Course:SOWK551/2021/Impacts of language barrier for immigrants on healthcare access
Short Summary
Literature review of Impacts of language barrier for immigrants on healthcare access.
Please do not remove this section.
Author: Bruce Ngan
Date: April 6, 2023
Introduction
There has been significant growth in immigrants in Canada over the past decades. Canada has recorded the highest proportion of immigrants since Confederation in the 2021 Census. Almost 1 in 4 people have been landed immigrant or permanent resident in Canada (Statistics Canada, 2021). Most immigrants to Canada now originate from Asia and the Middle East regions, where languages and cultures can differ significantly from the Canadian context. In addition, immigrants greatly contribute to Canada’s economic growth, accounting for as much as 90% of labour force growth and approximately 75% of population growth (Immigration, Refugees and Citizenship Canada, 2021).
Though immigrants play a vital role in Canada, their health status declines after migration. Gushulak et al. (2011) reviewed 20 population health studies that utilized various databases, including the National Population Health Survey, Canadian Community Health Survey, and Longitudinal Survey of Immigrants to Canada, to examine the health of immigrants. The studies found that immigrants report better health and health characteristics upon arrival in Canada than the general Canadian-born population. However, this advantage gradually declines over time, and certain immigrant groups are at a higher risk of experiencing a decline in their health status and poorer health outcomes. The drop in immigrants’ health can be related to several factors, such as poor access to health care (Asanin & Wilson, 2008; Harrington et al., 2014) and stress during the settlement process (Dean & Wilson, 2009).
In the literature, there was extensive discussion on how access to healthcare is closely linked to the health results of immigrants. This paper aims to identify the most significant barrier to immigrants’ healthcare access and its impact. Finally, the paper will discuss the implication for healthcare workers on working with immigrants to promote better healthcare access.
Language is the most reported barrier for immigrants in healthcare access
Language has been a significant obstacle that impedes immigrants’ access to health care in Canada over the years. For example, Kalich et al. (2016) conducted a scoping review of healthcare access barriers experienced by immigrants. The study reviewed 27 articles published from 2002 to 2014, using both qualitative and quantitative methodologies to identify several barriers to immigrant healthcare access and concluded that language is the most cited barrier to accessing healthcare in Canada, followed by a lack of information about how to access or navigate services, and cultural differences.
Another recent scoping review on immigrants’ experience of healthcare access in Canada, studying 21 articles published from 2014 to 2022 with qualitative and quantitative approaches, revealed that language or communication difficulties are the most identified barriers to immigrant healthcare access, followed by cultural barriers and limited health literacy. (Tsai & Ghahari, 2023).
In the past two decades, language proficiency has been the major hindrance that has obstructed immigrants’ ability to access healthcare services in Canada. However, there is also mounting evidence of how language barriers negatively impact immigrants’ access to health care. The impacts of the language barrier on healthcare access will be discussed in the following paragraphs.
Impacts of language barrier on healthcare access
Limited access to health information and services
Language barriers prevent immigrants from accessing ambient health information (Bowen, 2015). Ambient health information in Canada is usually provided in English or French. This information is typically disseminated through various channels such as mass media, community events, public health campaigns, or social networks. Ambient health information sources include billboards, flyers, brochures, radio or TV advertisements, social media posts, community events, and public announcements. However, language barriers can prevent individuals from accessing ambient health information effectively, which can be particularly concerning for immigrants or individuals with limited English proficiency. As a result, such individuals may miss out on critical health-related information that could help them make informed decisions about their health and well-being.
Language proficiency also notably influences their capacity to identify necessary healthcare services, such as scheduling appointments, and interact effectively with healthcare providers during medical consultations and follow-up care (Bowen, 2015; Pandey et al., 2021). This is because healthcare services, such as telephone hotlines or online appointments, are only available in English or French. Moreover, healthcare service information is typically presented in English or French, which can be a significant obstacle for clients who are not fluent in either language. As a result, clients with language barriers may not have access to sufficient information on available services, which can hinder their ability to access the care they need promptly. For example, poor English proficiency was reported as contributing to low breast cancer screening rates among immigrant women, and their general exposure to breast cancer information was also restricted (Ferdous et al., 2020).
Limited capacity to establish a therapeutic relationship with healthcare providers
Language can significantly affect the therapeutic relationship between patients and healthcare providers (Pandey et al., 2021). Effective communication is essential for building a trusting and collaborative relationship between patients and healthcare providers. However, patients with limited proficiency in the language used in healthcare settings may struggle to communicate their health concerns with the healthcare provider.
Immigrants also face difficulties explaining their symptoms and emotions, comprehending medical terminology, and understanding doctors’ instructions due to communication barriers in either English or French, the official languages (Wang et al., 2019; Raynault et al., 2020). Immigrants feel stressed about discussing their health issues with doctors hurriedly in a second language and follow the conversation when the doctors offer limited time for the appointment (Turin et al., 2020; Pandey et al., 2021). In addition, because of language barriers, immigrants are often unable to explain the emergent nature of their health status in the hospital's emergency department (Pandey et al., 2021). Patients with limited proficiency in the local language may encounter challenges in scheduling medical appointments and may also miss appointments due to difficulties posed by the language barrier (Ali & Watson, 2018). The ineffective therapeutic relationship between patients and healthcare providers impacts the treatment process, patient satisfaction and underutilization of the available healthcare services, ultimately resulting in poor health outcomes (Turin et al., 2020; Pandey et al., 2021).
