title: Language support for linguistic minority chronic hepatitis B/C patients: an exploratory study of availability and clinicians' perceptions of language barriers in six European countries.
abstract: Language support for linguistic minorities can improve patient safety, clinical outcomes and the quality of health care. Most chronic hepatitis B/C infections in Europe are detected among people born in endemic countries mostly in Africa, Asia and Central/Eastern Europe, groups that may experience language barriers when accessing health care services in their host countries. We investigated availability of interpreters and translated materials for linguistic minority hepatitis B/C patients. We also investigated clinicians' agreement that language barriers are explanations of three scenarios: the low screening uptake of hepatitis B/C screening, the lack of screening in primary care, and why cases do not reach specialist care.
  
  
  
  An online survey was developed, translated and sent to experts in five health care services involved in screening or treating viral hepatitis in six European countries: Germany, Hungary, Italy, the Netherlands, Spain and the United Kingdom (UK). The five areas of health care were: general practice/family medicine, antenatal care, health care for asylum seekers, sexual health and specialist secondary care. We measured availability using a three-point ordinal scale ('very common', 'variable or not routine' and 'rarely or never'). We measured agreement using a five-point Likert scale.
  
  
  
  We received 238 responses (23% response rate, N = 1026) from representatives in each health care field in each country. Interpreters are common in the UK, the Netherlands and Spain but variable or rare in Germany, Hungary and Italy. Translated materials are rarely/never available in Hungary, Italy and Spain but commonly or variably available in the Netherlands, Germany and the UK. Differing levels of agreement that language barriers explain the three scenarios are seen across the countries. Professionals in countries with most infrequent availability (Hungary and Italy) disagree strongest that language barriers are explanations.
  
  
  
  Our findings show pronounced differences between countries in availability of interpreters, differences that mirror socio-cultural value systems of 'difference-sensitive' and 'difference-blindness'. Improved language support is needed given the complex natural history of hepatitis B/C, the recognised barriers to screening and care, and the large undiagnosed burden among (potentially) linguistic minority migrant groups.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. am.falla@rotterdam.nl.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. am.falla@rotterdam.nl.
authors.forename: Abby M
authors.initials: AM
authors.lastname: Falla
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Irene K
authors.initials: IK
authors.lastname: Veldhuijzen
authors.affiliation: Department of Health Sciences, Faculty Life Sciences / Public Health Research, Hamburg University of Applied Sciences, Hamburg, Germany.
authors.forename: Amena A
authors.initials: AA
authors.lastname: Ahmad
authors.affiliation: Department of Health Sciences, Division of Hygiene, Preventive Medicine and Public Health, University of Florence, Florence, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Levi
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005060:Europe / Q000453:epidemiology; D005192:Family Health; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D019694:Hepatitis B, Chronic / Q000208:ethnology*; D019698:Hepatitis C, Chronic / Q000208:ethnology*; D006801:Humans; D007802:Language; D008037:Linguistics; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008913:Minority Groups / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012036:Refugees / Q000523:psychology; D060728:Reproductive Health; D063127:Secondary Health Care / Q000706:statistics & numerical data; D012944:Social Support; D011795:Surveys and Questionnaires; D014175:Translating
keywords: Chronic viral hepatitis; Hepatitis B; Hepatitis C; Language barriers; Linguistic minorities; Migrants; Translating