Table 1 Summary of study findings
From: The safety of health care for ethnic minority patients: a systematic review
Authors | Year | Setting/ Country | Method/ Sample | Ethnic minority conceptualisation | Aims/Objectives | Relevant Findings |
|---|---|---|---|---|---|---|
Alhomoud et al [26] | 2013 | UK Community setting | Systematic Review n = 15 articles | Ethnic minorities. Defined as groups who share minority status in their country of residence due to ethnicity, place of birth, language, religion, citizenship and other cultural differences. | a) Establish types and causes of medicine related problems (MRPs) b) Identify recommendations in support of effective use of these medications. | • Differing cultural perceptions and beliefs about health, illness, prescribed treatment and medical care impact on the use of medicine. • Lack of awareness of the extent of patients’ decision-making regarding the use of their medicines and/or poor appreciation of their experience of MRPs, may cause MRPs • Recommendations identified involved education, use of interpreters, bilingual workers to bridge the cultural divide and to encourage participation of minority communities in decision-making. |
Alhomoud et al [33] | 2015 | UK Community setting (pharmacy) | Face to face semi-structured interviews n = 80 | South Asian and Middle Eastern patients | a) To describe medicine related problems b) Identify contributing factors | • Religious practices and beliefs, use of non-prescription medicines, extent of family support, and travelling abroad--to patient’s homeland or to take religious journeys were identified as factors specific to SA and ME patients. • Illiteracy, language and communication barriers, lack of translated resources, perceptions of healthcare providers, and difficulty consulting a doctor of the same gender may also contribute to MRPs. |
Ajdukovic et al [34] | 2007 | Australia Hospital setting (ED) | Interviews with patients. n = 100 patients (24 with language barrier) | Patient subgroups; ‘general’ patients, patients with a ‘language barrier’ and patients from a residential aged care facility. | a) To identify medication-related ED presentations and describe the incidence in these demographic groups. | • The number of correctly recorded medications was lowest in the ‘language barrier’ group (13.8%) compared with 18 and 19.6% of medications for ‘general’ patients and patients from residential aged care facilities respectively. |
Baehr et al [35] | 2015 | US All settings | Systematic Review n = 40 articles. | Low English Proficiency (LEP) | a) To synthesize existing literature in order to understand the state of evidence for racial and ethnic disparities associated with ADEs in the USA b) To identify gaps in existing knowledge in order to target future research. | • Asian race was associated with an approximately fourfold risk of anticoagulant related ADEs such as bleeding, haemorrhage. • African Americans were the most commonly identified group at risk for ADEs caused by diabetes agents such as hypoglycaemia. • Caucasians were most frequently identified as at risk for opioid related ADEs such as overdose. • Opioid related side effects were noted in 58% of African Americans as compared to Caucasians. |
Bakullari et al [15] | 2015 | US Hospital Setting | Retrospective chart review n = 79,019 | Six racial/ethnic groups. | a) To determine whether racial/ethnic disparities exist in the rate of occurrence of Healthcare Acquired Infections captured in the Medicare Patient Safety Monitoring System (MPSMS). | • The occurrence rate for HAIs was 1.1% for Caucasians, 1.3% for African Americans, 1.5% for Hispanic patients, 1.8% for Asian patients, 1.7% for Native Hawaiian/Pacific Islander patients, and 0.70% for other patients. • Compared with Caucasians patients, the odds ratios of occurrence of HAIs were 1.1 (95% confidence interval [CI], 0.99–1.23) for African Americans, 1.3 (95% CI, 1.15–1.53) for Hispanics, 1.4 (95% CI, 1.07–1.75) for Asians. |
Blennerhasset et al [36] | 2011 | Australia Community Setting (Pharmacy) | Multistage qualitative study Interviews with patients (n = 18) and focus groups (n = 9) with staff. | Greek [5], Russian [5], mandarin or Cantonese [4] and English [4] speaking. | a) Examine medicine management in older people from Non-English-speaking background. | • Patients lack knowledge about medications and medication changes. • Interpreter services not routinely used. • Lack of systematic, standardized processes for identifying people at risk of medicine mismanagement or for the implementation of actions to minimise risks. |
