newcomers and health linguistic hindrances. multiple non - standard languages ‘under’ a...

Transcultural Nursing © 2014 Novantiqua MultimediaI.P.A.S.V.I. Frosinone 5 settembre 2014 I.P.A.S.V.I. Latina 6 settembre 2014

newcomers and health linguistic hindrances

multiple non - standard languages ‘under’ a language

“... The error rate of untrained “interpreters” (including family and friends) is sufficiently high as to make their use more dangerous in some circumstances than no interpreter at all. This is because it lends a false sense of security to both provider and client that accurate communication is actually taking place.” From a report of the U. S. Office of Minority Health (1999)

Strip from: A. Bischoff - l. Lautan, Due lingue un colloquio, 1999

dr. Paolo Tentori - Novantiqua Multimedia

“The components of clinical assessment, including observation of the patient, history-taking, physical exami-nation, and laboratory testing, all may be influenced by cultural factors. The cultural issues are most obvious if the patient has distinctly different background from the healthcare provider.” W.S. Tseng, J. Streller, Cultural Competence in Health Care- A Guide for Professionals, 2008


communication aimsto promote the health of the immigrant population

translation skills: a duty for healthcare providers?

Translation is a professional activity and the purpose of this work isn’t to disqualify expert knowledge but increase the use of passive language competence. Our aim is to valorise interrelated competences and extra-linguistic sub-competences (management of precompiled documentation resources; use of linguistic automatic tools for use by nurses, doctors and other health care professionals when thay encounter a patient who does not speak a usually common language, especially when a translator is not immediately available).

Anthony Pym, Alternatives to Borders in Translation Theory, in: Susan Petrilli (ed.), Translation Translation, Amsterdam/New York, Rodopi, 2003, 660 pp.http://usuaris.tinet.cat/apym/on-line/intercultures/alternatives.pdf



Machine or computer-aided translation tools

“The availability of on-line translation tools makes them tempting to use and they can seem like an efficient short-cut to providing material in different languages. But, as with many short-cuts, there can be hidden dangers and unpredictable results. When using these tools, you may not really know whatyou are sending out to your patients, or what you are really saying” (WHRA French Language Service). However, multicultural communication is problem solving and we will see later that IT-based program information can be helpful in the context of “low risk messages” (e.g. daily patients interaction).

Anthony Pym, A Theory of Cross-Cultural Communication, 2003.http://usuaris.tinet.cat/apym/on-line/intercultures/cross-cultural.pdf

http://www.ingenuitor.com/thesolution.html



Communicative success conditions (Pym model)

COMMUNICATION ACT


COOPERATION BENEFITS FOR ALL PARTICIPANTS

LOW RISKMESSAGES

HIGH RISKMESSAGES

Reduction to effort in health back-ground messages. E.g. patient daily procedures and interaction.

Tools: automatic translation

MANY MESSAGESMANY LEVELS

Particular attention to them in terms of: production, reception, mediation. E.g. informed consent, medical procedures, instructional input.

Standardised forms and procedures




COMMUNICATION PARTICIPANTS


SENDER INA SOURCE CULTURE

RECEIVER INTARGET CULTURE

The mediator may more normally be seen as an active member of the communication group, usually member who uses specialized knowledge of communication norms in one or several receiving cultures, multilinguistic written materials and IT-based program informa-tion combined whit oral interaction. In our health care context mediator can be a healthcare provider in hospital ward. He is able to decode a communication properly.

MEDIATOR





REDUCTIONOF COMPLEXITY UNDERSTANDING

Anthony Pym declare “Success conditions” as criteria that make the communicative act beneficial for all or some of the participants concerned. Such criteria may be simple, subtle and multiplex.E.g.: (in our health context) explication and comprehension of a multilingual informed con-sensus and his purpose.

INTERPRETATION:linguistic,cultural,

denotative/connotativemessage.




TRANSACTIONCOST

SUM OF THE EFFORTSPUT INTO

The selection of cheaper communication (in our health context precompiled medical proce-dures, medical app) does not in itself ensure the minimal ethical requirement that benefits ensure for all participants. However, the lowering of transaction costs may allow for looser success conditions, greater general benefits, and thus a greater probability of mutual be-nefits.E.g.: (in our health context) the project “mDiabetes” that has launched in Senegal just in time for the month of Ramadan (2014).

production,reception,mediation

GIVENCOMMUNICATION ACT


I.P.A.S.V.I. Frosinone 5 settembre 2014I.P.A.S.V.I. Latina 6 settembre 2014 Nursing transculturale © 2014 Novantiqua Multimedia


The cooperative principle in communication (Grice’s maxims)

Betty J. Birner, Introduction to Pragmatics, Wiley- Blackwell 2013.http://en.wikipedia.org/wiki/Cooperative_principle

The maxim ofquantity

Communication, either orally or in writing, can work only because both people are traying to be cooperative - trying to make their contribution appropriate to the interchange at hand. Health provider may use interpretable communication instruments in a reasonably concise and articulate way.

