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      Building freeways: piloting communication skills in additional languages to health service personnel in Cape Town, South Africa

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          Abstract

          Background

          This study reflects on the development and teaching of communication skills courses in additional national languages to health care staff within two primary health care facilities in Cape Town, South Africa. These courses were aimed at addressing the language disparities that recent research has identified globally between patients and health care staff. Communication skills courses were offered to staff at two Metropolitan District Health Services clinics to strengthen patient access to health care services. This study reflects on the communicative proficiency in the additional languages that were offered to health care staff.

          Methods

          A mixed-method approach was utilised during this case study with quantitative data-gathering through surveys and qualitative analysis of assessment results. The language profiles of the respective communities were assessed through data obtained from the South African National census, while staff language profiles were obtained at the health care centres. Quantitative measuring, by means of a patient survey at the centres, occurred on a randomly chosen day to ascertain the language profile of the patient population. Participating staff performed assessments at different phases of the training courses to determine their skill levels by the end of the course.

          Results

          The performances of the participating staff during the Xhosa and Afrikaans language courses were assessed, and the development of the staff communicative competencies was measured. Health care staff learning the additional languages could develop Basic or Intermediate Xhosa and Afrikaans that enables communication with patients.

          Conclusions

          In multilingual countries such as South Africa, language has been recognised as a health care barrier preventing patients from receiving quality care. Equipping health care staff with communication skills in the additional languages, represents an attempt to bridge a vital barrier in the South African health care system. The study proves that offering communication skills courses in additional languages, begins to equip health care staff to be multilingual, that allows patients to communicate about their illnesses within their mother tongues.

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          Most cited references15

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          The need for more research on language barriers in health care: a proposed research agenda.

          Many U.S. residents who speak little English may face language barriers when seeking health care. This article describes what is currently known about language barriers in health care and outlines a research agenda based on mismatches between the current state of knowledge of language barriers and what health care stakeholders need to know. Three broad areas needing more research are discussed: the ways in which language barriers affect health and health care, the efficacy of linguistic access service interventions, and the costs of language barriers and efforts to overcome them. In each of these areas, we outline specific research questions and recommendations.
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            Language as a barrier to care for Xhosa-speaking patients at a South African paediatric teaching hospital.

            Disease is closely linked to the social context in which we live. Difficulty with communication, cultural incompatibility between patients and health care providers and socioeconomic obstacles are important barriers to quality care when doctors and patients come from different backgrounds and speak different languages. Red Cross War Memorial Children's Hospital (RCH) is a paediatric teaching hospital in Cape Town where staff members communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language. The study aimed to identify barriers to optimal care for Xhosa-speaking parents of patients at RCH. The contribution of language difficulties was assessed as a possible barrier to health care for this group. A questionnaire was developed and administered to 53 Xhosa-speaking parents of children admitted to the short-stay ward at RCH. The questionnaire examined parents' perceptions of barriers to their children's care, using openended questions, closed-ended questions and selection from lists. Parents experienced significant structural and socioeconomic barriers to access of health care for their children. Language and cultural barriers were cited by more parents as a major barrier to health care than structural and socioeconomic barriers. Parents did not have access to same-language practitioners, as only 6% of medical interviews were conducted partly or wholly in the patient's home language. Of the 94% of interviews where no Xhosa was spoken by medical staff, 21% were conducted with the aid of an interpreter (formal or ad hoc) and in 79% no interpreter was used. Parents experienced difficulties with understanding the doctors (64%), making themselves understood (54%) and asking questions (38%). Sixty-nine per cent of parents were dissatisfied with communication between themselves and their doctors and 45% were concerned about negative effects of poor communication on them or their children. Parents tended to blame their own linguistic limitation rather than those of the doctors.
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              The effects of a language barrier in a South African district hospital.

              Communication between health workers and patients at Hottentots Holland Hospital (HHH) is hindered by staff and patients not speaking the same language. HHH is a district hospital in the Cape Town Metropolitan District of the Western Cape where staff mainly speak Afrikaans or English and a large number of patients mainly Xhosa. The study aimed to explore the effects of this language barrier on health workers and patients at HHH. Three focus group interviews were held with 21 members of staff and 5 in-depth patient interviews were conducted. The language barrier was found to interfere with working efficiently, create uncertainty about the accuracy of interpretation, be enhanced by a lack of education or training, cause significant ethical dilemmas, negatively influence the attitudes of patients and staff towards each other, decrease the quality of and satisfaction with care, and cause cross-cultural misunderstandings. The effects of the language barrier were considerable and persistent despite an official language policy in the province. The training and employment of professional interpreters as well as teaching of basic Xhosa to staff are recommended.
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                Author and article information

                Contributors
                joel.claassen@uct.ac.za
                zukile.jama@uct.ac.za
                nayna.manga@uct.ac.za
                minnie.lewis@uct.ac.za
                derek.hellenberg@uct.ac.za
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                7 June 2017
                7 June 2017
                2017
                : 17
                : 390
                Affiliations
                ISNI 0000 0004 1937 1151, GRID grid.7836.a, , University of Cape Town, ; Cape Town, South Africa
                Author information
                http://orcid.org/0000-0002-4560-3986
                Article
                2313
                10.1186/s12913-017-2313-1
                5463348
                28049468
                3add9beb-f95d-4687-bb77-64fe9a36444e
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 August 2016
                : 17 May 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                south africa,language learning,career-orientated language teaching,health care barriers,multilingualism,health care staff,afrikaans and isixhosa

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