Multilingualism and Language Barriers in Health Delivery system in Ghana
DOI:
https://doi.org/10.4314/gjl.v11i2.268Keywords:
multilingualism, Ghana, healthcare, language barriersAbstract
In this paper, we explore language differences in health worker-patient interaction as a potential barrier to quality and safe healthcare delivery among urban populations in Ghana. Two sets of data were collected through survey to identify the language (s) of health communication in urban Ghana where linguistic diversity is densest. While the first set of data were collected from a cross section of urban patient population in Ghana (Accra and Kasoa), the second set of data were collected from an online survey of health workers across a number of regions in Ghana. The data which were analyzed mainly using descriptive statistics revealed that even though both patient and health worker participants self-reported as coming from varying ethnolinguistic backgrounds (speaking many different L1s), 65% of the patient population reported as accessing healthcare in a second language, mainly English or Akan, while 70% of health worker participants reported as using only two languages, English and Akan, in providing health care services to an obviously highly multilingual population. This situation has a potential to cause language barrier and raise miscommunication in the healthcare delivery process in urban Ghana. This paper, therefore, calls on the health authorities in Ghana, e.g. Ministry of Health, Department of Public Health, in Ghana to pay (more) attention to the language needs of urban/multilingual populations in ensuring quality and safe healthcare delivery in Ghana.
References
References
Adams, P., & Fleck, F. (2015). Bridging the language divide in health. World Health Organiza
tion. Bulletin of the World Health Organization, 93(6), 365.
Andrulis, D., Goodman, N., & Pryor, C. (2002). What a difference an interpreter can make:
Health care experiences of uninsured with limited English proficiency. Brandeis
University, The Access Project
Amfo, N. A. A., Houphouet, E. E., Dordoye, E. K., & Thompson, R. (2018). Insanity is from
home. International Journal of Language and Culture, 5(1), 1-28.
Belaskri, Khadidza. (2012) A sociolinguistic study of communication and language barriers in
Algerian health setting. Dissertation submitted to the department of English, university of
Tlemcen, for the degree of MAGISTER in Sociolinguistics
Bishop, V. "Why Learn a Language? The Potential of Additional Language Tuition for Linguistic
Identity Awareness and Anti-Discriminatory Practice within British Social Work
Education." Social Work Education 27, 8 (December 2008): 913–924.
doi:10.1080/02615470701844357.
Bitner, M.J.; Faranda, W.T.; Hubbert, A.R.; Zethaml, V.A. (1997) Customer contributions and
roles in service delivery. International Journal of Service Industry Management. Vol. 8,
No.3. Pp. 193-205.
Bourhis, R. Y., & Montreuil, A. (2017). Acculturation, vitality, and bilingual health care. In The
Oxford handbook of acculturation and health. Oxford University Press.
Bowen, S. "Language Barriers in Access to Health Care." Statistics Canada, catalogue no. H39-
578/ 2001E, November 2001, 141 p. Consulted at
http://www.hc-sc.gc.ca/hcssss/pubs/acces/2001-lang-acces/index-eng.php.
Bourhis, R. Y., & Montreuil, A. (2017). Acculturation, vitality, and bilingual health care. In The
Oxford handbook of acculturation and health. Oxford University Press.
Carrasquillo, O; Orav, E.J.; Brennan, T.A.; Burstin H.R. (1999) Impact of language barriers on
patient satisfaction in an emergency department. Journal of General Internal Medicine.
Vol. 14. Pp. 82-87.
Clark M.M. (1983). Cultural context of medical practice. Western Journal of Medicine, 139,
806810.
David, R. A., & Rhee, M. (1998). The impact of language as a barrier to effective health care in
an underserved urban hispanic community. The Mount Sinai Journal of Medicine, New
York, 65(5-6), 393-397.
Department of Health (2017). http://www.health.wa.gov.au/circularsnew/pdfs/13359.pdf.