Bloo et al [37] | 2014 | Country not applicable Hospital setting | Systematic review n = 26 | Ethnic minorities | a) Review the literature on safety differences between patients from minority ethnic groups and those from the ethnic majority undergoing surgery. | • Minority ethnic groups had statistically significant higher complication rates compared with the ethnic majority. • Higher incidence of infection and graft rejection among ethnic minorities • Higher incidence of pain and re-operation among ethnic minorities. |
Cantarero-Arevalo et al [38] | 2014 | Denmark Community setting | Before and after study. Mixed Methods. Participants: Pre n = 30 Post n = 23 | Arabic speaking from 10 different countries. | a) To explore the perceptions, barriers and needs of Arabic-speaking ethnic minorities regarding medicine use b) To use an education program to enhance the knowledge and competencies of the ethnic minorities about the appropriate use of medicines | • Misconceptions relating to medication use, mistrust with Danish doctors and low compliance to doctor’s recommendations were identified as barriers to correct medicine use. • A culturally competent education program may potentially reduce medicine-related problems. |
Coffey et al [39] | 2005 | US Hospital setting | Quantitative Study Sixteen Sate sample. | Three racial/ethnic minorities group (Black, Hispanics & Asian/Pacific Islanders) | a) To determine whether racial and ethnic differences between in patient safety events disappear when income is considered. | • Each ethnic minority group has a higher rate of nosocomial infections, post-operative sepsis and 2 post-operative complications. • African Americans have 1.25 to 1.5 times the rate of infection due to medical care, postoperative sepsis, decubitus ulcers, postoperative respiratory failure and PE/DVT as Caucasians. • Hispanics have 1.25 to 1.50 times the rate of 2 post-operative complications as Caucasians. • Asian/Pacific Islanders have 1.25 to 1.50 times the rate of 4 post-operative complications. |
Cohen et al [40] | 2005 | US Hospital setting: Paediatric. | Case control study Cases, n = 97 Ctrl, n = 475 | Language barrier defined by self- or provider-reported need for an interpreter. | a) Determine whether hospitalized paediatric patients whose families have language barriers are more likely to incur serious medical errors than patients whose families do not have language barriers | • No increased risk for serious medical events in patients and families who requested an interpreter compared with patients and families who did not request an interpreter (odds ratio: 1.36; 95% confidence interval: 0.73–2.55). • Spanish speaking patients who requested an interpreter had two-fold increased risk of adverse events compared with patients who did not request an interpreter. • All other language groups composed of < 1% patient population and had no detectable increased risk of adverse events. |
Divi et al [41] | 2007 | US Hospital setting. | Quantitative analysis of AEs incident reports n = 1083 | Low English proficiently – LEP | a) To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals. | • Overall, 29.5% of reported adverse events in English speaking patients and 49.1% of reported adverse events in LEP patients caused some physical harm to the patient • LEP patients experienced a statistically significantly greater proportion of adverse events that were attributable to communication failure (52.4%) than did English speaking patients (35.9%). • LEP patients experienced a statistically significantly greater proportion of events attributable to questionable advice/interpretation than English speaking patients (11.2 vs. 3.5%). • Overall, system factors were found to play a statistically significantly greater role in the occurrence of adverse events for LEP patients than for English speaking patients especially, they were more attributable to organisational factors. • Adverse events associated with practitioner factors occurred more often to LEP patients than to English speaking patients. |
Flores et al [42] | 2003 | US Hospital setting: Paediatrics | Analyses of audiotaped interpreter encounters n = 13 | Spanish speaking | a) To determine the frequency, categories and potential clinical consequences of errors in medical interpretation. | • Sixty three percent of all errors had a potential clinical consequence. • Errors committed by ad hoc interpreters were more likely to result in a significant clinical consequence as compared to hospital interpreters. • Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media. |
Flores et al [43] | 2012 | US Hospital setting: Paediatrics | Analyses of audiotaped encounters (n = 57), 20 with professional interpreters, 27 with ad hoc interpreters and 10 with no interpreters. | Spanish speaking limited English proficiency patients, caregivers, families and their interpreters | a) To compare interpreter errors and their potential consequences in encounters with professional vs ad hoc vs no interpreters. | • The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). • Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. • Interpreters with greater than or equal to 100 h of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) |
