Top

International Journal of Emergency Medicine

Published in:

Open Access 01-12-2021 | Care | Original Research

Language diversity and challenges to communication in Indian emergency departments

Authors: Katherine Douglass, Lalit Narayan, Rebecca Allen, Jay Pandya, Zohray Talib

Published in: International Journal of Emergency Medicine | Issue 1/2021

Abstract

Background

Communication in emergency departments (ED) in India is complicated by the country’s immense language diversity. Prior research has revealed challenges in language and communication as barriers to care. Our objective was to quantify language diversity among clinicians in Indian EDs and better understand issues related to clinician-clinician and clinician-patient communication.

Methodology

A cross-sectional survey of ED clinicians was conducted. Survey participants were recruited in-person and through email at six partner sites in India. ANOVA and binary logistic regression were used for subgroup analysis. Semi-structured interviews were conducted with ED clinicians. Interview data was analyzed using the rapid assessment process to determine predominant themes.

Results

106 clinicians completed the survey. On average, clinicians spoke 3.75 languages. Seventy-one percent used a non-English language to speak to fellow clinicians most of the time, and 53% reported at least one critical incident over the last year where poor communication played a part. Interviews revealed challenges including low health literacy, high patient volume, and workplace hierarchy.

Conclusions

This study is the first to document the impact of language diversity and communication barriers in Indian EDs. The results highlight the need for effective strategies to improve communication between the multiple languages spoken by clinicians and patients.

Available only for authorised users

Slade D, Manidis M, McGregor J, et al. Communicating in Hospital Emergency Departments. Final Report. 2011. https://www.academia.edu/20463985/Communicating_in_Hospital_Emergency_Departments.

Slade D, Scheeres H, Manidis M, et al. Emergency communication-the discursive challenges facing emergency clinicians and patients in hospital emergency department. 2008:271-298, 2, 3, DOI: https://doi.org/10.1177/1750481308091910.

Haskard Zolnierek KB, Dimatteo MR. Physician Communication and Patient Adherence to Treatment A Meta-Analysis.; 2009. www.lww-medicalcare.com. .

Chang BP, Sumner JA, Haerizadeh M, Carter E, Edmondson D. Perceived clinician-patient communication in the emergency department and subsequent post-traumatic stress symptoms in patients evaluated for acute coronary syndrome. doi:https://doi.org/10.1136/emermed-2015-205473, 2016.

Narayan L. Addressing language barriers to healthcare in India. Natl Med J India. 2013;26(4):236–8.PubMed

Berdahl TA, Kirby JB. Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015. J Gen Intern Med. 2018;34(8):1434–40. https://doi.org/10.1007/s11606-018-4757-3.CrossRefPubMedPubMedCentral

Fields A, Abraham M, Gaughan J, Haines C, Hoehn KS. Language matters: Race, trust, and outcomes in the pediatric emergency department. Pediatr Emerg Care. 2016;32(4):222–6. https://doi.org/10.1097/PEC.0000000000000453.CrossRefPubMed

Schlemmer A, Mash B. The effects of a language barrier in a South African district hospital. S Afr Med J. 2006;96(10):1084–7.PubMed

Levin ME. Different use of medical terminology and culture-specific models of disease affecting communication between Xhosa-speaking patients and English-speaking doctors at a South African paediatric teaching hospital. South African Med J. 2006;96(10):1080–4.

10.

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: An updated systematic review. Ann Intern Med. 2011;155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.CrossRefPubMed

11.

Sarangarm D, Ernst A, Horner R, et al. Cross-Sectional Study of the Relation of Health Literacy to Primary Language and Emergency Department Length of Stay. South Med J. 2017;110(12):796-801. doi:https://doi.org/10.14423/SMJ.0000000000000743.

12.

Brice JH, Travers D, Cowden CS, Young MD, Sanhueza A, Dunston Y. Health literacy among Spanish-speaking patients in the emergency department. J Natl Med Assoc. 2008;100(11):1326–32. https://doi.org/10.1016/S0027-9684(15)31512-1.CrossRefPubMed

13.

Wesson HKH, Kwong M. Trauma care in India: A review of the literature. Surgery. 2017;162(6):s85–s106. https://doi.org/10.1016/j.surg.2017.01.027.CrossRefPubMed

14.

Douglass K, Pousson A, Gidwani S, Smith J. "Postgraduate Emergency Medicine training in India: An educational partnership with the private sector. " J Emerg Med. 2015: 49(5), 746-754. doi:https://doi.org/10.1016/j.jemermed.2015.03.010.

15.

Pun J, Chan EA, Murray KA, Slade D, Matthiessen C. Complexities of emergency communication: Clinicians' perceptions of communication challenges in a trilingual emergency department. J Clin Nurs. 2017;26(21-22):3396–407. https://doi.org/10.1111/jocn.13699.CrossRefPubMed

16.

Cole, Charles Lee. Rapid assessment process in qualitative inquiry. Review Essay: James Beebe (2001). Rapid Assessment Process: An Introduction [19 paragraphs]. Forum: Qualitative Social Research; 2002, 3(4), Art. 33. http://www.qualitative-research.net/index.php/fqs/article/view/773/1678. Accessed 4 Jan 2020

Title: Language diversity and challenges to communication in Indian emergency departments
Authors: Katherine Douglass
Lalit Narayan
Rebecca Allen
Jay Pandya
Zohray Talib
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: International Journal of Emergency Medicine / Issue 1/2021
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-021-00380-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Language diversity and challenges to communication in Indian emergency departments

Abstract

Background

Methodology

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methodology

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

A rare case of persistent air leak: beware of all the tubes

The next wave: key adaptations to operational workflows of National Screening Centre (Singapore) and the emergency department during the COVID-19 pandemic

Interhospital transfer of COVID-19 patients treated with high-flow nasal oxygen therapy

Microbiological findings in emergency department patients with sepsis identified by the Sepsis-3 criteria: a single-center prospective population-based cohort study

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

The use of dual oxygen concentrator system for mechanical ventilation during COVID-19 pandemic in Sabah, Malaysia