Ens, T. A., Seneviratne, C. C., Jones, C., Green, T. L., & King-Shier, K. M. (2014). South asians'
cardiac medication adherence. European Journal of Cardiovascular Nursing : Journal of
the Working Group on Cardiovascular Nursing of the European Society of Cardiology,
13(4), 357-368. doi:10.1177/1474515113498187; 10.1177/1474515113498187
Fagan, M.J.; Diaz, J.A.; Reinert, S.E.; Sciamanna, C.N.; Fagan, D.M. (2003) Impact of interpre
tation method on clinic visit length. Journal of General Internal Medicine. Vol. 18, No. 8.
Pp. 634-638.
Fernandez, A.; Schillinger, D.; Grumbach, K.; Rosenthal, A.; Stewart, A.L.; Wang, F.; Perez
Stable, E.J. (2004) Physician language ability and cultural competence. Journal of
General Internal Medicine. Vol. 19. Pp. 167-174.
Flores, G; Laws, M.B.; Mayo, S.J.; Zuckerman, B; Abreu, M; Medina, L; Hardt, E.J. (2003).
Errors in medical interpretation and their potential clinical consequences in pediatric
encounters. Pediatrics. Vol. 111, No. 51. Pp. 6-14.
Hampers, L. C., and McNulty, J. E. Professional Interpreters and Bilingual Physicians in a
Pediatric Emergency Department: Effect on Resource Utilization.Archives of Pediatrics
& Adolescent Medicine 156, 11 (November 2002): 1108–1113.
Han, A., Laranjo, H., and Friedman, S. M. The Design and Pilot of a Translation Aid to Help
ED Clinicians Enhance Communication with the Portuguese-Speaking Patient.
International Journal of Emergency Medicine 2, 1 (April 2009): 41–46.
doi: 10.1007/s12245-008-0081-8.
Holmqvist, J. (2011) Consumer language preferences in service encounters: a cross-cultural
perspective. Managing Service Quality. Vol. 21, No. 2. Pp. 178-191.
Jackson, C. (1998). Medical interpretation: an essential service for non-English speaking immi
grants. In S. Loue (Ed.), Handbook of Immigrant Health (pp. 61-79). New York: Plenum.
Jacobs, E; Chen, A; Karliner, L.S.; Agger-Gupta, N; Mutha, S. (2006). The need for more
research on language barriers in health care: a proposed research agenda. The Milbank
Quarterly. Vol. 84, No. 1. Pp. 111-133.
John-Baptiste, A; Naglie, G; Tomlinson, G; Alibhai, S; Etchells, E; Cheung, A; Kapral, M; Gold,
W.; Abrams, H; Bacchus, M; Krahn, M. (2004) The effect of English language
proficiency on length of stay and in-hospital mortality. Journal of General Internal
Medicine. Vol. 19, No. 3. Pp. 221-228.
Kaplan, S. H., Greenfield, S., & Ware, J. E.,Jr. (1989). Assessing the effects of physician-patient
interactions on the outcomes of chronic disease. Medical Care, 27(3 Suppl), S110-27.
Karliner, L.S.; Jacobs, E.A.; Chen, A.H.; Mutha, S. (2007). Do professional interpreters improve
clinical care for patients with limited English proficiency? A systematic review of the
literature. Health Services Research. Vol. 42, No. 2. Pp. 727-754.
Krueger, K. P., Berger, B. A., & Felkey, B. (2005). Medication adherence and persistence: A
comprehensive review. Advances in Therapy, 22(4), 313-356. Retrieved from
http://www.scopus.com/inward/record.url?eid=2-s2.029344456174&partner
ID=40&md5=8dfeb72df4822648759c5d564f468896.
Masland, M. C., Kang, S. H., & Ma, Y. (2011). Association between limited english proficiency
and understanding prescription labels among five ethnic groups in California. Ethnicity
&Health, 16(2), 125-144. doi:10.1080/13557858.2010.543950.
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective commune
cation when patients or clinicians use a second language. BMC health services research,
15(1), 371.
Morales, L.S.; Cunningham, W.E.; Brown, J.A.; Liu, H.; Hays, R.D. (1999) Are Latinos less
satisfied with communication by health care providers? Journal of General Internal
Medicine. Vol. 14. Pp. 409-417.
Ouimet, A., Trempe, N., Vissandjée, B. and Hemlin, I. 2013. Language Adaptation in Health
Care and Health Services: Issues and Strategies.Saint-Foy: Québec.