Fejzic et al [44] | 2004 | Australia Community Setting | Mixed method n = 25 NESB patients | NESB – residents of former Yugoslavia now residing in Australia. | a) Medication management reviews (MMR) in people from a NESB in their native language in order to identify medication-related problems | • Psychological and sociological factors were identified as having significant impacts on medication management. • Not understanding how to take medications, unknown side effects, no recognition of professional help, taking paracetamol wrong were identified as some of the main medication related problems. |
Goenka [45] | 2016 | US Not specified | Literature Review Sample size not available. | Low English Proficiency (LEP) patients | a) To summarize the legal basis for providing language access in the healthcare setting, discuss the impact of interpretation services on clinical care, and explore the effects of language barriers on health outcomes | • There is often an overestimation of patients’ English proficiency leading to inadequate language assistance. • The lack of interpretation, or use of informal, untrained interpreters, has significant effects on patient safety, quality of care, and patient satisfaction. • The inconsistencies in communication appear to have a direct impact on the incidence of adverse events. • Children with LEP parents are twice as likely to experience a preventable adverse drug event. |
Hadziabdic et al [46] | 2011 | Sweden Community setting: primary health care | Qualitative analysis of incidents (n = 60 incidents) | Person of foreign background. | a) To explore what problems are reported by professionals in primary healthcare concerning the use of interpreters and what the problems lead to. | • Incident reports analysis highlighted problems faced by health care professionals due to lack of available interpreters and also lack of interpreters’ understanding of Swedish. • The main problems documented were related to language, such as lack of the interpreters with proficiency in a particular language, and to organisational routines, with difficulties in the availability of interpreters and access to the interpreter agency. • Consultations were limited possibilities to communicate and thus consultation was carried out without a professional interpreter, using family members instead. |
Harris et al [47] | 2017 | US Outpatient clinical setting – Paediatrics. | Cross-sectional analysis of data from multisite randomized controlled experiment n = 1126 | Self-identified as Hispanics | a) To examine associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents. | • Liquid medication dosing errors by Hispanic parents are common, with over 80% of parents making at least one error, and that errors were more common among those with limited health literacy and LEP. • Efforts to revise existing standards or to redesign paediatric medication labels and dosing tools should be specifically tailored to meet the needs of limited literacy and LEP individuals. |
Hernandez-Suarez et al [48] | 2019 | US Hospital Setting | National Inpatient Sample (NIS) database files n = 36,270 | Caucasians, African Americans and Hispanics. | a) To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing TAVR | • Hispanic patients had higher in-hospital complications. • Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95%CI, 1.06–3.85;P = .03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04–3.14;P = .04), acute kidney injury (aOR = 1.65; 95% CI, 1.23–2.21;Pb.01). |
Inagaki et al [49] | 2017 | US Hospital setting | Retrospective record review (Patients: Non-English Speaking - 51, English speaking – 210) | Non-English Speaking | a) To evaluate the effect of language discordance on post-operative outcomes among vascular surgery patients. | • Adjusted analysis showed that language discordance did not affect the odds of adverse outcomes of wound infections or adverse graft events. |
Karliner et al [50] | 2012 | US Hospital Setting | Participant survey followed by a phone interview n = 308 participants | LEP – Low English Proficiency (English, Spanish and Chinese) | a) Was language barrier is associated with lower rates of understanding of discharge instructions, including diagnosis, type of follow-up appointments, and medication category and purpose after discharge from the acute care hospital b) Was language concordance and interpretation at discharge associated with understanding of discharge instructions. | • Most LEP patients’ understanding of medications and of the type of follow-up appointment was low. • Language concordant discharge instructions had lower odds of understanding for outcomes related to appointment type and combined medication category and purpose. • LEP participants reporting a family/friend interpreter at discharge had lower odds of understanding their medications. • LEP participants reporting no interpretation at discharge had similar outcomes to the English-speaking group. • Number of medications was associated with lower rates of medication understanding regardless of other factors and each additional medication was associated with a 10–15% reduction in rate of any kind of medication understanding. |
