Overcoming language and cultural barriers in your practice

Research Audiologist, Dr. Elizabeth Stewart, summarizes findings from a recent study looking at some of the challenges clinicians face when providing hearing healthcare to culturally and linguistically diverse families and a few ways these challenges can be overcome.

I first experienced the impact of language and cultural barriers in hearing healthcare in the summer of 2010 when I participated in a medical mission trip to Antigua, Guatemala to provide hearing care services to underserved members of the surrounding communities.

Lest you give me too much credit, please keep in mind that, in addition to being only a first-year audiology student with limited clinical experience, I also spoke barely a word of Spanish when I signed up to do this and would have been basically useless without the support of the team of Spanish-language interpreters.

Yet even when communication seemed to proceed smoothly, I was still never certain that the message either I or my patient was receiving was accurate. However, according to a study published earlier this year, my experiences were not unique, and in fact are shared by even seasoned clinicians.

Study out of University of Queensland

A team of researchers at the University of Queensland recently examined the views and experiences of clinicians working with culturally and linguistically diverse (CALD) families of children with hearing loss.1

Challenges that emerged from the study

  • Involving interpreters in appointments, while valuable, adds complexity. Providers found it difficult to determine precisely what information CALD families were receiving, especially if the message needed to be paraphrased – either because no word-for-word translation was available or because the interpreter had limited understanding of the subject matter.
  • Difficult to build relationships with families. The presence of a language barrier made expressing empathy and picking up on social and emotional cues more challenging, which in turn made it harder to build rapport and trust with CALD families of children with hearing loss.
  • Perceived barriers to accessing services and information. Some providers suggested that some CALD families may be unaware of their eligibility for services, or have difficulty navigating the healthcare system generally.  

    Live translation required extra time within appointments, meaning CALD families often received less information than their non-CALD counterparts because clinicians needed to simplify their messages to focus on the most essential information and omit more minor details. Further, printed materials were not always available in the CALD family’s home language.

  • Challenges completing diagnostic assessments and monitoring children’s progress. Even routine clinical procedures were more complicated with children of CALD families because assessments and questionnaires in the family’s home language were often limited in number, if they were available at all. Clinicians also tended to be hesitant to administer assessments in English, even if the child was multilingual, as this provided only partial information about their overall language development.

How challenges were overcome

  • Use of a mix of strategies for providing family-centered care. These included using simplified English and learning a few words and phrases from the family’s home language to use when greeting the family or engaging with the child.

    Many clinicians sought out training opportunities and other sources of information focused on language and cultural differences, guidance regarding multilingual development, and strategies for working with interpreters.

  • Use of adapted, translated, and non-English tools. In addition to identifying the challenges of working with CALD families, clinicians also offered possible solutions. This included the use of adapted and informal assessments, more translated materials (printed forms and informational brochures, captioned videos, etc.), greater availability of non-English assessments, and more training opportunities.

Overcoming the present challenges associated with cultural and language barriers not only has the potential to strengthen relationships between CALD families and their hearing care providers but may offer the additional benefit of improving outcomes for multilingual children with hearing loss, who are at higher risk of delayed diagnosis and intervention, compared to their monolingual peers.2,3


Methodology of this study
This was a qualitative descriptive study – qualitative meaning the outcome measures of interest were not assessed using numerical data; descriptive because the goal was to summarize the characteristics of those outcome measures, rather than to examine possible cause-and-effect relationships.

Semi-structured interviews were conducted with ten audiologists, ten speech-language pathologists, and seven service managers – all of whom worked in early intervention with CALD families of children with hearing loss. Audio recordings of the interviews were transcribed and analyzed subjectively to identify patterns and themes within the responses.

For more on this topic, we invite you to read a previous blog article, Importance of cultural competence in family-centered hearing healthcare by Dr. Patricia McCarthy.


To access Phonak publications and evidence related to Family-Centered Care, visit
Phonak.com.

References:

1. Ng, Z. Y., Waite, M., Ekberg, K., & Hickson, L. (2022). Clinicians’ and managers’ views and experiences of Audiology and Speech-Language Pathology service provision for culturally and linguistically diverse families of young children with hearing loss. J Speech Lang Hear Res, 65(7), 2691-2708. https://doi.org/10.1044/2022_JSLHR-21-00378

2. Rethfeldt, W. S. (2019). Speech and language therapy services for multilingual children with migration background: A cross-sectional survey in Germany. Folia Phoniatr Logop, 71(2-3), 116-126. https://doi.org/10.1159/000495565

3. Crowe, K., & Guiberson, M. (2021). Professionals’ perspectives on supporting deaf multilingual learners and their families. J Deaf Stud Deaf Educ, 26(1), 70-84. https://doi.org/10.1093/deafed/enaa025