Rivadeneyra, R.; Elderkin-Thompson, V.; Silver, R.C.; Waitzkin, H. (2000) Patient centeredness
in medical encounters requiring an interpreter. American Journal of Medicine. Vol.
108. Pp. 470-474.
Samuels-Kalow, M. E., Stack, A. M., & Porter, S. C. (2013). Parental language and dosing errors
after discharge from the pediatric emergency department. Pediatric Emergency Care,
29(9), 982-987. doi:10.1097/PEC.0b013e3182a269ec; 10.1097/PEC.0b013e3182a269ec.
Sarver, J. & Baker, D.W. (2000) Effect of language barriers on follow-up appointments after
an emergency department visit. Journal of General Internal Medicine. Vol. 15, No. 4.
Pp. 256-264.
Schyve, P. M. (2007). Language differences as a barrier to quality and safety in health care:
The joint commission perspective. Journal of General Internal Medicine, 22 Suppl 2,
360361. doi:10.1007/s11606-007-0365-3
Snowden, L. R., Masland, M. C., Peng, C. J., Wei-Mien Lou, C., and Wallace, N. T. Limited
English Proficient Asian Americans: Threshold Language Policy and Access to Mental
Health Treatment.Social Science & Medicine 72, 2 (January 2011): 230–237.
doi: 10.1016/j.socscimed.2010.10.027. Statistics.
Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: A
review. CMAJ : Canadian Medical Association Journal = Journal De l'Association
Medicale Canadienne, 152(9), 1423-1433.
Stewart, M., Brown, J. B., Boon, H., Galajda, J., Meredith, L., & Sangster, M. (1999). Evidence
on patient-doctor communication. Cancer Prevention & Control : CPC = Prevention &
Controle En Cancerologie : PCC, 3(1), 25-30.
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., & Jordan, J.
(2000). The impact of patient-centered care on outcomes. The Journal of Family
Practice, 49(9), 796-804.
Teutsch, C. (2003). Patient-doctor communication. The Medical Clinics of North America, 87(5),
1115-1145.
Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010).
Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity
and language concordance matter? Journal of General Internal Medicine, 25(11),
1172-1177. doi:10.1007/s11606-010-1424-8; 10.1007/s11606-010-1424-8
Wilson, E., Chen, A. H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited
english proficiency and physician language on health care comprehension. Journal of
General Internal Medicine, 20(9), 800-806. doi:10.1111/j.1525-1497.2005.0174.x
Yeo, S.(2004). Language Barriers and Access to Care.Annual Review of Nursing Research 22 (2004): 59–73.
Adams, P., & Fleck, F. (2015). Bridging the language divide in health. World Health Organiza
tion. Bulletin of the World Health Organization, 93(6), 365.
Andrulis, D., Goodman, N., & Pryor, C. (2002). What a difference an interpreter can make:
Health care experiences of uninsured with limited English proficiency. Brandeis
University, The Access Project
Amfo, N. A. A., Houphouet, E. E., Dordoye, E. K., & Thompson, R. (2018). Insanity is from
home. International Journal of Language and Culture, 5(1), 1-28.
Belaskri, Khadidza. (2012) A sociolinguistic study of communication and language barriers in
Algerian health setting. Dissertation submitted to the department of English, university of
Tlemcen, for the degree of MAGISTER in Sociolinguistics
Bishop, V. "Why Learn a Language? The Potential of Additional Language Tuition for Linguistic
Identity Awareness and Anti-Discriminatory Practice within British Social Work
Education." Social Work Education 27, 8 (December 2008): 913–924.
doi:10.1080/02615470701844357.
Bitner, M.J.; Faranda, W.T.; Hubbert, A.R.; Zethaml, V.A. (1997) Customer contributions and
roles in service delivery. International Journal of Service Industry Management. Vol. 8,
No.3. Pp. 193-205.
Bourhis, R. Y., & Montreuil, A. (2017). Acculturation, vitality, and bilingual health care. In The
Oxford handbook of acculturation and health. Oxford University Press.
