Language Barriers in Access to Health Care
Prepared by Sarah Bowen, B. A., M. Sc.
for Health Canada
November 2001
ISBN: 0-662-30538-8
Cat. No.: H39-578/ 2001E
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 (2,310K)
Some sections of this report include excerpts from: Methodological and Policy Issues in Evaluation of Health Interpreter and Language Access Services (2000) by Sarah Bowen, and Dr. J. M. Kaufert, Department of Community Health Sciences, University of Manitoba, supported by the Multiculturalism Program of the Department of Canadian Heritage.
The author would also like to acknowledge the contributions of Dr. Joseph Kaufert in the development of this report.
Sarah Bowen, B. A., M. Sc.
Table of Contents
Executive
Summary
1.
Introduction
1.1
Purpose and Scope of Report
1.2
How this Report is Organized
2.
Overview of Issues
2.1
Approaches to Addressing Language Access to Health
Care
2.1.1
Increasing Proportion of Same-Language
Encounters
2.1.2
Providing Interpretation Services
2.2
Stakeholders in Language Access Services
2.3
Current Issues and Initiatives
2.3.1
Current Issues in Interpretation
2.3.2
Current Initiatives
3.
The Canadian Context of Service Provision
3.1
Introduction
3.2
Constituencies Affected by Language Barriers to Health
Care
3.2.1
Health Needs of Language Constituencies
3.2.2
Similarities and Differences between
Constituencies
3.3
Historical and Cultural Context of Language Service
Provision
3.3.1
Official Languages
3.3.2
First Nations and Inuit Languages
3.3.3
Visual Languages
3.3.4
"Immigrant" Languages
3.4
The Canada Health Act
3.5
Rights to Language Services in Health Care
3.5.1
The Canadian Charter of Rights and Freedoms
3.5.2
The Canadian Human Rights Act
3.5.3
The Canadian Multiculturalism Act
3.5.4
The Right to Informed Decision Making
3.6
Canadian Research Related to Diversity and Health
3.7 Summary
4. Overview of Research Design Issues
4.1 Introduction
4.2 Methodological Approaches to Language Access
Research
4.2.1 Descriptive Research
4.2.2 Surveys
4.2.3 Secondary Data Analysis
4.2.4 Experimental Designs
4.2.5 Economic Evaluation
4.3Measurement Issues
4.3.1 Defining Language Barriers and Language
Proficiency
4.3.2 Variables Related to Interpreter Role and Model of
Service Delivery
4.3.3 Variables Related to the Individual Interpreter
4.3.4 Variables Related to the Individual Client
4.3.5 Variables Related to the Client Community
4.3.6 Variables Related to the Individual Provider
4.3.7 4.3.7
Variables Related to the Health System
4.4 Summary
5. Models of Interpretation Services
5.1 Introduction
5.2 The Interpreter's Role
5.3 Models of Service Provision
5.3.1 Hospital/ Clinic-based Interpreters
5.3.2 Community-based Health Interpreters
5.3.3 Generic Professional Interpreters
5.3.4
Telephone Interpreters
5.3.5 Bilingual Staff
5.3.6 Combined Roles
5.4 Effects of Interpreters on Communication and
Utilization
5.5 Interpreter Training
5.5.1 Accreditation and Evaluation
5.6 Research
Priorities
5.7 Summary
6. Effects of Language Barriers on Patient Access and Care
6.1 Introduction
6.2 Estimating the Need for Language Access Programs
6.2.1 Need for Interpretation Services
6.2.2 Proportion of Those Facing Language Barriers Who
Receive
Service
6.2.3 6.2.3
Implications for Canadian Health Services
6.3 Effects of Language Barriers on Initial Service
Access
6.3.1 The Issue of Acculturation
6.3.2 Access to Prevention Programs
6.3.3 Initial Access to Mental Health, Rehabilitation and
Counseling Services
6.3.4 Other Differences in Initial Utilization.
6.3.5 6.3.5
Canadian Research: The Effects of Language Barriers
on
Initial Access
6.3.6 Implications for Canadian Providers: Research on
Barriers
to Access
6.4 The Effect of Language Barriers on Quality of Care
6.4.1 The Case Study Literature
6.4.2 6.4.2
Differences in Treatment Due to Language
Barriers
6.4.3
Specific Health Outcomes
6.4.4 Patient Satisfaction
6.4.5 Patient Understanding and Compliance
6.4.6 Ethical Standards of Care
6.5 How Do Language Barriers Affect Health and
Utilization?
6.5.1 Analysis of Provider-Interpreter-Patient
Interactions
6.5.2 Making the Links: Research on Patient-Provider
Communication
6.5.3 Making the Links: Research Related to Health
Literacy
6.5.4 Making the Links: Time Needed for Consultation
6.5.5 Making the Links: Provider Continuity and Regular
Source of Care
6.5.6. Ethnic Matching" Between Client and Provider
6.6 Summary
7. Other Effects of Language Barriers
7.1 Effects on Health Research and Development of
Knowledge
7.2 Effects on Health Care Providers
7.2.1 Differences Between Provider and Patient Assessment
of
Barriers
7.3 Effects on Costs of Service Provision
7.4 Summary
8. Conclusions and Recommendations
8.1 Effects of Language Barriers
8.2 Current Challenges
8.2.1 Promoting Cultural Competence and Social
Responsiveness
8.2.2 Research
Needs
8.2.3 Models of
Interpretation Services
8.2.4 Development
of National Standards
8.2.5 Economic
Evaluation
8.3 Recommendations
8.4 Summary
9. Glossary
References
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