Limited access to mental health service
Many factors affect immigrants’ mental health during the settlement process. A study concluded that nine factors influence the mental health of immigrants’: employment and poverty, immigration status, community belonging, family conflict, gender, discrimination and racism, time since migration and age at immigration, culture shock, and parental stress. The combination of these circumstances not only affects the mental health of individual immigrants but also obstructs the treatment of mental health concerns by limiting access to proven, effective support services. In addition, language is also identified as one of the barriers to access and use of mental healthcare services for many immigrants. Most immigrants are concerned that their service providers might misunderstand them due to their inability to express medical terminology in English or because English language options may not accurately convey their intended message. (Salami, et, al., 2017). Another study also revealed that limited English proficiency might hinder immigrants from using mental health services. Although immigrants have levels of emotional distress, they are less likely to access mental health services than non-immigrants due to limited English proficiency (Kim et al., 2011).
Language barriers can significantly impact immigrants’ healthcare access and eventually deteriorate their physical and mental health (Asanin & Wilson, 2008; Harrington et al., 2014). Therefore, healthcare workers must work with immigrants facing language barriers and facilitate reasonable access to health services. The following paragraphs discuss how healthcare workers can work with immigrants and promote better healthcare access.
Implication for healthcare workers in promoting healthcare access for immigrants
Adopt Trauma Informed Care in establishing trusting relationships with patients
Understanding the impact of trauma on individuals is crucial for the healing process. Adopting Trauma Informed Care (TIC) can significantly affect the quality of service provided and the effectiveness of the healing process (Xwi7xwa Collection & Klinic Community Health Centre, 2013). TIC improves provider-patient communication, patient satisfaction, medical information recall, compliance and patients’ perception of care delivery (Oral et al., 2020). Therefore, a healthcare worker can adopt Trauma Informed Care to work with immigrants with language barriers to promote better healthcare access.
A core of TIC is a shift away from labelling clients or patients as "sick" and towards recognizing that they have been affected by an "injury". By viewing trauma as an injury, the focus changes from asking, "What is wrong with you?" to "What has happened to you?" (Xwi7xwa Collection, & Klinic Community Health Centre, 2013). In application to working with immigrants with a language barrier, healthcare worker views the language barrier as a significant need to address rather than a weakness or a problem of the immigrants, allowing the healthcare worker to understand more the impact of trauma that immigrants have on seeking support.
An essential component of TIC is acknowledging trauma's pervasive impact (Miller et al., 2019). Immigrants may experience different traumas during the settlement process, such as discrimination (Oxman-Martinez, 2012). Patients might also have an unpleasant and harmful experience accessing healthcare services. Healthcare workers should acknowledge how their language barrier impeded their access to healthcare and the challenges they have encountered due to the language barriers. For example, the healthcare worker can acknowledge the steps the immigrants have taken in moving into a new country and accessing an unfamiliar healthcare system.
Promoting a trusting relationship between healthcare workers and patients is another fundamental principle of TIC (Miller et al., 2019). Immigrants struggle to build trustful therapeutic relationships with healthcare service providers, and it limits their access to healthcare. Therefore, in applying TIC, healthcare workers should carefully assess the needs of the immigrants, explain the need for any medical exams and clarify follow-up treatment and medication. Healthcare should also ask permission to discuss sensitive topics and allow the patients to stop at any time (Miller et al., 2019). As such, the healthcare worker can create an environment to prevent further traumatization or re-traumatization (Harris & Fallot, 2001).
Utilization of interpretation service
The language barrier can cause communication difficulties between medical professionals and immigrants, resulting in low satisfaction with healthcare, limited comprehension of their diagnosis, an increased risk of medication complications and less access to usual sources of healthcare (Al Shamsi et al., 2020). Healthcare workers can utilize interpretation services to overcome the language barrier faced by immigrants.
Interpretation services can help to overcome communication barriers by providing a professional and accurate translation of medical terminology and instructions, which helps to ensure that patients fully understand their health condition, diagnosis, and treatment options. Interpreters can also assist patients in conveying their symptoms, concerns, and questions to healthcare providers, which can help to facilitate an accurate diagnosis and effective treatment. A study revealed that patients who use interpreter services had been found to have a significant association with increased physician visits, prescription drugs prescribed by physicians, receipt of preventative services and satisfaction (Brach et al., 2005; Squires, 2018). Even though the interpretation service has room to improve in most healthcare institutions, and it increases the duration and cost of physician visits (Al Shamsi et al., 2020), it is still recommended to fully utilize the interpretation with an immigrant in light of their health status.
Advocate for immigrant-friendly policies or service
Healthcare workers can act as a role to advocate for immigrant-friendly policies and services. Frontline healthcare workers have opportunities to work with immigrants directly and understand their challenges in healthcare access. According to the Code of Ethics and Standards of Practices of BCCSW, a social worker shall advocate change in the client’s best interest and for society’s overall benefit. As such, healthcare workers should use this power and knowledge to advocate the best practices for the care of immigrants to promote better healthcare access to necessary information and services (Miller et al., 2019).
Conclusion
Language has been the most common and reported barrier to healthcare access for immigrants. It negatively impacts the health status of immigrants. Moreover, immigrants face many complexities and difficulties apart from the abovementioned challenges. The paper provides a very brief discussion on how healthcare workers can promote better healthcare access. Healthcare workers are encouraged to learn the latest research and best practices in working with immigrants to provide their clients with the best and most appropriate support.
References
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