How Many Languages Do I Need to Speak?

1. Dr. Karen Okrainec SMBD – Jewish General Hospital 3755 Côte-Ste-Catherine, Room H 462 Montreal, Quebec, H3T 1E2 Karen.okrainec@mail.mcgill.ca Phone: 514-340-8222 ext..8375 Fax: 514-340-7578 How Many Languages Do I Need to Speak? Okrainec K1, Miller M2, Holcroft Christina3, Boivin JF3, Greenaway C2,3 Department of Internal Medicine, McGill University1, Division of Infectious Diseases, Jewish General Hospital, McGill University2, Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital and the Lady Davis Institute for Medical Research3 Results Background Results Capture rate=72%, participation rate= 88%. • Immigrants make up a large proportion of the Canada population, accounting for 20% in the 2006 Census. • Canada receives ~250,000 new immigrants/year and >80% of whom over at least the past 10 years have a maternal language other than English or French. • Language barriers impact health-care access and delivery for immigrants, as well as quality of care. • Language barriers lead to: • Poor self-reported health (OR= 2.0) • Longer hospital stays (up to 4.3 days) • Increased emergency room visits (2 times more likely) • Poor follow-up (3 times more likely) • Poor medication compliance (3 times more likely to omit medication) • Use of professional interpreters is associated with improved clinical care (communication, utilization, clinical outcomes and satisfaction with care). • Stated language preference is used as the gold standard for determining whether translator services should be offered. How this variable correlates with other questions about self reported language proficiency and communication ability is unknown. Table 1: Characteristics of Study Population Table 6: Use of Translators in Different Groups of Patients Table 2: Language Characteristics Objective • To determine the best question to identify patients with language barrier and whom would benefit from translator services. Methods Summary • Setting: The Jewish General Hospital is a 637 bed hospital in the Cote-des-Neiges/Notre-Dame-de-Grace borough of Montreal, Canada where 45% of the population are immigrants and 30% are newly arrived (<5 years). • Study Design: Cross-sectional survey administered over a 6 week period (March-May 2010). • Population: 1000 adults recruited from one of 3 inpatient units (medical, obstetrics, surgical), 4 outpatient units (endocrinology, cardiology, family medicine, tuberculosis) and the emergency room. • Questionnaire: Nurse administered questionnaire. Demographics, country of origin, length of time in Canada, maternal language, self reported language ability, communication ability with health care workers, language preference, use of translators, type of translators. • Statistical Analysis: All statistical analyses were performed using SAS 9.0 (SAS Institute, Cary, North Carolina). The strength of correlation between Language Preference and complete language barrier, language proficiency and ability to communicate were measured with a Kappa statistics for correlation. • Our study population represented a multicultural population originating from 110 countries and speaking >90 languages. • 7% had a complete language barrier. • 14% had limited self-reported proficiency in both English and French. • 18% had difficulty communicate their health needs to medical staff in English or French. • 28% preferred to have their medical needs explained in a language other than English or French • Only 11% of the total population used a translator. Most translators used are family or friends. Table 3: Relationship between Language Preference and Language Barriers Conclusions • The questions Ability to Communicate and Self Reported Language Ability correlated poorly with Language Preference (Kappa 0.57 and 0.47 respectively). • 15% of those with Not Easy Communication and 13% of those with Limited Language Ability stated their preferred language was English or French. • 15% of those with Easy Communication and 19% of those with good language ability still preferred to be served in a language other than English or French • However 93% of patients with combined limited language proficiency and difficult communication prefer to be served in a language other than English or French. • The questions Ability to Communicate and Self reported language ability correlated only moderately well (Kappa=0.69, P=<0.001) with each other. A total of 34% of those with good language ability reported that it was difficult to communicate and 2% of those that could communicate easily claimed to have poor language proficiency. • Effective communication in the health care setting in this and likely other multi cultural populations is challenging. A large proportion (28%) of participants in this survey preferred to be served in a language other than English or French but only 32% of them used a translator. Table 5: Relationship between Language Barrier categories and Language Preference Table 4: Correlation of Language Proficiency and Ability to Communicate Definitions • Complete Language Barrier: inability to answer questionnaire on their own due to a complete language barrier • Self–Reported Language Proficiency : How well do you think you speak English (or French)? • Good = Fluently, Very Well, or Well in Either English or French • Limited => Fairly Well, Poorly, Cannot speak in Both English and French • Ability to communicate with health providers: How easy is it for you to tell a doctor or nurse what the problem is? • Very Easy => “Very Easy” in Either English or French • Not Easy => “Not easy- I need some help”, “Not easy- I need a lot of help”, “Very difficult- not able to speak” in Both English and French • Language Preference: If your medical care could be provided in any language, which language would you prefer? (Language listed) References Manson A. Language concordance as a determinant of patient compliance and emergency room visits in patients with asthma. Med Care 1988; 26: 1119-1128. Gardam M, VermaGeetika, Campbell A, Wang J, Khan Kamran. Impact of the Patient-Provider Relationship on the Survival of Foreign Born Outpatients with Tuberculosis. J Immig Minority Health 2009; 11: 1557-1912. Williams Mv, Baker DW, HonigEg, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest 1998; 114: 1008-1015. Pottie K, Ng E, Spitzer D, Mohammed A, Glazier R. Language proficiency, Gender and Self-reported Health. Can J Public Health 2008 Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res 2007; 42: 727-54.