Researchers from the UAB have carried out a report that highlights the main communication problems between healthcare personnel and patients who are not fluent in any of the official languages: Catalan, Aranese, or Spanish. The study points out that here is a lack of resources and protocols to manage these situations and therefore professional and stable coordinated policies are needed that can guarantee interpreting and mediation services across the country to prevent creating inequalities.
Language barriers are a recurring reality in clinical practice in public healthcare centres across Catalonia. They negatively affect the relationship between healthcare personnel and patients who are not fluent in any of the official languages: Catalan, Aranese, or Spanish. There is a lack of resources and protocols to manage these situations and therefore professional and stable coordinated policies are needed that can guarantee interpreting and mediation services across the country to prevent creating inequalities.
This is the conclusion reached in a report published by researchers of the Universitat Autònoma de Barcelona (UAB) working on the project "CIMAS: Comunicació Intercultural Mediada a l'Àmbit Sanitari". The results of the project were presented in a conference held at the UAB Teaching Unit of the Vall d'Hebron Hospital.
The study was conducted by researchers from the group Mediació i Interpretació: Recerca en l'Àmbit Social (MIRAS) of the Department of Translation and Interpreting and East Asian Studies. Also participating were researchers and healthcare professionals from Rovira i Virgili University, the Vall d'Hebron Hospital, and the Mútua de Terrassa Hospital.
"In Catalonia, where according to IDESCAR data 16.3% of the population has a migrant background, the efforts in these past three decades on behalf of healthcare services and the administration have not been enough to reduce these communication barriers. The report we present offers an overall perspective on the current situation, which until now has been studied in a very fragmented way," explain Anna Gil-Bardají and Gema Rubio, coordinators of the report.
1,400 healthcare professionals surveyed
The report includes a pilot study, in which 1,390 healthcare professionals and some forty professional language mediators were surveyed, as well as a qualitative analysis of the attitudes and perceptions of all groups involved: healthcare professionals and community health agents, patients, professional interpreters, and accompanying adults and minors.
The results of the survey reveal that language difficulties have a large impact for 85% of healthcare workers, and interfere a lot or quite a lot in their professional practices; while 29% experience communication difficulties at least once a week and 9% experience them daily.
Interpreters and intercultural mediation services are clearly insufficient in covering real needs, and this often forces professionals to turn to informal solutions, such as communicating through relatives or friends of the patient, even when they are minors. Apart from this option, machine translation is the second most-used resource among healthcare professionals, while very few (1.5%) make use of the phone interpreting services offered at the public health helpline, 061.
Communication problems entail a high emotional load for all those involved, with consequences that affect the quality and equity of patient care, misunderstandings, informed consent, adherence to treatment, and information confidentiality.
Risks and limitations of machine translations
The report shows that machine translation technologies are already part of everyday healthcare practices, and warns of the limitations and risks they represent, as they can generate a false sense of understanding and make important communication problems invisible.
According to the research team, the problem is not just whether the translation is linguistically correct, but the tendency to assume that communication has already occurred simply because a machine translation has been used. Furthermore, these tools may work relatively well in the most common languages but have many more limitations in less represented languages, or in those with great dialectal diversity. Moreover, the use of these tools can increase the workload of healthcare personnel and affect the efficiency of the system, since consultations require more time, more reformulations, and more effort to verify understanding.
Job insecurity and regional gaps
The report points to an absence in planning and coordinated public policies, which leads to significant gaps in different regions (Barcelona and the Metropolitan Area versus other places in the provinces of Lleida and Tarragona); externalisation, and job insecurity for professional interpreters. All of which cause an erosion in the quality of the service and a limited use of mediation, subordinated to epidemiological control logics that have distanced patients from the right to healthcare.
"We hope that the study will serve to advance towards stable public policies across Catalonia that can better train, fund and deploy language and cultural mediation throughout the Catalan healthcare system", the authors of the report conclude.
The research team used the results obtained to create a list of clinical practice recommendations and design specialised training courses for healthcare professionals.
The project "CIMAS: Comunicació Intercultural Mediada a l'Àmbit Sanitari" was funded by the Spanish Ministry for Science, Innovation and Universities (Reference number: PID2022-137113OB-I00) and was conducted from 2023 to 2026.
Link to the report: https://webs.uab.cat/cimas/