The maxim ofquality

The maxim ofrelation

the maxim ofmanner

Say enought, but don’t say too much.

Say only you have reason to believe is true.

Say onlywhat is relevant.

Be brief, clear,and unambiguous.

In the healthcare arena, where the transfer of accurate and of-ten complex information is critical, make your utterances ap-propriate and straightforward to their conversational context.

I.P.A.S.V.I. Frosinone 5 settembre 2014I.P.A.S.V.I. Latina 6 settembre 2014 Nursing transculturale © 2014 Novantiqua Multimedia


Health literacy

AA.VV., Attributes of a Health Literate Organization, National Academy of Sciences, 2012http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf

Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate decisions (HRSA).



translation skills in the cross-cultural situations

“Cross-cultural communication might be characterized by a relatively high degree of effort required to reduce complexity, by relatively high transaction costs, by relatively low trust, and by relatively narrow or restrictive success conditions. In short, it is harder to meet success conditions between culturesthan within just one culture...” (Anthony Pym).

Anthony Pym, A Theory of Cross-Cultural Communication, 2003http://usuaris.tinet.cat/apym/on-line/intercultures/alternatives.pdf



translation skills in the cross-cultural situations

It is vital to understand the importance of cultural competence while providing information about medical procedures. Information given in a proper way can create better understanding, acceptance and tolerance towards the procedure. The patient who is having this procedure is given feelings of safety and trust. This means that cultural differences are taken into consideration when informing the patients (Chen, Wang, Gilala 2013).

Pingying Chen, Ruilan Wang, Sonja Gilala, Informing patients about intermittent urinary catheterization in tran-scultural patient-nurse interactions, Bachelor thesis, 2013



The foreign citizen’s guide of the district of ASL Frosinone

The “guida multilingue” is a concise and practical tool, as comprehensive as possible, available in 6 different languages: Italian, English, French, Arabic, Russian, Albanese.

http://www.oltreloccidente.org/guida/en/index.htm



The foreign citizen’s guide of the district of Frosinone

The guide for foreign citizens wants to solve practical problems as, for example, to enrol to the regional health system, booking for tests and examinations, to access to the Emergencies department, hospitalization, but, more importantly, to provide information and essential knowledge to protect the health of individuals and of the whole community.





We can use the guide as a basis for practical examples of translation , knowledge of alphabets other than the Latin (Arabic, Devanagari, Chinese, Cyrillic).





Latin alphabet: health information in English. Copy and paste in Google.





Cyrillic alphabet: health information in Russian. Copy and paste in Google.





Latin alphabet: health information in French. Copy and paste in Google.





Latin alphabet: health information in Albanian. Copy and paste in Google.





Arabic alphabet: health information





Arabic alphabet: health information. Copy and paste in Google

http://www.oltreloccidente.org/guida/en/index.htmhttps://translate.google.it




Arabic alphabet: health information. Copy and paste in Google. Lessan Wörterbuch word occurrences.

http://www.oltreloccidente.org/guida/en/index.htmhttp://www.lessan.org/ https://translate.google.it



become more digitally literate

Language learning is defined according to basic concepts:

- Mother tongue (L1)

- Second language or target language (L2)

- Foreign Language (FL)

- Interlingua.

With the new computer resources you can focus on vehicular tools that approach the learner to multi- FL in the contest of reading and writing by: automatic translators based on mathematical algorithms; relations of ontological concepts translated. Our primary purpose is not spoken communication, but the use of written translations on the basis of clear objectives.Sadananda Meher, Using Learner’s Home Language in Teaching English at the Secondary Level in West Odisha, British Council, 2013http://www.britishcouncil.in/sites/britishcouncil.in2/files/tec_13_publication_final_version.pdf



translation competence (technical and instrumental)

“Predominantly procedural knowledge related to the use of documentation resources and information, and communication technologies applied to tran-slation” (PACTE, “Investigating translation competence. Conceptual and methodological issues”, Meta, vol. 50, no. 2, 2005, p.208).

“Knowing how to search for appropriate information to gain a better grasp of the thematic aspects of a document” (EMT expert group, Competencies for professional tran-slators, experts in multilingual and multimedia communication, Brussels, European Commission, 2009., p. 7)

Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Wor-kplace: Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011http://ilcea.revues.org/pdf/1060



translation competence (technical and instrumental)

http://www.healthtranslations.com/aspx/topics/topics.aspx?topicid=12

English - Farsi Admission agreement



translation competence (instrumental sub-competence)

“The ability to use translation-specific conventional and electronic tools” (GÖP-FERICH Susanne, “Towards a model of translation competence and its acquisition: The longitudinal study TransComp”, in S. Göpferich, A. L. Jakobsen, and I. M. Mees (eds), Behind the Mind: Methods, Models and Results in Translation Process Research (= Copenhagen Studies in Language 37),Copenhagen, Sam fundslit-teratur, 2009).

Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Workplace: Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011 http://ilcea.revues.org/pdf/1060


AA..VV., “Results of the Validation of the PACTE Translation Competence Model: Acceptability and Decision Making, Across Languages and Cultures, Vol. 10 núm. 2, PACTE 2009


translation competence (instrumental sub-competence)

“Predominantly procedural knowledge related to the use of documentation resources and information and communication technologies applied to transla-tion (dictionaries of all kinds, encyclopaedias, grammars, style books, parallel texts, electronic corpora, search engines, etc.).”

www.mdbg.net www.qutrub.de

https://ddd.uab.cat/pub/artpub/2009/67883/PREI2010_acrlanculv10n2.pdf


Ioannis E. Saridakis, Georgia Kostopoulou, “Methods and the role of revision in academic and professional environ-ments of translation”, 4th FEDER.CEN.TR.I. Conference, Bologna 10-11 October 2003


translation competence (seven textlinguistic factors)

Translation is considered to be both a mental process

and a practical procedure.

Kostopoulou & Saridakis 2003

www.mhcs.health.nsw.gov.au

http://www.academia.edu/2589325/Methods_and_the_role_of_revision_in_academic_and_professional_environments_of_translation



translation competence for health practioner

- Efficient resource and desktop management;- knowledge of (automated) tool features and effective interaction with user interfaces;- familiarity with resource features and capabilities, and adequate evaluation, selection and manipulation of resources.

Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Wor-kplace: Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011http://ilcea.revues.org/pdf/1060



digital tools: example for Roma (Romani čhib) language use

Dieter W. Halwachs, Roma and Romani in Austria, in Romani Studies 5; 15/1 (2005).Webref: http://translationromani.net

Romani is a heterogeneous bundle of dialect’s varieties (Sinti, Lovara, Kalde-rash, Gurbet, Arlijie...) with a homogenous lexical and morphological core, but without a homogenizing standard.



digital tools: example for Roma (Romani čhib) language use

Use of Romlex Lexical Database. Basic question in Sinte Romani: What’s your name? har = how khareh be called tu = you

Webref: http://romani.uni-graz.at/romlex/lex.xml

har = come

khareh = 3° sing.sei chiamato

tu = tu



digital tools: example for information in a variety of languages.

Webref.: http://www.mylanguage.gov.au/translated-information.html




Webref.: http://www.mylanguage.gov.au/translated-information/health.html


Webref.: http://www.healthtranslations.vic.gov.au/bhcv2/bhcht.nsf/pages/topics




Webref.: http://www.health.qld.gov.au/multicultural/health_workers/support_tools.asp





actively, passively and interactively multilinguism

A multilingual person can communicate in more than one language, be it actively through

speaking and writing

or passively and interactively

through reading, listening and perceiving.

Exploration and experimentation are two key terms in any health provider’s activity. New interactive tools usage allows at least passively and interactively lingui-stic interaction between the patient and the healthcare provider.

Multicultural communication is a problem-solving activity.

Sadananda Meher, Using Learner’s Home Language in Teaching English at the Secondary Level in West Odisha, British Council, 2013http://www.britishcouncil.in/sites/britishcouncil.in2/files/tec_13_publication_final_version.pdf



actively, passively and interactively multilinguism

Efficient health practitioners are able to choose an effective technology tool from many options that meets the needs of the opereting task (Google Tran-slator, mdgb.net, nciku.com; written multilinguistic material precompiled on line or off line: e.g. for informated consensus, medical procedures, hospital dismission).

Dawn Bikowski, The Pedagogy of Collaboration: Teaching Effectively within an Evolving Technology Landscape, British Council, 2014

Making these choices effectively requires practice using a variety of types of techno-logies and moving beyond multilingual writ-ten tests.In contexts with a wide penetration of mobi-le devices, apps provide an opportunity for health practitioners to explore multilingual resources creatively. The task is work toge-ther using interactive technologies in inno-vative interlanguage knowledge.

http://www.britishcouncil.in/sites/britishcouncil.in2/files/day_1_-_dawn_bikowski.docx



how languages differ

We may find a relatively exact fit for the English “pain” in other languages: Italian “dolore”; Spanish “dolor”; Arabish “Ālm”; Turkish “ağrı”; Persian “dard”. But we have e.g. in Italian and English many synonims as shown in Google:

