Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, UK.
Health Soc Care Community. 2009 Nov;17(6):636-46. doi: 10.1111/j.1365-2524.2009.00867.x. Epub 2009 May 27.
Inequalities in access to appropriate and acceptable healthcare contributes to a pattern of poorer health status, reduced life expectancy and greater dissatisfaction with healthcare amongst people from Black and minority ethnic communities (BME). Language acts as a further barrier to access. The development of bilingual advocacy fuses two key functions--interpretation and advocacy--to ensure that people from BME communities are able to have their healthcare needs met appropriately. This paper explores the development of bilingual advocacy in East London, which has a highly diverse population speaking over 100 different languages. It considers the development of the bilingual advocacy services by an NHS University Hospital Trust, the local experience of these services and the factors that have influenced their development. We employed the Delphi method amongst the four authors to examine the advocate-, service- or client-related challenges that face advocacy services; and the threats of these challenges to Trust-based advocacy and their implications to the service, client and advocate. Advocate-related challenges included status, esteem and remuneration of bilingual advocates in relation to other health professionals, as well as skills development, career progression, gender, capacity building and potential research contributions. Service-related challenges included work load, case mix, administration, commissioning processes/arrangements; entrepreneurial aspects of advocacy services; and mechanisms/potentials for cost recovery. Client-related challenges included continuity of advocacy; language requirements and advocacy needs of clients; and ways in which mobile populations influence planning and delivery of advocacy services for inner city hospitals. The paper concludes with identifying the implications for future development of bilingual advocacy services and the implications for their workforce.
在获得适当和可接受的医疗保健方面的不平等导致了一种模式，即来自黑人和少数族裔社区（BME）的人的健康状况较差、预期寿命缩短以及对医疗保健的不满程度更高。语言是获得医疗保健的另一个障碍。双语倡导的发展融合了两种关键功能——口译和倡导——以确保来自 BME 社区的人能够适当地满足他们的医疗保健需求。本文探讨了东伦敦双语倡导的发展，该地区拥有高度多样化的人口，使用超过 100 种不同的语言。它考虑了一家 NHS 大学医院信托基金双语倡导服务的发展、这些服务的当地经验以及影响其发展的因素。我们在四位作者之间采用德尔菲法来检查倡导者、服务或客户相关的挑战，这些挑战对信托倡导服务的威胁，以及对服务、客户和倡导者的影响。倡导者相关的挑战包括双语倡导者相对于其他卫生专业人员的地位、尊重和薪酬，以及技能发展、职业发展、性别、能力建设和潜在的研究贡献。服务相关的挑战包括工作量、病例组合、行政、委托程序/安排；倡导服务的创业方面；以及成本回收的机制/潜力。客户相关的挑战包括倡导的连续性；客户的语言要求和倡导需求；以及流动人口如何影响市中心医院的倡导服务规划和交付。本文最后确定了双语倡导服务未来发展的影响及其劳动力的影响。
