There are several main factors contributing to communication as a barrier in health care: unproficiency in the common language, inadequate health literacy, inadequate reading level, and different meanings of a word to different cultures. Language becomes a barrier when it is assumed there is proficient understanding of a common language. This can occur when the patient states they understand an adequate amount of the common language or when the provider believes they are proficient in the patient’s language. Often times a patient will use a family member as their interpreter, but the family member is not proficient enough to translate medical terminology. Using a family member, such as a child, as an interpreter can inhibit the patient from sharing sensitive information such as sexuality, drug and alcohol misuse, and domestic violence (Purnell, 2014).
Cultural differences in language interpretation present as a barrier due to different meanings or understandings of a word in different cultures. Low health literacy can present due to language and cultural barriers, but often within groups of people of the same culture. Health literacy also involves the patient’s ability to read and write. Often a provider will assume the patient is health literate if they speak the same language and are of the same culture. A patient can feel embarrassed by their lack of knowledge and my not communicate their lack in understanding, so the provider is unaware. This assumption leads to inadequate understanding of health care by the patient (Schyve, 2007, p. 360-361). Patient’s may also be at a low reading level and can’t read the instructions on their care instructions or the directions on the medication bottles. This can also be embarrassing for the patients to admit to, so the health care team can be unaware. The patient may also be very proficient with reading, but only in their own language, however they could receive instruction in English, which they can’t read. All of these issues encountered with communication barriers lead to inadequate health care for the patient and increases cost as well as health risks.
According to research conducted by the Center for Immigration Studies, one in five U.S. residents speak a foreign language at home. That is a record of 61.8 million people. The research also concluded that of those who speak a foreign language, 25.1 billion (41 percent) reported to the Census Bureau they speak English less than very well (Camarota, Zeigler, 2014). Roughly eight percent of America’s population is at risk for experiencing communication issues in health care. Some studies show an association between a language barrier and health care related issues such as preventative care and screening, mental health care, pain and symptom management, chronic disease management, informed consent, and medication errors.
For those who have limited English skills knowing what health care services are available to them and making an appointment can prove challenging. Many online, over the phone, or print resources are usually available in English or Spanish. Limited skills can also prevent a person from picking up health information from places most of us learn our information such as the newspaper, advertisements, T.V., or radio. Lack of English proficiency is correlated with lack of knowledge about stroke and heart attacks (Chow et al., 2008; DuBard et al., 2006), and lack of information regarding cancer signs and symptoms (Fitch et al., 1997).
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