Bowen, S. "Language Barriers in Access to Health Care." Statistics Canada, catalogue no. H39-
578/ 2001E, November 2001, 141 p. Consulted at
http://www.hc-sc.gc.ca/hcssss/pubs/acces/2001-lang-acces/index-eng.php.
Bourhis, R. Y., & Montreuil, A. (2017). Acculturation, vitality, and bilingual health care. In The
Oxford handbook of acculturation and health. Oxford University Press.
Carrasquillo, O; Orav, E.J.; Brennan, T.A.; Burstin H.R. (1999) Impact of language barriers on
patient satisfaction in an emergency department. Journal of General Internal Medicine.
Vol. 14. Pp. 82-87.
Clark M.M. (1983). Cultural context of medical practice. Western Journal of Medicine, 139,
806810.
David, R. A., & Rhee, M. (1998). The impact of language as a barrier to effective health care in
an underserved urban hispanic community. The Mount Sinai Journal of Medicine, New
York, 65(5-6), 393-397.
Department of Health (2017). http://www.health.wa.gov.au/circularsnew/pdfs/13359.pdf.
Ens, T. A., Seneviratne, C. C., Jones, C., Green, T. L., & King-Shier, K. M. (2014). South asians'
cardiac medication adherence. European Journal of Cardiovascular Nursing : Journal of
the Working Group on Cardiovascular Nursing of the European Society of Cardiology,
13(4), 357-368. doi:10.1177/1474515113498187; 10.1177/1474515113498187
Fagan, M.J.; Diaz, J.A.; Reinert, S.E.; Sciamanna, C.N.; Fagan, D.M. (2003) Impact of interpre
tation method on clinic visit length. Journal of General Internal Medicine. Vol. 18, No. 8.
Pp. 634-638.
Fernandez, A.; Schillinger, D.; Grumbach, K.; Rosenthal, A.; Stewart, A.L.; Wang, F.; Perez
Stable, E.J. (2004) Physician language ability and cultural competence. Journal of
General Internal Medicine. Vol. 19. Pp. 167-174.
Flores, G; Laws, M.B.; Mayo, S.J.; Zuckerman, B; Abreu, M; Medina, L; Hardt, E.J. (2003).
Errors in medical interpretation and their potential clinical consequences in pediatric
encounters. Pediatrics. Vol. 111, No. 51. Pp. 6-14.
Hampers, L. C., and McNulty, J. E. Professional Interpreters and Bilingual Physicians in a
Pediatric Emergency Department: Effect on Resource Utilization.Archives of Pediatrics
& Adolescent Medicine 156, 11 (November 2002): 1108–1113.
Han, A., Laranjo, H., and Friedman, S. M. The Design and Pilot of a Translation Aid to Help
ED Clinicians Enhance Communication with the Portuguese-Speaking Patient.
International Journal of Emergency Medicine 2, 1 (April 2009): 41–46.
doi: 10.1007/s12245-008-0081-8.
Holmqvist, J. (2011) Consumer language preferences in service encounters: a cross-cultural
perspective. Managing Service Quality. Vol. 21, No. 2. Pp. 178-191.
Jackson, C. (1998). Medical interpretation: an essential service for non-English speaking immi
grants. In S. Loue (Ed.), Handbook of Immigrant Health (pp. 61-79). New York: Plenum.
Jacobs, E; Chen, A; Karliner, L.S.; Agger-Gupta, N; Mutha, S. (2006). The need for more
research on language barriers in health care: a proposed research agenda. The Milbank
Quarterly. Vol. 84, No. 1. Pp. 111-133.
John-Baptiste, A; Naglie, G; Tomlinson, G; Alibhai, S; Etchells, E; Cheung, A; Kapral, M; Gold,
W.; Abrams, H; Bacchus, M; Krahn, M. (2004) The effect of English language
proficiency on length of stay and in-hospital mortality. Journal of General Internal
Medicine. Vol. 19, No. 3. Pp. 221-228.
Kaplan, S. H., Greenfield, S., & Ware, J. E.,Jr. (1989). Assessing the effects of physician-patient
interactions on the outcomes of chronic disease. Medical Care, 27(3 Suppl), S110-27.
