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A Study About Language Communication with Bilingual Swedish Speakers in Finnish Healthcare

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A Study About Language Communication with Bilingual Swedish Speakers in Finnish Healthcare Language matters: a study about language communication with bilingual Swedish speakers in Finnish healthcare Marianne Mustajoki Doctoral dissertation, to be presented for public discussion with the permission of the Faculty of Medicine of the University of Helsinki, in Auditorium 1, Haartman Institute, on the 17th of September, 2020 at 12 noon. Helsinki 2020 Department of General Practice and Primary Health Care University of Helsinki Finland Doctoral Programme Brain and Mind ISBN 978-951-51-6277-9 (nid.) ISBN 978-951-51-6278-6 (PDF) Unigrafia Oy Helsinki 2020 Supervised by Johan Eriksson, professor University of Helsinki Department of General Practice and Primary Health Care Finland Tom Forsén, docent University of Helsinki Department of General Practice and Primary Health Care Finland Pre examined by Sakari Suominen, professor University of Turku Sanna Salanterä, professor University of Turku Opponent Marjukka Mäkelä, emerita professor University of Helsinki The Faculty of Medicine uses the Urkund system (plagiarism recognition) to examine all doctoral dissertations. Contents Abbreviations ............................................................................................................................. 6 Abstract ...................................................................................................................................... 7 Sammandrag .............................................................................................................................. 9 Tiivistelmä ............................................................................................................................... 11 List of Original Publications .................................................................................................... 13 Introduction .............................................................................................................................. 14 Review of the literature ............................................................................................................ 17 Implications of language barriers in healthcare ................................................................................ 17 Bilingual Swedish speakers in Finnish healthcare ............................................................................ 19 Bilingual patients visiting healthcare ................................................................................................ 20 Patients’ perspective on care quality ................................................................................................. 22 Discordant language communication in healthcare .......................................................................... 23 Discordant language communication a safety risk? .......................................................................... 27 Patient-centred approach improves communication ......................................................................... 28 Describing pain in a non-native language ......................................................................................... 29 Summary of the literature review...................................................................................................... 31 Aims of the Study .................................................................................................................... 33 Participants and Methods ......................................................................................................... 34 Study I ............................................................................................................................................... 34 Study II and III .................................................................................................................................. 35 Study IV ............................................................................................................................................ 37 Statistical analyses ............................................................................................................................ 38 Ethics ................................................................................................................................................ 39 Results ...................................................................................................................................... 40 Communication language and healthcare quality ............................................................................. 40 Language discordance complicated description of pain and healthcare utilization .......................... 42 Pain assessment in native and non-native language .......................................................................... 47 Discussion ................................................................................................................................ 50 Language discordance main outcomes ............................................................................................. 50 Comprehension problems are common ............................................................................................. 51 Risk of weak adherence .................................................................................................................... 55 Language communication and healthcare utilization ........................................................................ 58 Description of pain ............................................................................................................................ 60 Strengths and weaknesses of data collection .................................................................................... 61 Conclusions and future considerations .................................................................................... 64 Acknowledgements .................................................................................................................. 65 References ................................................................................................................................ 67 Supplements ............................................................................................................................. 84 Original publications I-IV ...................................................................................................... 101 6 Abbreviations BMI Body mass index, kg/m² CT Computed tomography GP General Practitioner MPQ McGill Pain Questionnaire PREM Patient Reported Experience Measure sfMPQ Short form of McGill Pain Questionnaire 7 Abstract Language matters: a study about language communication with bilingual Swedish speakers in Finnish healthcare Aims: To examine patient-reported aspects of communication by bilingual Swedish speaking patients using their second language, Finnish. The effects of discordant language communication were measured in four studies. Methods: In total, 411 Swedish speaking and 746 Finnish speaking patients participated in four studies. Study I was performed during 2004−2005 in a healthcare center with a structured questionnaire including partly standardized questions about Swedish speaking patients’ ability to express their health problems in their second language, Finnish. Furthermore, the occurrence of misunderstandings and effects on adherence to medical instructions caused by discordant language communication were explored. The effects of concordant and discordant language communication were compared between Swedish and Finnish speaking emergency patients during 2008−2009 using a researcher- designed pre-visit and post-visit questionnaire in study II and III. The pre-visit questionnaire included questions about the socioeconomic status and health conditions based on the FINRISK protocol. The patients’ proficiency in their second language was measured on a standardized 5 grade scale. Patients were also asked about the language they used with the physician and their language preference, their experiences of discordant language communication, annual visits to a physician and the reason for the emergency visit. In the fourth study, performed during 2013−2016, fifty-one Swedish speaking patients with diabetes aged 28−72 years completed the verbal sensory and affective pain vocabulary sfMPQ, twice, first in Finnish (test I) and after 30 minutes in Swedish (re-test II). A Finnish speaking control group (n=10) aged 40−65 years was also tested in order to reveal intrinsic repetition variations. Results: The first study revealed that 50.7 % of Swedish speaking patients in the healthcare center (n=221) considered communication in their native language very important. One third of the participants reported getting along with Finnish in the absence of a common native language with healthcare providers. Every tenth patient reported miscomprehensions, either often or always. Poor proficiency in Finnish and low education level increased the risk of misunderstandings. Due to deficient language communication 41 % of the patients reported revisits (n=32), talked with another expert (n=40) or discontinued relevant healthcare visits (n=10). In the second and third studies the effects of concordant and discordant language communication with the physician were compared between 139 bilingual Swedish speaking and 736 Finnish speaking emergency patients. No significant differences between the 8 language groups in health condition and prevalence of self-reported chronic diseases were observed but the Finnish speakers
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