Koster et al [51] | 2014 | The Netherlands Community setting | Cross-sectional study (quantitative survey) of 691 non-Dutch speaking migrants. | First generation migrants. *(Antilles, Persians, Surinamese and Turks) | a) Assess interpretation of drug label instructions in different migrant populations living in the Netherlands. | • Many standardly used drug label instructions are unclear, and misinterpretation of these instructions occurs both in highly educated natives and immigrants. • Turkish migrants most often experienced problems withcomprehension of the tested instructions. • Information presented on these labels is very limited, and these labels are only effective if patients are able to understand instructions, interpreted the information correctly, and can follow the advice provided on them. • Lower understanding of drug labels for Surinamese and Antillean migrants compared to the reference group was not observed as Dutch is also an official language in these countries. |
Lee et al [52] | 2015 | US Community Setting | A pre- postsurvey study. (n = 68) | Korean adult migrants | a) Investigate the knowledge and understanding of older adult Korean immigrants concerning prescription and over-the-counter medication directions. | • Even when information is communicated in native language, there is a lack of understanding of medication directio |
Lion et al [53] | 2013 | US Hospital setting: Paediatrics | Retrospective chart review of 33,885 admissions | Self-reported primary language spoken was used to identify participants because no data on English proficiency were available for the study period. | a) To evaluate the risk for serious/sentinel adverse events among hospitalized children according to race, ethnicity, and language and to evaluate factors affecting length of stay associated with serious/sentinel adverse events. | • Hospitalized children from Spanish speaking families had significantly longer hospital stays in association with an adverse event and may have increased odds of a serious or sentinel event. • Results according to ethnicity were similar but somewhat attenuated, suggesting that language difference, rather than Hispanic/Latino ethnicity, was the operative factor. |
Lopez et al [54] | 2015 | US Hospital setting | Retrospective cohort study n = 4,224,564 (13%) were LEP. | Self-reported LEP status | a) Are hospitalized LEP patients receiving interpreter services during hospital clinical encounters? | • Results indicate that in a well-resourced academic hospital, use of interpreters by clinical staff remains highly variable, with 66% of LEP patients having no interpreter use during the inpatient clinical encounter. |
Masland et al [55] | 2011 | US Community setting | Cross-sectional survey n = 48,968 surveys | Mexicans, Central Americans, Chinese, Koreans, and Vietnamese. | a) Examine the effect of language and cultural factors on prescription label understanding by ethnic groups. | • In multivariate analysis, limited English increased odds of difficulty in understanding prescriptions by three times for Mexicans, Central Americans, and Koreans, and four times for Chinese; it was insignificant for Vietnamese. • In controlled analysis, Chinese and Korean ethnicity increased odds of difficulty of understanding compared to Mexican or Central American ethnicity; Vietnamese ethnicity reduced odds of difficulty compared to others. • Having a bilingual doctor reduced odd of difficulty while disability, low education, low income or recent immigration increased odds of difficulty. |
McDowell et al [56] | 2006 | Country not applicable All settings | Systematic review and meta-analysis n = 24 | Studies identifying at least 2 ethnic groups with one or more ADRs. | a) To review the evidence for ethnic differences in susceptibility to adverse drug reactions (ADRs) to cardiovascular drugs | • The relative risk of angio-oedema from angiotensin converting enzyme (ACE) inhibitors in African Americans compared with non-African American patients was 3.0 (95% CI 2.5 to 3.7) • The relative risk of cough from ACE inhibitors was 2.7 (1.6 to 4.5) in East Asian compared with white patients • The relative risk of intracranial haemorrhage with thrombolytic therapy was 1.5 (1.2 to 1.9) in African Americans compared with non-African American patients |
