Emergency physician's perception of cultural and linguistic barriers in immigrant care: results of a multiple-choice questionnaire in a large Italian urban emergency department

doi:10.5847/wjem.j.1920-8642.2015.02.005

Abstract

Abstract:

BACKGROUND: A poor communication with immigrants can lead to inappropriate use of healthcare services, greater risk of misdiagnosis, and lower compliance with treatment. As precise information about communication between emergency physicians (EPs) and immigrants is lacking, we analyzed difficulties in communicating with immigrants in the emergency department (ED) and their possible associations with demographic data, geographical origin and clinical characteristics.
METHODS: In an ED with approximately 85 000 visits per year, a multiple-choice questionnaire was given to the EPs 4 months after discharge of each immigrant in 2011.
RESULTS: Linguistic comprehension was optimal or partial in the majority of patients. Significant barriers were noted in nearly one fourth of patients, for only half of them compatriots who were able to translate. Linguistic barriers were mainly found in older and sicker patients; they were also frequently seen in patients coming from western Africa and southern Europe. Non-linguistic barriers were perceived by EPs in a minority of patients, more frequently in the elderly and frequent attenders. Factors independently associated with a poor final comprehension led to linguistic barriers, non-linguistic obstacles, the absence of intermediaries, and the presence of patient's fear and hostility. The latter probably is a consequence, not the cause, of a poor comprehension.
CONCLUSION: Linguistic and non-linguistic barriers, although quite infrequent, are the main factors that compromise communication with immigrants in the ED, with negative effects especially on elderly and more seriously ill patients as well as on physician satisfaction and appropriateness in using services.

Key words: Linguistic barriers, Cultural barriers, Immigrants, Emergency department

Filippo Numeroso, Mario Benatti, Caterina Pizzigoni, Elisabetta Sartori, Giuseppe Lippi, Gianfranco Cervellin. Emergency physician's perception of cultural and linguistic barriers in immigrant care: results of a multiple-choice questionnaire in a large Italian urban emergency department[J]. World Journal of Emergency Medicine, 2015, 6(2): 111-117.

Figures/Tables 5

Figure 1.

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Variables	Results
Gender (n, %)
Males	248 (51.8)
Females	231 (48.2)
Mean age (years)	38 (18-85)
Geographical origin (%)
North Africa	23.9
Eastern Europe	22.0
West Africa	17.8
Southern Europe	14.7
Other	21.6
Priority color code (%)
White	14.3
Green	71.0
Yellow	13.1
Red	1.7
ED use^a (%)
Occasional	82.6
Habitual	12.7
Frequent attainder	4.8

Variables	%
Linguistic barriers
None	43.4
Mild	32.0
Substantial	14.1
Complete	10.6
Intermediaries
Able to translate	24.9
Not able to translate	6.4
No intermediaries	68.3
External translators	0.4
Final level of comprehension
Full	58.1
Partial	29.5
Low	11.8
None	0.6
Physician's final satisfaction
Good	23.0
Neutral	68.0
Poor	9.0
Presence of
Patient fear, hostility, aggressiveness	8.4
Non-linguistic barriers	14.1
External influences	12.2

Variables	Significant linguistic barriers^a	Intermediares able to translate	Age >60 years	Non- linguistic barriers	Priority codes yellow or red	Patient's fear or hostility	External influences	Very poor or null final comprehension	Frequent ED use	EPs aversion
General population	24.8	25	7.2	14.1	14.6	8.4	12.2	12.4	18	9.0
Patients with very poor or null final comprehension	83.3^**	25.3^*	11.6	36.6^**	25.4^*	16.6^**	23^**	NA	21.1^*	34.3^**
Patients over 60 years old	58.3^**	63.9^**	NA	22.2	33.3^**	8.3	8.3	19.4	11.1	2.8
Patients with yellow or red code	43.8^**	32.9	16.4^**	20.5	NA	12.3	17.8	23.3^*	28.7^*	19.2^**
Habitual or frequent ED users	20	15.5	4.7	39^**	23.3^*	14.4	43.5^**	16.6^**	NA	19^**
Patients with a poor EPs final satisfaction	53.4^**	23.9*	2.3	37.2^**	30.4^**	27.9^**	30.2^**	46.5^**	37**	NA

Independent variables	B	Standard error	Beta	t	P value
Constant	-0.61	0.21	0.00	-2.85	0.00
Linguistic barriers	0.48	0.03	0.66	16.95	0.00
Absence of intermediaries	0.19	0.03	0.22	5.88	0.00
Non-linguistic barriers	0.45	0.07	0.22	6.44	0.00
Patient's fear or hostility	0.35	0.09	0.13	3.98	0.00
Geographical origin	-0.01	0.00	-0.06	-1.85	0.07
Age (recodified in groups)	-0.18	0.10	-0.06	-1.81	0.07
Frequency of ED use	0.07	0.05	0.05	1.49	0.14
Priority code	0.03	0.04	0.02	0.06	0.55
Gender	0.01	0.05	0.01	0.16	0.87

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