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This study systematically investigates how language barriers influence trust formation in multinational teams (MNTs). On the basis of 90 interviews with team members, team leaders and senior managers in 15 MNTs in 3 German automotive corporations, the authors show how MNT members' cognitive and emotional reactions to language barriers influence their perceived trustworthiness and intention to trust, which in turn affect trust formation. The authors contribute to diversity research by distinguishing the exclusively negative language effects from the more ambivalent effects of other diversity dimensions. Their findings also illustrate how surface-level language diversity may create perceptions of deep-level diversity. Furthermore, their study advances MNT research by revealing the specific influences of language barriers on team trust, an important mediator between team inputs and performance outcomes. It thereby encourages the examination of other team processes through a language lens. Finally, their study suggests that multilingual settings necessitate a reexamination and modification of the seminal trust theories by Mayer, Davis and Schoorman, and by McAllister. In terms of practical implications, the authors outline how MNT leaders can manage their subordinates' problematic reactions to language barriers, and how MNT members can enhance their perceived trustworthiness in multilingual settings.

Background Ethiopia is a multilingual and multinational federation with Addis Ababa serving as both the capital city of Oromia regional state and the seat of the Ethiopian federal government. Nevertheless, only Amharic is considered as the working language of the city and federal offices, including hospitals. As a result, Afaan Oromoo-speaking patients may be facing language barriers in the healthcare settings in Addis Ababa. Language barriers have the capacity to affect patients’ experience of care and treatment outcomes. This study, hence, examined the impacts of language barriers on the healthcare access and quality for the Afaan Oromoo-speaking patients in public hospitals in Addis Ababa. Methods In-depth interviews with patients ( N  = 27) and key informant interviews with healthcare providers ( N  = 9) were conducted in six public hospitals found in Addis Ababa. All the interviews were audio-taped and transcribed verbatim. A thematic analysis technique was employed to address the study objectives. Results The study participants indicated the widely existing problem of language discordance between patients and healthcare providers. The impacts of language barriers on the patients include preventable medical errors, low treatment adherence, low health-seeking behavior, additional treatment cost, increased length of hospital stays, weak therapeutic relation, social desirability bias, less confidence, and dissatisfaction with the healthcare. For the healthcare providers, language barriers are affecting their ability to take patient history, perform diagnoses and provide treatment, and have also increased their work burden. The use of ad hoc interpreters sourced from bilingual/multilingual patients, patient attendants, volunteer healthcare providers, and other casual people has been reported to deal with the problem of language barriers. Conclusion A significant number of Afaan Oromoo-speaking patients are facing language barriers in accessing quality healthcare in public hospitals in Addis Ababa, and this constitutes structural violence. As a way out, making Afaan Oromoo an additional working language of the public hospitals in Addis Ababa, the assignment of professional interpreters, and a hiring system that promotes the recruitment of qualified multi-lingual healthcare providers are suggested.

This study used a video prompting intervention to overcome language barriers between English-speaking trainers and Spanish-speaking immigrant parents of children with autism. Parents were taught instructional skills targeting independent dressing. A multiple baseline design across three families and a replication using an alternating treatments design with a fourth family were used to evaluate the effects of the intervention. All mothers reached mastery criterion and generalization of instructional skills was observed for three mothers, with treatment gains maintaining during follow-up. Improvement in independent dressing skills was observed for four children. Findings suggest that video prompting can be used to teach immigrant parents of children with autism who have limited English proficiency when there is a language mismatch between parents and trainers.

Background With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study. Methods Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use. Results More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by “using gestures” (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified. Conclusion Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.

BackgroundUnderstanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients.MethodsThrough retrospective review, primary kidney transplant recipients, 0–21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan–Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression.ResultsOur sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant.ConclusionsPediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters.

