Falla Abby M, Veldhuijzen Irene K, Ahmad Amena A, Levi Miriam, Richardus Jan Hendrik
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
BMC Health Serv Res. 2017 Feb 20;17(1):150. doi: 10.1186/s12913-017-2095-5.
Language support for linguistic minorities can improve patient safety, clinical outcomes and the quality of health care. Most chronic hepatitis B/C infections in Europe are detected among people born in endemic countries mostly in Africa, Asia and Central/Eastern Europe, groups that may experience language barriers when accessing health care services in their host countries. We investigated availability of interpreters and translated materials for linguistic minority hepatitis B/C patients. We also investigated clinicians' agreement that language barriers are explanations of three scenarios: the low screening uptake of hepatitis B/C screening, the lack of screening in primary care, and why cases do not reach specialist care.
An online survey was developed, translated and sent to experts in five health care services involved in screening or treating viral hepatitis in six European countries: Germany, Hungary, Italy, the Netherlands, Spain and the United Kingdom (UK). The five areas of health care were: general practice/family medicine, antenatal care, health care for asylum seekers, sexual health and specialist secondary care. We measured availability using a three-point ordinal scale ('very common', 'variable or not routine' and 'rarely or never'). We measured agreement using a five-point Likert scale.
We received 238 responses (23% response rate, N = 1026) from representatives in each health care field in each country. Interpreters are common in the UK, the Netherlands and Spain but variable or rare in Germany, Hungary and Italy. Translated materials are rarely/never available in Hungary, Italy and Spain but commonly or variably available in the Netherlands, Germany and the UK. Differing levels of agreement that language barriers explain the three scenarios are seen across the countries. Professionals in countries with most infrequent availability (Hungary and Italy) disagree strongest that language barriers are explanations.
Our findings show pronounced differences between countries in availability of interpreters, differences that mirror socio-cultural value systems of 'difference-sensitive' and 'difference-blindness'. Improved language support is needed given the complex natural history of hepatitis B/C, the recognised barriers to screening and care, and the large undiagnosed burden among (potentially) linguistic minority migrant groups.
为语言少数群体提供语言支持可改善患者安全、临床结局及医疗保健质量。欧洲大多数慢性乙型/丙型肝炎感染病例是在非洲、亚洲及中东欧等流行国家出生的人群中发现的，这些群体在其所在国获得医疗服务时可能会遇到语言障碍。我们调查了针对语言少数群体的乙型/丙型肝炎患者的口译员及翻译材料的可获得性。我们还调查了临床医生对于语言障碍能否解释以下三种情况的认同度：乙型/丙型肝炎筛查接受率低、初级保健中缺乏筛查以及病例未得到专科治疗的原因。
设计了一项在线调查，将其翻译后发送给六个欧洲国家（德国、匈牙利、意大利、荷兰、西班牙和英国）参与病毒性肝炎筛查或治疗的五项医疗服务领域的专家。这五个医疗领域分别为：全科医疗/家庭医学、产前护理、寻求庇护者的医疗保健、性健康及专科二级护理。我们使用三点有序量表（“非常常见”“不稳定或不常规”“很少或从不”）来衡量可获得性。我们使用五点李克特量表来衡量认同度。
我们收到了来自每个国家各医疗领域代表的238份回复（回复率23%，N = 1026）。口译员在英国、荷兰和西班牙很常见，但在德国、匈牙利和意大利则不稳定或很少见。匈牙利、意大利和西班牙很少或根本没有翻译材料，但荷兰、德国和英国有常见或不稳定的翻译材料。各国对于语言障碍能否解释这三种情况的认同程度不同。在口译员最不易获得的国家（匈牙利和意大利），专业人员最不认同语言障碍是这些情况的解释。
我们的研究结果表明，各国在口译员可获得性方面存在显著差异，这些差异反映了“差异敏感”和“差异盲视”的社会文化价值体系。鉴于乙型/丙型肝炎复杂的自然史、公认的筛查和治疗障碍以及（潜在的）语言少数群体移民中的大量未确诊负担，需要改善语言支持。
