Effective Communication for People with Refugee Experience

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Original Editor - Donald John Auson & Jordan Awale as part of the PREP Content Development Project

Top Contributors - Naomi O'Reilly  

Introduction

Communication is the process of exchanging information, ideas and thoughts between two or more individuals which can include verbal and non-verbal forms. Effective communication is important for it can be the ground for building good interpersonal relationship. In the healthcare setting, effective communication can create a more effective therapeutic setting leading to improved outcomes and attainment of goals. [1]

Communicating with Refugees

A refugee is someone who has been forced to flee their country and crossed an international border to find safety in another country as a result of persecution, war or violence.However, establishing communication is often a challenge. They may be speaking a different language or a different dialect. Cultural differences are another factor to consider when communicating with refugees.

A study published by the BBC Media Action in July 2016 presented the needs of refugees when it comes to communication and access to information as well as the challenges humanitarian agencies face when it comes to providing the needs of refugees.[2] The study also showed that communication needs are not only for the information, refugees need: to be listened to, to be able to tell their stories, to participate in dialogue that provides them with physical, social and psychosocial support and, trauma counselling.[2]

Strategies have been implemented to address communication barriers. A review identified four strategies used in the healthcare setting to address communication barriers. [3] These are: cultural mediation, interpretation, translation of health information, and guidance and training for health care providers. [3]

Building Trust

Trust is a key factor when it comes to communicating with refugees. It can be a catalyst or a barrier in establishing communication with refugees. Trust is defined by the Merriam-Webster Dictionary as “assured reliance on the character, ability, strength, or truth of someone or something”. [4] Having trust on healthcare workers involves reliance on the capabilities and competence of the staff, even with the existence of uncertainties and without assurance.

Factors Affecting Trust

  • Communication Skills
  • Knowledge

Ways to Build Trust

  • Improve Communication Skills; Verbal and Non-Verbal
  • Increase Knowledge

Creating Therapeutic Space and Alliance

Creating therapeutic space involving refugees involves some challenges due to communication barriers, cultural differences and other factors. However, these challenges can be overcome. This involves clear communication between the healthcare service provider and the patient through the aid of interpreters or translators. Participation of the patient in creating goals has been known to lead to better outcomes.

There are different strategies that can be implemented in order to decrease the challenges when communicating with refugees. Some of these strategies are: cultural mediation, interpretation, translation and cultural adaptation of health information and materials, and guidance and training for health staff. [3] Other strategies that can be implemented are: a migrant-friendly hospital initiative, employment of bilingual staff, two culturally adapted treatment programmes that did not use cultural mediators, and establishment of a database of language needs. [3]

Interpreters and Translators

An Interpreter is a skilled and trained person that converts oral information into another language, while a translator is a skilled and trained person that converts written information into another language. [5] Their role is to make clear communication between the health care provider and the refugee who are both speaking different languages. Their goal is to convert oral or written information as “meaning for meaning” and not as “word for word”.[5] This implies that interpretation and translation must be done with some context of the message being conveyed as well as the emotions and expressions it was delivered with. You can read further details about the Use of an Interpreter and Translator for People with Refugee Experience.

Key Points for Communicating with Interpreters

  • Shorten the sequence of your sentences. Do not give long sentences with many words
  • Adjust the kind of language that you normally use – e.g. less medical or formal words, instead use Lehman’s terms
  • Make sure that information is not lost in translation. It is easier if you stick to saying short, concise sentences
  • Interpreters should not have to feel the need to filter what they are translating. No matter how crude, harsh, or offensive, the interpreters should still translate exactly what was said from the patient – the purpose of this is to enable medical professionals to gain a full understanding of how the patient is feeling.
  • It is the medical professional’s job to work out what is going on if the conversation is going off topic, they should make sure they are in control. So following on from the point above, the professional should encourage the interpreter to translate EXACTLY what the patient has said at all times, but ensure only the important necessary details are told
  • As you try to be in control, it is CRUCIAL to make sure that the interpreters you work with have breaks and adequate rests. Breaks are VERY important for interpreters and mental fatigue can massively affect the quality of translation. Also please consider the potential psychological effects of either past experiences or interpreting the trauma of patients, it is so important to make sure that they do not burn out! [6]

Facilitating Optimal Communication

AAAQ Framework

The AAAQ Framework is a standard set of guidelines generic to international communities for the provision of rights such as healthcare services. AAAQ Stands for Availability, Accessibility, Acceptability and, Quality.

Availability

The presence of healthcare services.

Accessibility

Ease of access to healthcare services and has 4 Sub-Criteria:

    1. Physical Accessibility
    2. Economic Accessibility
    3. Non-Discrimination
    4. Information Accessibility

Acceptability

The quality and state of healthcare services being acceptable and is subjective to a person.

    1. Consumer Acceptability
    2. Cultural Acceptability

Quality

The objective assessment of healthcare services based on international standards and grounded on scientific evidence.

Resources

References

  1. Roohangiz Norouzinia. Maryam Aghabarari. Maryam Shiri. Mehrdad Karimi. Elham Samami.Communication Barriers Perceived by Nurses and Patients. Global Journal of Health Science [Internet]. 2015 Sep [cited 2020 Jun 16]. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954910/doi: 10.5539/gjhs.v8n6p65
  2. 2.0 2.1 Theodora Hannides. Nicola Bailey. Dwan Kaoukji. Voices of Refugees Information and Communication Needs of Refugees in Greece and Germany. Research Report. BBC Action Media. [Internet] 2016 Jul [cited 2020 Jul 26]. Available at https://reliefweb.int/sites/reliefweb.int/files/resources/voices-of-refugees-research-report.pdf
  3. 3.0 3.1 3.2 McGarry O, Hannigan A, De Almeida MM, et al. What strategies to address communication barriers for refugees and migrants in health care settings have been implemented and evaluated across the WHO European Region? Themed Issues on Migration and Health, IX [Internet]. [cited 2020 Jun 27]. Available at https://www.ncbi.nlm.nih.gov/books/NBK534367/
  4. Merriam-Webster Dictionary [cited 2020 Jun 23]
  5. 5.0 5.1 https://refugeehealthta.org/access-to-care/language-access/interpreters-vs-translators/
  6. Medical Volunteers International (2019) Inservice Training by German Sign Language interpreter, Lesvos Greece.