Cultural Barriers Limit Immigrant Patient-Provider Interactions

Cultural differences and language barriers considerably hinder strong immigrant patient-provider interactions, according to a study published in the journal Patient Experience.

As the US continues to see high levels of immigration, it will be important for healthcare professionals to understand how cultural differences affect the immigrant patient-provider interaction, the research team said.

Generally, clinicians are expected to accomplish three broad goals during the care encounter: establish a positive rapport with the patient, understand what may be ailing the patient, and determine the proper treatment for that ailment.

However, cultural barriers can get in the way of those goals, the researchers said.

“Immigrant patients experience many barriers when accessing healthcare, such as culture and language differences, lower socio-economic status, lack of knowledge, etc,” the investigators explained. “Among these, communication barriers between healthcare providers and immigrant patients are extremely common and have significant impact and consequences.”

The researchers conducted an extensive literature review to better understand how both immigrant patients and their providers perceived their healthcare relationships. The literature review included 32 studies in total. Seven of those studies looked at physician perspectives, 15 at patient perspectives, and 10 examined both.

The investigators categorized their findings into three areas, including physician perceptions about communication, immigrant patient perspectives, and overall views of third-party interpreters in the care encounter.

First, the literature review revealed that providers struggle to communicate with patients who do not speak English proficiently.

“These challenges are diverse and include insecurity to engage with patients, misunderstanding of patients, more directive communication, negative impacts on shared decision making, more time-consuming communication, perceived power distance between patients and physicians, etc.,” the researchers reported.

Clinicians usually feel insecure in their patient communications because they were unsure of whether patients understand the discussion or are properly articulating health issues. The lack of trust between patient and provider has a negative impact on shared decision-making, an often empowering element of patient engagement strategies.

The research also showed that clinicians will often remove elements of relationship-building during the care encounter. In its place, clinicians will adopt a more paternalistic approach to patient care.

“They are more directive with immigrant patients and deliberately withhold information, based on the belief that immigrant patients will have limited understanding,” the team explained. “Physicians tend to give more direct advice rather than information and often make decisions for their immigrant patients.”

Second, the researchers found that immigrant patients also note language barriers. Understanding medical terminology outside of one’s native language presents a significant challenge to immigrant patients.

Patients also perceive trust issues due to cultural differences, the researchers found.

“They are hesitant to seek care from Western physicians due to the experience of stereotyping by physicians,” the team noted. “Moreover, lack of cultural awareness by physicians also affects communication with their culturally sensitive immigrant patients.”

Immigrant patients are also reportedly reluctant to engage using digital or connected health technology. In some cultures, a face-to-face encounter is the only appropriate strategy for seeking medical care. Immigrants largely do not like to engage via telehealth or secure messaging, the researchers found.

Lastly, the literature review revealed that third-party interpreters are also viewed with trepidation in the care encounter. Although an English language interpreter seems an intuitive solution to language barriers, providers have some concerns.

“Translation typically falls into one of three categories: simultaneous, line-by-line, or summarization, the latter being the least accurate but most commonly used method in healthcare,” the researchers explained.

“When using the summarization method, interpreters may intentionally or unintentionally add or subtract things; they may have attitudes and values that differ from physicians or patients; or they may have a different knowledge base or understanding of the context and may not understand the non-verbal cues of the speaker,” the team added.

Although this study did reveal the perceptions both patients and providers had about communication with immigrant patients, more work must be done to determine a path forward.

“Physicians should cognizant of potential communication barriers when caring for immigrant patients and take the necessary steps to address those barriers to help improve quality of care,” the researchers concluded. “Additional research is required to assist in determining effective solutions to address physician-immigrant patient communication challenges.”