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Literature Review: Strategies for Addressing Language Barriers During Humanitarian Relief Operations

Published online by Cambridge University Press:  23 October 2019

Carlo Rossi*
Affiliation:
Canadian Armed Forces
Sylvain Grenier
Affiliation:
University of Ottawa and Canadian Blood Service
Régis Vaillancourt
Affiliation:
Childrens’ Hospital of Eastern Ontario
*
Correspondence and reprint requests to Lieutenant-Colonel Carlo Rossi, 713 Montreal Road, Ottawa, Ontario, Canada, K1A 0K2, (e-mail: carlo.rossi@forces.gc.ca).

Abstract

Humanitarian relief operations (HUMRO) represent a nexus between military diplomacy and global health engagement, and may play an increasing role in military operations in the near future. Language barriers between providers and the individuals being assisted are a significant constraint on HUMRO. A literature review was conducted to identify recommendations to address patient-provider language discordance in the international HUMRO context. This was supplemented by a North Atlantic Treaty Organization and US Department of Defense doctrinal review to identify existing best practices for addressing language barriers. Four general themes were identified: (1) print-based aids, (2) information technology, (3) bilingual responders, and (4) the effective use of medical interpreters in the HUMRO setting. Each strategy is reviewed. Informed by expert opinion, we provide concrete leadership and training recommendations for how HUMRO providers might more effectively communicate with patients in a deployed language-discordant context.

Type
Concepts in Disaster Medicine
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc.

