Abstract
<b>Introduction</b>
Addressing language barriers in accessing health care may improve equitable access in line with current United Nations Sustainable Development Goals.1 English proficiency is associated with socioeconomic position, social segregation, and employment,2 and the intersectionality of ethnicity, immigration status, and lack of language proficiency results in cumulative disadvantage.3 Guidance for commissioners in the UK states that language and communication requirements should not prevent patients from receiving equitable care.4 Limited evidence is available on interpreting service uptake and patient experience that is crucial to ensure services reduce ethnic and socioeconomic health inequalities.5 We aimed to address this evidence gap.
<b>Methods</b>
This national, cross-sectional community-based pilot survey conducted from December 1, 2020, to January 5, 2021, adhered to the STROBE reporting guideline. Ethical approval was obtained from the University of Surrey. Survey interviews were conducted by telephone by multilingual researchers, and participants provided verbal informed consent. Eligibility criteria included self-reported limited or no English language proficiency, age older than 18 years, and self-reported Pakistani, Indian, or Bangladeshi ethnicity. Convenience and snowball sampling were undertaken to identify eligible participants across the UK, including London, Birmingham, Leicester, Manchester/Oldham, and Bradford. Measures included type(s) of interpreting service used and perceived barriers to their uptake. We evaluated differences between people who had and had not used interpreting services with χ2 and Fisher exact tests. Two-sided P < .05 indicated statistical significance. Analyses were performed using SPSS, version 28.0.1.0 (IBM Corporation).
<b>Results</b>
Of 105 people in the sample, 35 (33.3%) each reported Indian, Bangladeshi, or Pakistani ethnicity, with ages ranging from 18 to 79 years. Fifty-four participants (51.4%) were women and 51 (48.6%) were men; 83 (79.0%) were married or cohabiting; and 17 (16.2%) had no formal education. Sixty-three participants (60.0%) reported using at least 1 type of formal interpreting service, including face-to-face (57 [54.3%]), telephone (18 [17.1%]), and video-mediated (5 [4.8%]). Forty-seven participants (44.8%) reported family or friends interpreting for them during consultations; of these, only 18 (38.3%) reported formal interpreting service uptake. Thirty-four participants (32.4%) reported having a physician or nurse who speaks their language; of these, 11 (32.4%) used a formal interpreting service. Thirty-seven participants (35.2%) reported being offered a choice of language support by primary care clinicians. Compared with participants who had never used formal interpreting services, those who had were more likely to have no formal education (16 of 63 [25.4%] vs 1 of 42 [2.4%]), report lower confidence in managing conditions (24 of 63 [38.1%] vs 7 of 42 [16.7%]), perceive a need for language support (51 of 63 [81.0%] vs 16 of 42 [38.1%]), and have been told about language support by primary care clinicians (35 of 63 [55.6%] vs 12 of 42 [28.6%]) (Table). The Figure summarizes interpreting service barriers.
<b>Discussion</b>
This cross-sectional survey study found that most respondents reported using at least 1 type of formal interpreting service, with face-to-face interpreting being most common, followed by telephone interpreting. Video-mediated interpreting use was rare. However, nearly half of the respondents relied on family or friends. Raising awareness of professional interpreting services, patient education, and addressing perceived barriers to accessing formal language support services have the potential to improve access among groups who lack English proficiency.
Our study has some limitations. Data were collected during the COVID-19 pandemic, which may have affected responses, although we did not restrict responses to this timescale, and some likely related to prepandemic experiences. Although we found important indications about the likely influences on interpreting service uptake, larger-scale studies are required to account for the selection bias associated with snowball sampling.6
Use of formal interpreters is known to close gaps in quality of clinical care for patients with limited English proficiency. Our survey, which was developed to understand why uptake and experiences may vary, can be used at scale to obtain this vital information to improve equitable health service access.