民中的36%转诊接受进一步医疗护理，6%转诊接受心理护理。8%的面谈使用了专业口译员，16%使用了临时口译员。分别有54%、27%和18%的咨询报告语言一致性充分、部分充分和不充分。语言一致性充分与过去创伤性事件经历和严重心理症状的报告率较高显著相关，而语言一致性不充分时转诊接受心理护理的情况则少得多。这些结果表明，在初级保健中心解决语言障碍对于充分发现和转诊受创伤的难民很重要。为解决这一问题，建议使用专业口译员。
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