Metersky et al [57] | 2011 | US Hospital Setting | Retrospective chart review n = 102,623 | Ethnic minority. African Americans and Caucasians | a) Determine racial disparity in the frequency of adverse events in the Medicare Patient Safety Monitoring System | • The risk-adjusted odds of African American patient suffering a hospital-acquired infection, or an adverse drug event compared with a Caucasian patient were 1.34 (95% CI, 1.17–1.55) and 1.29 (95% CI, 1.19–1.40), respectively. • The risk-adjusted odd ratios were 0.94 (95% CI, 0.85–1.04) and 0.94 (95% CI, 0.78–1.13) for general events and procedure-related adverse events, respectively. |
Nwachukwu et al [58] | 2010 | Country not applicable Hospital setting | Systematic Review n = 9 | Ethnic minorities | a) To assess if the minorities have more complications than whites do after total hip re-placement and total knee replacement. | • Racial and ethnic minority groups appear to have a higher risk for early complications (those occurring within ninety days), particularly joint infection, after total knee replacement. • There was no significant difference between African Americans and Caucasians for infection rate associated with total hip replacement. |
Okoroh et al [59] | 2017 | US Setting not applicable | Systematic review n = 24 | Ethnic minorities | a) Explore differences in reporting race/ethnicity in studies on disparities in patient safety assess adjustment for socioeconomic status, comorbidity, and disease severity | • Eight studies included race/ethnicity in baseline characteristics and adjusted for confounders. • Hospital-level variations were infrequently analysed. • The evidence on the existence of disparities in the adverse events was mixed. |
Patel et al [60] | 2002 | Canada Setting not specified | Mixed method study – three group of participants. Grp 1: 8 Kenyan and 5 Canadians. Grp 2: 25 English, 7 East Indians and 16 Greek parents. Grp 3: 8 English, 7 East Indians and 16 Greek | Different ethnic and cultural backgrounds. | a) Investigate and characterize the errors in cognitive processes deployed in the comprehension of procedural texts found on pharmaceutical labels by subjects of different cultural and educational backgrounds. | • All participants read and interpreted the preparation instructions for the ORT correctly, regardless of cultural background and level of formal education. • Only three of the eight (37.5%) Kenyan mothers were able to correctly administer the treatment. • The Canadian mothers were more accurate in their administration of the treatment. • Overall, cultural and educational background appeared to be only weakly related to the accuracy of dosage and administration • All groups of participants had considerable difficulty in interpreting the instructions |
Raynor [61] | 2016 | US Clinical setting: Paediatric | Survey (n = 36) | Spanish and Arabic speaking | a) Identify factors affecting care in NES patients and families | • Fifty percent respondents answered that hat they did not know why they were seeing that provider, did not understand the tests, or had difficulty with interpreters. • Barriers to communication can lead to adverse medical outcomes, poor compliance with therapy, and poor understanding of medical conditions. |
Romano et al [62] | 2003 | US Hospital setting | Quantitative analysis of 1995–2000 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Sample size not available | Population wide. | a) To presents national data on the incidence of Patient Safety Incidents over time and their association with patient and hospital characteristics. | • African American inpatients had a higher risk of most medical and nursing-related postoperative complications (such as decubitus ulcer; infection following infusion, injection, or transfusion; and postoperative physiologic and metabolic derangements, thromboembolism, and sepsis). • Mortality-related events and the rarest sentinel-event indicators were similarly frequent across racial/ethnic categories |
Samuels-Kalow et al. [63] | 2013 | US Hospital setting – Pediatric ED | Prospective observational study (n = 146) | Spanish speaking. | a) To examine the relationship between language and discharge comprehension regarding medication dosing. | • Fifty-four percent of Spanish-speaking parents had a dosing error, as compared with 25% of English-speaking parents (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.6Y8.1). • Half of the Spanish-speaking parents discharged in English (discordant discharge) had a dosing error, as compared with 62% of those discharged in Spanish. • Spanish-speaking parents were significantly more likely to have a dosing error (odds ratio, 3.7; 95% confidence interval, 1.6Y8.1), even after adjustment for language of discharge, income, and parental health literacy (adjusted odds ratio, 6.7; 95% confidence interval, 1.4Y31.7) |
