Abstract
BACKGROUND: Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). AIM: To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. DESIGN OF STUDY: 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. SETTING: Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. METHOD: The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. RESULTS: At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P < 0.05) when compared with French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. CONCLUSIONS: The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.
Full Text
The Full Text of this article is available as a PDF (81.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baker D. W., Hayes R., Fortier J. P. Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care. 1998 Oct;36(10):1461–1470. doi: 10.1097/00005650-199810000-00004. [DOI] [PubMed] [Google Scholar]
- Bischoff A., Tonnerre C., Eytan A., Bernstein M., Loutan L. Addressing language barriers to health care, a survey of medical services in Switzerland. Soz Praventivmed. 1999;44(6):248–256. doi: 10.1007/BF01358973. [DOI] [PubMed] [Google Scholar]
- Bischoff A., Tonnerre C., Loutan L., Stalder H. Language difficulties in an outpatient clinic in Switzerland. Soz Praventivmed. 1999;44(6):283–287. doi: 10.1007/BF01358978. [DOI] [PubMed] [Google Scholar]
- Carrasquillo O., Orav E. J., Brennan T. A., Burstin H. R. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999 Feb;14(2):82–87. doi: 10.1046/j.1525-1497.1999.00293.x. [DOI] [PubMed] [Google Scholar]
- David R. A., Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998 Oct-Nov;65(5-6):393–397. [PubMed] [Google Scholar]
- Derose K. P., Baker D. W. Limited English proficiency and Latinos' use of physician services. Med Care Res Rev. 2000 Mar;57(1):76–91. doi: 10.1177/107755870005700105. [DOI] [PubMed] [Google Scholar]
- Flocke S. A. Measuring attributes of primary care: development of a new instrument. J Fam Pract. 1997 Jul;45(1):64–74. [PubMed] [Google Scholar]
- Hampers L. C., Cha S., Gutglass D. J., Binns H. J., Krug S. E. Language barriers and resource utilization in a pediatric emergency department. Pediatrics. 1999 Jun;103(6 Pt 1):1253–1256. doi: 10.1542/peds.103.6.1253. [DOI] [PubMed] [Google Scholar]
- Hayes R. P., Baker D. W. Methodological problems in comparing English-speaking and Spanish-speaking patients' satisfaction with interpersonal aspects of care. Med Care. 1998 Feb;36(2):230–236. doi: 10.1097/00005650-199802000-00011. [DOI] [PubMed] [Google Scholar]
- Jacobs E. A., Lauderdale D. S., Meltzer D., Shorey J. M., Levinson W., Thisted R. A. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001 Jul;16(7):468–474. doi: 10.1046/j.1525-1497.2001.016007468.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Karter A. J., Ferrara A., Darbinian J. A., Ackerson L. M., Selby J. V. Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care. 2000 Apr;23(4):477–483. doi: 10.2337/diacare.23.4.477. [DOI] [PubMed] [Google Scholar]
- Kaufert J. M., Putsch R. W. Communication through interpreters in healthcare: ethical dilemmas arising from differences in class, culture, language, and power. J Clin Ethics. 1997 Spring;8(1):71–87. [PubMed] [Google Scholar]
- Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988 Dec;26(12):1119–1128. doi: 10.1097/00005650-198812000-00003. [DOI] [PubMed] [Google Scholar]
- Morales L. S., Cunningham W. E., Brown J. A., Liu H., Hays R. D. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999 Jul;14(7):409–417. doi: 10.1046/j.1525-1497.1999.06198.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Perneger T. V., Etter J. F., Raetzo M. A., Schaller P., Stalder H. Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland. J Epidemiol Community Health. 1996 Aug;50(4):463–468. doi: 10.1136/jech.50.4.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Perneger T. V., Stalder H., Schaller P., Raetzo M. A., Etter J. F. Satisfaction des patients en milieu ambulatoire: validation d'une échelle et identification de facteurs associés. Schweiz Med Wochenschr. 1996 May 18;126(20):864–871. [PubMed] [Google Scholar]
- Rivadeneyra R., Elderkin-Thompson V., Silver R. C., Waitzkin H. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000 Apr 15;108(6):470–474. doi: 10.1016/s0002-9343(99)00445-3. [DOI] [PubMed] [Google Scholar]
- Sarver J., Baker D. W. Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med. 2000 Apr;15(4):256–264. doi: 10.1111/j.1525-1497.2000.06469.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shah N. M., Shah M. A., Behbehani J. Ethnicity, nationality and health care accessibility in Kuwait: a study of hospital emergency room users. Health Policy Plan. 1996 Sep;11(3):319–328. doi: 10.1093/heapol/11.3.319. [DOI] [PubMed] [Google Scholar]
- Stolk Y., Ziguras S., Saunders T., Garlick R., Stuart G., Coffey G. Lowering the language barrier in an acute psychiatric setting. Aust N Z J Psychiatry. 1998 Jun;32(3):434–440. doi: 10.3109/00048679809065538. [DOI] [PubMed] [Google Scholar]
- Tang S. Y. Interpreter services in healthcare. Policy recommendations for healthcare agencies. J Nurs Adm. 1999 Jun;29(6):23–29. doi: 10.1097/00005110-199906000-00006. [DOI] [PubMed] [Google Scholar]
- Westermeyer J. Working with an interpreter in psychiatric assessment and treatment. J Nerv Ment Dis. 1990 Dec;178(12):745–749. doi: 10.1097/00005053-199012000-00003. [DOI] [PubMed] [Google Scholar]
- Williams B., Coyle J., Healy D. The meaning of patient satisfaction: an explanation of high reported levels. Soc Sci Med. 1998 Nov;47(9):1351–1359. doi: 10.1016/s0277-9536(98)00213-5. [DOI] [PubMed] [Google Scholar]
- Woloshin S., Bickell N. A., Schwartz L. M., Gany F., Welch H. G. Language barriers in medicine in the United States. JAMA. 1995 Mar 1;273(9):724–728. [PubMed] [Google Scholar]
- Woloshin S., Schwartz L. M., Katz S. J., Welch H. G. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997 Aug;12(8):472–477. doi: 10.1046/j.1525-1497.1997.00085.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