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References

REFERENCES

Gregg, J, Saha, S. Communicative competence: a framework for understanding language barriers in health care. J Gen Intern Med. 2007;22(Suppl 2):368-70.10.1007/s11606-007-0364-4CrossRefGoogle ScholarPubMed
Greenhalgh, T, Robb, N, Scambler, G. Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective. Soc Sci Med. 2006;63(5):1170-87.CrossRefGoogle ScholarPubMed
Sears, J, Khan, K, Ardern, CI, et al. Potential for patient-physician language discordance in Ontario. BMC Health Serv Res. 2013;13:535.10.1186/1472-6963-13-535CrossRefGoogle ScholarPubMed
Woloshin, S, Bickell, NA, Schwartz, LM, et al. Language barriers in medicine in the United States. JAMA. 1995;273(9):724-8.10.1001/jama.1995.03520330054037CrossRefGoogle ScholarPubMed
Canadian Council for International Co-operation (CCIC). Code of Ethics and Operational Standards. 2009. https://www.bccic.ca/wp-content/uploads/2015/09/001_code_ethics_operational_standards_e.pdf. Accessed September 30, 2019.Google Scholar
Humanitarian Accountability Partnership. The 2010 HAP Standard in Accountability and Quality Management. 2010. https://www.chsalliance.org/files/files/Resources/Standards/2010-hap-standard-in-accountability.pdf. Accessed January 15, 2019.Google Scholar
The Sphere Project. Humanitarian Charter and Minimum Standards in Humanitarian Response. 2014. http://www.sphereproject.org/handbook/. Accessed January 15, 2019.Google Scholar
UNICEF. Emergency Field Handbook. 2005. http://www.unicef.org/publications/files/UNICEF_EFH_2005.pdf. Accessed January 15, 2019.Google Scholar
USAID. Field Operations Guide for Disaster Assessment and Response. 2005. https://scms.usaid.gov/sites/default/files/documents/1866/fog_v4.pdf. Accessed January 15, 2019.Google Scholar
World Health Organization (WHO). Emergency Response Framework. 2013. http://www.who.int/hac/about/erf_.pdf. Accessed January 15, 2019.Google Scholar
Daftary, RK, Cruz, AT, Reaves, EJ, et al. Making disaster care count: consensus formulation of measures of effectiveness for natural disaster acute phase medical response. Prehosp Disaster Med. 2014;29(5):461-7.10.1017/S1049023X14000922Google ScholarPubMed
Nielson-Bohlman, L, Panzer, A, Kindig, D, eds. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.10.17226/10883Google Scholar
NATO. NATO Allied Joint Medical Support Doctrine AJP-4.10(A), 2006.Google Scholar
NATO. Allied Joint Civil-Military Medical Interface Doctrine AJMEDP-6, 2011.Google Scholar
Department of Defense (DOD). Department of Defense Support to Foreign Disaster Relief: Handbook for JTF Commanders and Below GTA 90-01-030. 2011.Google Scholar
United States Agency for International Development (USAID). Field Operations Guide for Disaster Assessment and Response Version 4.0. 2005.Google Scholar
Department of Defense (DOD). Joint Publication: Civil Military Operations JP3-57. 2013.Google Scholar
Department of the Navy. Disaster Response Operations NWP 3-29. 2011.Google Scholar
Department of Defense (DOD). Joint Publication: Foreign Humanitarian Assistance JP3-29. 2014.Google Scholar
Dowse, R. Pictograms for conveying medicine instructions: comprehension in various South African language groups. S Afr J Sci. 2004;100(11):687-93.Google Scholar
Sorfleet, C, Vaillancourt, R, Groves, S, et al. Design, development and evaluation of pictographic instructions for medications used during humanitarian missions. Can Pharm J. 2009;142(2). doi: 10.3821/1913-701X-142.2.82 CrossRefGoogle Scholar
Malhotra, R, Bautista, MA, Tan, NC, et al. Bilingual text with or without pictograms improves elderly Singaporeans’ understanding of prescription medication labels. Gerontologist. 2019;59:378-90.Google ScholarPubMed
Doucette, D, Vaillancourt, R, Berthenet, M, et al. Validation of a pictogram-based diabetes education tool in counselling patients with type 2 diabetes. Can Pharm J. 2014;147(6):340-4.10.1177/1715163514552662CrossRefGoogle ScholarPubMed
Grenier, S, Vaillancourt, R, Pynn, D, et al. Design and development of culture-specific pictograms for the labelling of medication for first nation communities. J Comm Health. 2011;4(4):238-45.10.1179/1753807611Y.0000000007CrossRefGoogle Scholar
Place, RJ. Caring for non-combatants, refugees, and detainees. Surg Clin North Am. 2006;86(3):765777.10.1016/j.suc.2006.02.004CrossRefGoogle ScholarPubMed
Clawson, TH, Leafman, J, Nehrenz, GM Sr, et al. Using pictograms for communication. Mil Med. 2012;177(3):291-5.CrossRefGoogle ScholarPubMed
Chan, YF, Alagappan, K, Rella, J, et al. Interpreter services in emergency medicine. J Emerg Med. 2010;38(2):133-9.10.1016/j.jemermed.2007.09.045CrossRefGoogle ScholarPubMed
Ong, WSS. Sequoyah Foreign Language Translation System - Business Case Analysis. Monterey, CA: Naval Postgraduate School; 2007.Google Scholar
Weiss, BA, Schlenoff, C. Performance assessments of two-way, free-form, speech-to-speech translation systems for tactical use. J Int Test Eval Assoc. 2011;32(1);6972.Google Scholar
Rominiecki, A (US ARMY). Tell me where it hurts: Army R&D improving translation technologies for OCONUS medics. https://www.cerdec.army.mil/news_and_media/tell_me_where_it_hurts/. Accessed January 15, 2019.Google Scholar
Babcock, C, Theodosis, C, Bills, C, et al. The academic health center in complex humanitarian emergencies: lessons learned from the 2010 Haiti earthquake. Acad Med. 2012;87(11):1609-15.CrossRefGoogle Scholar
Lee, SK, Sulaiman-Hill, CR, Thompson, SC. Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers. BMC Int Health Hum Rights. 2014;14:11.CrossRefGoogle ScholarPubMed
Samarasinghe, D. Disaster management: lessons from immediate responses to the tsunami. Ceylon Med J. 2005;50(1):25-7.10.4038/cmj.v50i1.1587CrossRefGoogle ScholarPubMed
Temple, B. Crossed wires: interpreters, translators, and bilingual workers in cross-language research. Qual Health Res. 2002;12(6):844-54.Google ScholarPubMed
Behar, S, Benson Ii, R, Kurzweil, A, et al. Use of an emergency medical pictorial communication book during simulated disaster conditions. Disaster Med Public Health Prep. 2013;7(5):475-80.CrossRefGoogle ScholarPubMed
Karliner, LS, Jacobs, EA, Chen, AH, et al. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727-54.10.1111/j.1475-6773.2006.00629.xCrossRefGoogle ScholarPubMed
The UN Refugee Agency. UNHCR Handbook for Emergencies. 2007; pp201 http://www.ifrc.org/PageFiles/95884/D.01.03.%20Handbook%20for%20Emergencies_UNHCR.pdf. Accessed January 15, 2019.Google Scholar
Diamond, LC, Schenker, Y, Curry, L, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-62.10.1007/s11606-008-0875-7CrossRefGoogle ScholarPubMed
Lee, KC, Winickoff, JP, Kim, MK, et al. Resident physicians’ use of professional and nonprofessional interpreters: a national survey. JAMA. 2006;296(9):1050-3.10.1001/jama.296.9.1050CrossRefGoogle ScholarPubMed
Kalet, AL, Mukherjee, D, Felix, K, et al. Can a web-based curriculum improve students’ knowledge of, and attitudes about, the interpreted medical interview? J Gen Intern Med. 2005;20(10):929-34.10.1111/j.1525-1497.2005.0193.xCrossRefGoogle ScholarPubMed
Karliner, LS, Perez-Stable, EJ, Gildengorin, G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med. 2004;19(2):175-83.CrossRefGoogle ScholarPubMed
Powell, C, Pagliara-Miller, C. The use of volunteer interpreters during the 2010 Haiti earthquake: lessons learned from the USNS COMFORT Operation Unified Response Haiti. Am J Dis Med. 2012;7(1):37-47.CrossRefGoogle ScholarPubMed
Hsieh, E, Kramer, EM. Medical interpreters as tools: dangers and challenges in the utilitarian approach to interpreters’ roles and functions. Patient Educ Couns. 2012;89(1):158-62.10.1016/j.pec.2012.07.001CrossRefGoogle ScholarPubMed
Greenstone, JL. Use of interpreters with crisis intervention teams, behavioral health units, and medical strike teams: responding appropriately and effectively. Int J Emerg Ment Health. 2010;12(2):7982.Google ScholarPubMed
Pollabauer, S. Interpreting in asylum hearings: issues of role, responsibility and power. Interpreting. 2004;6(2):143-80.CrossRefGoogle Scholar
Flores, G, Abreu, M, Barone, CP, et al. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med. 2012;60(5):545-53.CrossRefGoogle Scholar
Farooq, S, Fear, C. Working through interpreters. Adv Psychiatr Treat. 2003;9:104-9.10.1192/apt.9.2.104CrossRefGoogle Scholar
Bauer, AM, Alegria, M. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatr Serv. 2010;61(8):765-73.CrossRefGoogle ScholarPubMed
Flores, G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255-99.10.1177/1077558705275416Google ScholarPubMed
National Center for Disaster Medicine and Public Health (NCDMPH). Working with an Interpreter in a Disaster Setting. 2011. https://www.usuhs.edu/ncdmph-learn/ResourceReports/ResRep.htm. Accessed January 15, 2019.Google Scholar