Schwappach et al [64] | 2012 | Switzerland Community setting: Pharmacy | Cross-sectional survey (n = 498) | Foreign language patients | a) Investigate Swiss public pharmacists’ experiences and current practices in counselling foreign-language patients (FL) with a focus on patient safety and to identify needs for subsequent improvement activities. b) Examine whether frequent experience of communication barriers is associated with pharmacists’ satisfaction with quality of care provision. | • Approximately 10% of pharmacies reported that they at least weekly fail to explain the essentials of drug therapy to FL patients • Ad-hoc interpreting by minors is also common for a considerable number of pharmacies (26.5% reported at least one weekly occurrence) • Tools for supporting communication with FL patients are used only infrequently and by a minority of pharmacies – with printing information in foreign language as the most common tool. • The main strategy used by pharmacists to improve the quality of medication counselling for FL patients was the systematic employment of multilingual staff. |
Shadmi et al [65] | 2013 | Israel Hospital setting | Prospective Observational study (n = 385) | Russian speaking patients | a) Examine the quality of care transitions of minority patients (immigrants) versus the general population and assess the association between in-hospital provider–patient communication and the quality of minority care transitions. | • Russian speakers reported lower scores for understanding the purpose of taking their medications. |
Shen et al [66] | 2016 | US Hospital setting | Cross-sectional study of hospital discharges related with Patient safety indicators (n = 3,052,268) | Ethnic minority | a) Are minority patients weremore likely to incur adverse PSIs than their White counterparts; b) Are patients with Medicaidor uninsured were more likely to incur adverse PSIs than patients covered by private insurance. | • As compared with White patients, African American patients were more likely to experience pressure ulcer, postoperative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE). • Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs. • Hispanic/Latino patients were more likely to experience post-operative physio-metabolic derangement and accidental puncture/ laceration. |
Stockwell et al [67] | 2019 | US Hospital Setting | Multisite investigation using record review (N = 3790) | Ethnic minorities identified in records | a) To understand patient safety disparities not been previously identified in the pediatric inpatient environment by measuring rates of clinically confirmed AEs | • Compared with hospitalized Caucasians children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). • No significance difference was observed in other groups. |
Suurmond et al [17] | 2010 | The Netherlands Hospital setting | Qualitative semi-structured interviews (n = 12) for a total of 30 cases | Foreign language speaking | a) Explore the characteristics of in-hospital care and treatment of immigrant patients to better understand the processes underlying ethnic disparities in patient safety. | • Health care professionals preferred ad hoc interpreters or no interpreter at all. • There was limited availability of translated documents for patients who do not speak or read Dutch. • Lack of insurance was identified as a barrier to receiving appropriate care. • Organisations shortcomings to understand genetic and physical characteristics of migrants increases the risk of patient safety events. • Presumptions about the cultural background of the patient resulted in an adverse event or patient safety event. |
Thomas et al [68] | 2010 | Australia Hospital setting | Retrospective analysis of 4751 charts | Culturally and linguistically diverse *Those born outside Australia /New Zealand, non-English speaking, non-Caucasian and refugees | a) Determine whether CALD parameters, including country of birth, race, primary language spoken, need for an interpreter and refugee status are independent predictors of obstetric or neonatal outcomes. | • Use of interpreter services was associated with a reduced likelihood of an adverse outcome (P = 0.015),. • No significant difference observed between adverse outcomes and refugee status. |
Timmins et al [69] | 2002 | US All settings | Systematic review (n = 14) | Latinos * all persons living in the United States whose origins can be traced to the Spanish- speaking regions of Latin America, including the Caribbean, Mexico, Central America, and South America” | a) Provide knowledge for providers and institutions in devising effective strategies for bridging the language barrier. | • Health care providers need to educate themselves and their institutions about the laws and regulations that address language access in their own particular setting • Bilingual fieldworkers need to be trained appropriately to be used for bridging the communication gap. |