Karliner, L.S.; Jacobs, E.A.; Chen, A.H.; Mutha, S. (2007). Do professional interpreters improve
clinical care for patients with limited English proficiency? A systematic review of the
literature. Health Services Research. Vol. 42, No. 2. Pp. 727-754.
Krueger, K. P., Berger, B. A., & Felkey, B. (2005). Medication adherence and persistence: A
comprehensive review. Advances in Therapy, 22(4), 313-356. Retrieved from
http://www.scopus.com/inward/record.url?eid=2-s2.029344456174&partner
ID=40&md5=8dfeb72df4822648759c5d564f468896.
Masland, M. C., Kang, S. H., & Ma, Y. (2011). Association between limited english proficiency
and understanding prescription labels among five ethnic groups in California. Ethnicity
&Health, 16(2), 125-144. doi:10.1080/13557858.2010.543950.
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective commune
cation when patients or clinicians use a second language. BMC health services research,
15(1), 371.
Morales, L.S.; Cunningham, W.E.; Brown, J.A.; Liu, H.; Hays, R.D. (1999) Are Latinos less
satisfied with communication by health care providers? Journal of General Internal
Medicine. Vol. 14. Pp. 409-417.
Ouimet, A., Trempe, N., Vissandjée, B. and Hemlin, I. 2013. Language Adaptation in Health
Care and Health Services: Issues and Strategies.Saint-Foy: Québec.
Rivadeneyra, R.; Elderkin-Thompson, V.; Silver, R.C.; Waitzkin, H. (2000) Patient centeredness
in medical encounters requiring an interpreter. American Journal of Medicine. Vol.
108. Pp. 470-474.
Samuels-Kalow, M. E., Stack, A. M., & Porter, S. C. (2013). Parental language and dosing errors
after discharge from the pediatric emergency department. Pediatric Emergency Care,
29(9), 982-987. doi:10.1097/PEC.0b013e3182a269ec; 10.1097/PEC.0b013e3182a269ec.
Sarver, J. & Baker, D.W. (2000) Effect of language barriers on follow-up appointments after
an emergency department visit. Journal of General Internal Medicine. Vol. 15, No. 4.
Pp. 256-264.
Schyve, P. M. (2007). Language differences as a barrier to quality and safety in health care:
The joint commission perspective. Journal of General Internal Medicine, 22 Suppl 2,
360361. doi:10.1007/s11606-007-0365-3
Snowden, L. R., Masland, M. C., Peng, C. J., Wei-Mien Lou, C., and Wallace, N. T. Limited
English Proficient Asian Americans: Threshold Language Policy and Access to Mental
Health Treatment.Social Science & Medicine 72, 2 (January 2011): 230–237.
doi: 10.1016/j.socscimed.2010.10.027. Statistics.
Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: A
review. CMAJ : Canadian Medical Association Journal = Journal De l'Association
Medicale Canadienne, 152(9), 1423-1433.
Stewart, M., Brown, J. B., Boon, H., Galajda, J., Meredith, L., & Sangster, M. (1999). Evidence
on patient-doctor communication. Cancer Prevention & Control : CPC = Prevention &
Controle En Cancerologie : PCC, 3(1), 25-30.
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., & Jordan, J.
(2000). The impact of patient-centered care on outcomes. The Journal of Family
Practice, 49(9), 796-804.
Teutsch, C. (2003). Patient-doctor communication. The Medical Clinics of North America, 87(5),
1115-1145.
Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010).
Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity
and language concordance matter? Journal of General Internal Medicine, 25(11),
1172-1177. doi:10.1007/s11606-010-1424-8; 10.1007/s11606-010-1424-8
Wilson, E., Chen, A. H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited
english proficiency and physician language on health care comprehension. Journal of
General Internal Medicine, 20(9), 800-806. doi:10.1111/j.1525-1497.2005.0174.x
Yeo, S.(2004). Language Barriers and Access to Care.Annual Review of Nursing Research 22 (2004): 59–73.
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12/31/2022
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Ansah, G. N., & Orfson-Offei, E. K. (2022). Multilingualism and Language Barriers in Health Delivery system in Ghana. Ghana Journal of Linguistics, 11(2), 43–73. https://doi.org/10.4314/gjl.v11i2.268
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