Dawn Bikowski, The influence of the mother tongue on second language vocabulary acquisition and use, In Voca-bulary: Description, Acquisition and Pedagogy, ed. Schmitt and McCarthy, CUP 1997http://www.mikeswan.co.uk/elt-applied-linguistics/influence-second-language.htm



strategic and operational objectives

Understanding cultural and linguistic barriers to health literacy and procedu-res allow health operators to be able to overcome properly obstacles to good health.In the article ‘Potential barriers to the use of health services among ethnic minorities: a review’ (2005) published in oxfordjournal.com (Vol. 23, Issue 3, Pp.325-348) authots emphasize that “potential barriers occurred at three different levels: patient level, provider level and system level. The barriers at patient level were related to the patient characteristics: de-mographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness and personal health practices. The barriers at provider level were related to the provider characteristics: skills and attitudes. The barriers at system level were related to the system characteristics: the organisation of the health care system”.

Emmanuel Scheppers, Els van Dongen, Jos Dekker, Jan Geertzen and Joost Dekker, Potential barriers to the use of health services among ethnic minorities: a review, 2005http://fampra.oxfordjournals.org/content/23/3/325.full




Potential barriers to the use of health services among migrant patientthree different levels:

patient level provider level system level

Demographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness,personal health practices.

Emmanuel Scheppers, Els van Dongen, Jos Dekker, Jan Geertzen and Joost Dekker, Potential barriers to the use of health services among ethnic minorities: a review, 2005

Skills and attitudes. Organisation of the health care system”.

http://fampra.oxfordjournals.org/content/23/3/325.full




Potential barriers to the use of health services among migrant patient

patient level low health literacy cultural barriers limited local

Kate Singleton, MSW, LCSW, Elizabeth M. S. Krause, AB, SM, Understanding Cultural and Linguistic Barriers to Health Literacy, OJJN (Vol. 14, n.3, 2009)

Health literacy:the degree to which indi-viduals have the capacity

to obtain, process, and understand basic health information and services

needed to make appropria-te health decisions.

Purpose:decision making

Cultural background:patients’ perceptions of locus of control, preferences, communi-cation norms, and prioritization

of needs, as well as in their understanding of physical and mental illness and of the roles of the individual, family, and

community.Purpose:

dialog for efficient care

Language background:language is a body of words and the systems for their use common to a

people who are of the same commu-nity or nation, the same geographical area, or the same cultural tradition.

Purpose:comprehension

language proficiency

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Cultural-and-Linguistic-Barriers-.htm





patient level Languages barriers

- face to the health promotion/prevention;

- face to the contact with a variety of providers and health services;

- reduce comprehension in prescribed medication or to obtain informed con-sensus.

Sarah Bowen, B. A., M. Sc., Language Barriers in Access to Health Care, Health Canada, 2001http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-lang-acces/index-eng.php





patient level Negative effects of language barriers on a range of services

Physician and hospital care; long-term care; speech and occupational therapy; counseling and rehabilitation; community health nursing; pharmacy services; emergency/ambulance services; participation in cardiopulmonary resuscitation (CPR) classes; home care; access to out-ofhours services; abuse prevention and intervention services; support for caregivers of the elderly and disabled; health promotion and prevention on a variety of topics.






patient level Cultural barriers

Language and culture are inextricably intertwined. Establishing communication enables all parties in a health encounter to participate in the exploration of the illness or condition, and to determine together what aspects of the “culture” of both patient and provider must be considered in diagnosis and treatment.






provider level Languages barriers

It is not feasible to offer even primary care to all communities by a provider of the same ethnic or language background. Initiatives to increase the number of physicians speaking a minority language are inadequate as the sole respon-se, as physician access is only one component of health care. Comprehensive health system access necessitates dealings with many different health care providers (e. g. nurses, health educators, imaging technicians, dentists, phy-siotherapists, and psychologists).Increasing the number of providers who manage multilinguistic tools for mino-rity languages develops capability instruments in different settings.Effective “make-do” solutions in the absence of a formal, defined service.






provider level Models of service language provision

Such services may be provided by:

family members or friends of the client,bilingual personnel within the health care system,community language bank volunteers,medical interpreters who are trained and employed by the health institution,paraprofessionals with health, outreach, or educational responsibilities, who include interpretation as part of their role,other programs or services that address language barriers.







Interpreter functions or heatlh operator language interventation may take many forms:

- gain language fluency and proficiency (but... in how many languages?...);

- use of simple, easily accessible products, which can be “understood” by he-alth care providers (e.g. Translingo, Google Translator, multilingual tools).







- Increase the number of encounters where client and provider share the same language (i. e. the number of “language-congruent” encounters);

- provide some form of interpretation.

Increasing the number of language congruent encounters can be accompli-shed either by:Increasing the number of providers who speak other languages, orIncreasing the number of providers who manage automatic tools (Google tran-slator, precompiled multilingual health procedures).
