Language Diversity, Access to Care, & Health Equity
Special thanks to Grace Christou, Maxime Lê, & Yan Xu.
Content generated as part of the Critical Dialogues For Action Series session on Sept 10, 2024.
Background
We have examples from our own personal experiences where communications goes well, but likewise we have no shortage of examples where it goes very poorly.
Within the health system, this is especially true.
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“...patient dissatisfaction and adverse events have been shown to be more prevalent among limited English proficiency (LEP) patients than English-speaking patients” (reference)
In addition to language concordance, which focuses on our linguistic similarities, we also need to consider cultural concordance.
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While most would focus on ethnocultural similarities, for those who are health care professionals, there is a high probability of cultural discordance that occurs due to our professional identity formation within Western Medicine models. Thus while an individual may be culturally concordant from an ethnocultural perspective, they may be culturally discordant from a professional perspective.
Key Definitions & Concepts
Language Concordance
“Language concordance occurs when patients and providers communicate in a shared language, whereas language discordance occurs when patients and providers cannot communicate in a shared language.” (reference)
Interpretation
Interpretation deals with spoken language in real-time (in-person, over the phone, or via video). Delivered immediately, prioritizes understanding and communication over perfection. Interpreters must be fluent in both the source and target language as they typically are translating in both directions immediately without assistance from reference materials.
Translation
Translation focuses on written content. Have time to ensure accuracy. Professional translators typically work in one direction: into their own mother tongue.
Plain Language
"Plain language (also called plain writing or plain English) is communication your audience can understand the first time they read or hear it...Language that is plain to one set of readers may not be plain to others." (reference)
Chronemics
The study of peoples’ interactions with and interpretation of time, is something obvious when you think about it but is overlooked or goes unnoticed.
Key Principles of Language & Communications
Special thanks to Maxime Lê (member of EqHS Lab)
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Language is not always accessible for everyone. We need to be mindful of peoples' literacy and educational levels. Strive for plain language.
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Communication is a two-way street, and does not always "look or sound" like a verbal exchange of words.
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As much as we communicate we must also learn to be receptive to other peoples' modes or preferences of communication
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​The concept of time and punctuality drastically varies between people and cultures. Chronemics influence someone's willingness to wait, their patience, their punctuality, and the duration they are willing to interact with someone. There is so much variance for these individually.
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Compassion is understanding and acknowledging that some patients may not know about or understand something. And that if they fail to adhere to a treatment, maybe we should ask ourselves if the way we provided instructions wasn’t ideal.
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Most of the time, people just want to be heard or listened to. We may think that communication is just about everything we express outwards and how our interlocutor interprets that, but it's equally about how we receive information and use our previous knowledge of similar situations to determine how to proceed. We need to have enough presence of mind and awareness about the information that our interlocutor is providing us. ​​
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Key Lesson:
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Everything we do and say, every way we act or show restraint, provides information - either consciously but often unconsciously - about our interlocutors who will subsequently interpret our words and actions through their own biases, frames of reference, and understanding of the situation. Even if we mean well, sometimes things can get misinterpreted through no fault of our own.
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Articles & Books
= Article
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= EqHS Lab members
= Tool
= Website
Francophones en contexte linguistique minoritaire au Canada: défis et répercussions sur la santé mentale
H Archambault et al.
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English summary:
"Immigration experiences of Francophones in minority linguistic communities in Canada: challenges and impacts on mental health."