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‘They didn’t tell me much’: how language proficiency can disadvantage the healthcare experience of older people following stroke Caroline Fryer 1, Shylie.

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Presentation on theme: "‘They didn’t tell me much’: how language proficiency can disadvantage the healthcare experience of older people following stroke Caroline Fryer 1, Shylie."— Presentation transcript:

1 ‘They didn’t tell me much’: how language proficiency can disadvantage the healthcare experience of older people following stroke Caroline Fryer 1, Shylie Mackintosh 1, Mandy Stanley 1, Jonathan Crichton 2 1 School of Health Sciences, University of South Australia 2 School of Communication, International Studies and Languages, University of South Australia

2 Flows of international migration

3 Background People with LEP often disadvantaged in their healthcare –Longer length of stay (John-Baptiste et al 2004 JGIM) –Given less health information (Ngo-Metzger et al 2007 JGIM, Ramirez et al 2008 J Health Care Poor Underserved) –Difficulty accessing community healthcare (DuBard & Gizlice 2008 Am J Public Health, Kim et al 2011 JAGS, Ponce et al 2006 JGIM, Shi et al 2009 Ethn Health) –Receive less preventative healthcare (Cheng et al 2007 JGIM, DuBard & Gizlice 2008 Am J Public Health) Similar scenario in other language contexts (Bischoff and Hudelson 2010 J Travel Med, Kale and Syed 2010 Patient Educ Couns, Mladovsky 2007 Eurohealth)

4 Background Mechanisms of disadvantage unclear Focus on identifying ‘language barriers’ –perspective of older person largely absent

5 Aim To explore how older people with limited English proficiency managed in an English- speaking healthcare context after stroke and how it influenced their healthcare experience.

6 The study Constructivist grounded theory (Charmaz 2006) 14 older people with stroke +8 carers 7 language groups: Estonian, Cantonese, Croatian, Greek (3), Italian (4), Polish (2), Vietnamese (2) + English (1) Definition (Karliner et al 2008 JGIM) Prefer language other than English for healthcare, and speak English less than ‘very well’ Proficiency: 6 well, 7 not well, 1 not at all

7 The study 24 in-depth, semi-structured interviews 8 and 21 weeks post-d/c Professional interpreters English transcript analysed Constant comparative analysis

8 Overview of findings Healthcare experience after stroke for older people with LEP Being told and being a good patient Weighing up the value of care Hanging on to the familiar

9 Process Problematic conditions  Responses  Consequences

10 Conditions Being tested Everyone got to say…can I walk you know, how many points I have. Because they give you point, what you do. (Gino, English) Being told the rules …nurse came and ask me to, ‘Walk, walk.’ There’s a long corridor, and the nurse go to me, ‘Walk.’ (Ming, Cantonese) Being discouraged to ask

11 Conditions Nobody interested to talk like we talk (Gino, English) It's always been English to me and that’s all (Krystyna, Polish) Accustomed to managing in English Wanting to know I feel better, it would have direct me better, I would have known better (Christos, Greek)

12 Responses Being a good patient –Obeying the rules –Trusting the experts to be right Trusting to manage in English –Not question need to manage in English –Trusting health professionals to organise interpreters or translations I don’t demand that but of course it is better if I could have someone who speak my language (Ming, Cantonese)

13 Consequences asking family and friends to help asking bilingual health professionals asking health professionals to speak ‘clearly’ teaching health professionals their language relying on observation skills talking with other patients in ‘broke’ English Andreas (Greek): Sometimes they were talking very quickly and so I couldn’t understand. Interviewer (English): What did you do then, when they talked too quickly? Andreas: Nothing.

14 Consequences Uncertain –about stroke and its management I even today don’t really, don’t fully understand what does it mean, stroke? (Krystyna, Polish) Not involved –in decisions about healthcare …they didn’t tell me much (Benigno, English)

15 Recommendations Change passive patient role Leadership from health professionals –Open dialogue in preferred language regularly and often –Rights and access to professional interpreters –Prescribed use of interpreter –Translated resources

16 Acknowledgments Recruitment sites in South Australia Hampstead Rehabilitation Centre Royal Adelaide Hospital St. Margaret’s Rehabilitation Hospital The Queen Elizabeth Hospital Participants Professional interpreters

17 References Bischoff and Hudelson 2010 J Travel Med 17: 15-20 Charmaz 2006 Constructing grounded theory Cheng et al 2007 JGIM 22: 283-8 DuBard & Gizlice 2008 Am J Public Health 98: 2021-28 John-Baptiste et al 2004 JGIM 19: 221-228 Kale and Syed 2010 Patient Educ Couns 81: 187-91 Kim et al 2011 JAGS 59: 1246-52 Ngo-Metzger et al 2007 JGIM 22: 324-330 Mladovsky 2007 Eurohealth 13: 9-11 Ponce et al 2006 JGIM 21: 786-91 Ramirez et al 2008 J Health Care Poor Underserved 19: 352-362 Shi et al 2009 Ethn Health 14: 625-42


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