van Rosse et al [70] | 2016 | The Netherlands Hospital setting | Mixed method study Record review (n = 567) Patient questionnaire (n = 576) Qualitative data (n = 17) | Ethnic minority background | a) At which moments during hospitalization do language barriers constitute a risk for patient safety? b) How are language barriers detected and reported in hospital care? c) How are language barriers bridged in hospital care? What is the policy and what happens in practice? | • In 30% of the patients that reported a low Dutch proficiency, no language barrier was documented in the patient record. • Relatives of patients often functioned as interpreter for them and professional interpreters were hardly used. • Drop-out of protocolised name and DOB check was observed among people with low Dutch proficiency. • Language barrier threatened patient safety during daily nursing tasks (i.e. medication administration, pain management, fluid balance management) and patient–physician interaction concerning diagnosis, risk communication and acute situations. |
van Rosse et al [71] | 2014 | The Netherlands Hospital setting | Prospective cohort study (n = 763 Dutch patients and 576 ethnic minority patients) | Ethnic minority background | a) To compare incidence, type, nature, impact and preventability of AEs during hospitalisation of Dutch patients with those of ethnic minority patients. b) To assess the extent to which patient-related determinants (language proficiency, health literacy, education and religion) are related to the incidence of AEs among Dutch and ethnic minority patients. | • No significant difference in the incidence of AEs: 11% (95% CI 9 to 14%) in Dutch patients and 10% (95% CI 7 to 12%) in ethnic minority patients. • There was no significant difference in the incidence of preventable AEs: 3% (95% CI 1 to 4%) in Dutch patients and 1% (95% CI 0 to 2%) in ethnic minority patients • Low language proficiency, inadequate health literacy and low educational level did not increase the risk of an AE. |
2016 | The Netherlands Hospital setting | Mixed method study Document analysis (n = 20 cases) Observations (n = 3 cases) Qualitative interviews (n = 12) | Ethnic minority background | a) Explore the potential roles that relatives take on themselves and their influence on patient safety of hospitalised ethnic minority patients. | • Apart from fulfilling their usual role as a visiting family member, relatives often took on the role of the interpreter, the patient and the care provider. • Four roles can help optimise quality and decrease safety risks for the hospitalised patient but can also increase patient safety risks. • Good understanding between the healthcare provider(s) and the relatives tended to increase patient safety. | |
Wasserman et al [73] | 2014 | US Hospital setting | Mixed method study Analysis of 39,133 AEs from char review Interpreter analysis of 28 incidents Qualitative interviews (sample not provided) | Low English proficiency (LEP) | a) To describe the development, content, and testing of two new evidence-based Agency for Healthcare Research and Quality (AHRQ) tools for LEP patient safety. | • Integration of interpreters is a complex process requiring staff training and organizational change. • LEP patients have better safety outcomes when interpreters are used but the uptake of the interpreters by health professionals is not optimal. • Inconsistent collection of patient data on race, ethnicity, and language greatly affects understanding the role of language and culture in patient safety events. • Majority (60%) of the interpreter pilot related events were related to misuse of interpreter services. |
White et al [12] | 2012 | Australia Primary healthcare setting | Focus groups (n = 2) with Six Chinese & 11 Vietnamese | Chinese and Vietnamese immigrant | a) How aging home medicine review (HMR)-eligible Chinese and Vietnamese Australians who have never received a HMR manage their medicines; b) To what extent they are aware of the existence of this service c) How likely they might be to accept and receive a HMR in the future. | • Chinese participants had doubts about the effectiveness of prescribed medications, fear of generic brands, fear of taking too many medications and a lack of medicine information contributing to non-adherence and confusion. • Vietnamese patients, although having some concerns with medications did not show non-adherence to dosing regimen and voice strong respect for GP. • Both groups reported difficulties locating a pharmacist who spoke their native language, which contributed to an increased unmet need for medicine information. |