Student: Kara Seers
Supervisors: Prof Philip Schluter, Dr Gillian Abel, Dr Lynley Cook
Sponsor: Partnership Health Canterbury
According to data from the most recent census analysed by Statistics New Zealand, about 2.2% of the New Zealand population who are capable of having an everyday conversation are unable to do so in English. Language discordance between a patient and health provider poses a barrier to effective communication in healthcare. Professional interpreter services are able to facilitate effective conversation in such cases. Partnership Health Canterbury provides two fully funded professional interpreting services to general practices in Canterbury: Language Line, which provides telephone interpreting, and Interpreting Canterbury, which provides face-to-face interpreting. It has been found that the total actual utilisation of interpreter services approximately equals 0.7% of the expected number in general practice in Canterbury. This represents a major issue for patients with limited English proficiency as it indicates that they are largely not receiving the services needed to facilitate their primary health care needs.
The aim of this research was to identify key barriers and enablers to the use of interpreter services.
The barriers and enablers to interpreter service use were realised by analysing the transcripts from two focus groups and two interviews with general practitioners, practice nurses and practice administration staff from some Canterbury general practices.
Five key barriers to the use of interpreter services were identified: practicalities, culture, knowledge, perceptions and systems.
The first theme identified was one of practical issues which make the accessibility of interpreter services difficult. These practical issues include timing, cost and amenities. The organising of appointments, the need for longer appointments when an interpreter service was used, the cost and the problems with amenities such as conference call facilities were all identified as practical barriers to the use of interpreter services.
Patients with limited English proficiency may have different cultural values and beliefs which act as barriers to using interpreter services. However, there are also staff cultures within general practice which may be averse to interpreter service use. The participants in this study discussed how they felt that some patients will take offence at being offered an interpreter, or may feel that they are capable of managing without an interpreter despite having limited English proficiency. As a result, they did not explicitly offer the service out of fear of upsetting the patient. Power and control, cultural mannerisms, privacy and practice staff culture were all sub-themes of the global theme of culture.
It was evident from the interviews that there is a profound lack of knowledge about interpreter services among providers and patients. There is limited knowledge amongst the participants about what services were available and how to access the services and some indicated that they simply did not think to use them. They also indicated that they thought there was a lack of knowledge about this among their patients and that their patients were not aware of their rights, so were limited in their ability to navigate the health system.
Some of the various perceptions and attitudes of providers may act as barriers to accessing interpreters. Providers may not perceive the importance or ease in accessing interpreters to be high enough to warrant their use. Some providers may have perceptions of the quality of interpreter services that lead to their not using some services. This may lead to beliefs that it is sufficient to use family or staff as interpreters, or to make presumptions that patients are content with their “getting by”. Individual participants differed in their attitudes to patients with limited English and had different ideas of how to support them. Those participants who had not made use of interpreter services previously perceived this to be a difficult task and many indicated that they were able to “get by” quite adequately without the help of a service.
A lack of policy and information management poses a barrier to service access. Individual practices are inhibited by not having systematic recording of English proficiency, a lack of training policy regarding the use of interpreter services, and not having technical set-ups of facilities conducive to interpreter service use. The DHB and PHO may need to play a greater role of support for practices and patients in their use of interpreter services. More training for health professionals and general practice staff may be required to increase the understanding of interpreter service use issues and culture issues, and thus increase the access rate of these services.
In all, five major themes were identified which represented the barriers to the use of interpreter services: practicalities, culture, knowledge, perceptions and systems. Together, these broad themes cover a wide range of issues affecting all stakeholders. It is expected that addressing these issues would enable better access rates to interpreter services in general practice in Canterbury.
The current use of interpreter services in general practice in Canterbury is profoundly less than it should be. For the safety of patients with limited English proficiency, actions must occur to counter the barriers currently inhibiting interpreter service use.