Background China has 129 dialects with Mandarin as the standard and Chaoshan as the major dialect of the Chaoshan region in Guangdong. This study aimed to describe the dialect competence and usage, communication difficulty, impact of linguistic barriers, and subjective experience in healthcare. Methods Healthcare providers ( n  = 234) and healthcare consumers ( n  = 483) at two tertiary teaching hospitals in Shantou, Chaoshan region participated in an anonymous survey. Results Chaoshan and Mandarin were spoken respectively by ca. 80% and 6.1% of the participants. Monolinguals accounted for 28.5%, including 16.8% of Chaoshan-speaking healthcare providers and 18% of Mandarin-speaking healthcare consumers. The monolinguals preferentially used their competent dialect ( Ps  < 0.001) and had significant communication difficulties ( Ps  < 0.0001), with the mean (SD) score of 3.06 (0.96) out of 4 with Mandarin for healthcare providers and 2.18 (1.78) and 1.64 (1.40) with Mandarin and Chaoshan, respectively, for healthcare consumers. The monolingual healthcare providers perceived significant negative impacts of linguistic barriers on the entire healthcare delivery process ( Ps  < 0.0001). Regression analyses showed the length of stay in the Chaoshan region as a protective factor of linguistic barrier with a limited protective effect. Conclusions This is the first report of significant linguistic barriers in healthcare imposed by Mandarin and Chaoshan dialects in Chaoshan, China. With perceived adverse impacts on the entire healthcare delivery and risks to the healthcare quality and burden, interventions such as professional interpreter service, service-learning interpreter program, or mobile interpreting apps that are medically accurate and culturally sensitive are suggested for dialectally diverse China.

Background In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers. Methods We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS). Results Data from 1,430 pediatric rescue missions were analyzed with 3.1% ( n  = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results. Conclusion Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies. Trial registration This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.

Background As the number of Asian and African students studying medicine in China increases, it is imperative to evaluate the educational experiences of these international medical students (IMSs). This study was intended to investigate opinions of China-educated IMSs towards the medical curriculum and the impact of Chinese language capability on their clinical studies. Methods A self-administered questionnaire was circulated to the final-year IMSs during the graduation time from May 2019 to July 2019 in 4 universities in China. The questionnaire asked IMSs to assess the quality of medical education and provide a self-evaluation of their Chinese language capability. One-way Analysis of Variance (ANOVA) was used to determine whether IMSs’ Chinese language capability was associated with their clinical experiences and clinical competence. Results Overall, we received 209 valid responses, of which 76.1% were satisfied with the quality of medical education. Genetics, physics, and mathematics were perceived as the least relevant basic courses for medical practice, and 21.5% of student reported that community-oriented medicine was a neglected subject. Notably, 58.9% of students had positive views about discussions on ethical topics during their clerkships, and 71.3% believed they had acquired sufficient clinical skills to begin a residency program. Chinese speaking skills and communication initiatives were found to be critical factors in influencing students’ clinical experiences and competence. Conclusion This study presents the perceptions of China-educated IMSs towards medical curriculum from various aspects. Results show that language influences the education experiences of IMSs. Collectively, these results indicate that the curriculum for IMSs in China should be more problem-based and community-engaged to improve IMSs’ learning experiences and preparation for community deployment. Furthermore, training curriculum for the oral Chinese should be improved to equip IMSs with sufficient language competence to enable them to efficiently carry out clinical clerkship and rotations. Our findings provide evidence for benchmarking medical curricular codifications tailored for Asian and African students.

Background It is essential for medical treatment that patients and medical staff can communicate about acute complaints, pre-existing conditions, and the treatment procedure. Misunderstandings can have far-reaching consequences, particularly in time-critical emergencies, which require rapid assessments and decision-making and in which interpreters are rarely available. In this study, we aim to develop a digital communication tool that is to help paramedics communicate with patients who speak hardly any or no German, to monitor its implementation, and to investigate its effect on communication between foreign-language patients and staff. Furthermore, a large amount of data on patients that are cared for in emergency medical services in Germany are collected for the first time. Methods To consider the complex situations of paramedic care and to meet paramedics’ demands, we use an action-oriented research approach to develop the tool. We include the staff of the participating emergency medical service stations and software designers in our approach. The tool is then used and evaluated within an open interventional, non-randomised study with two control groups. Control group 1 (German-speaking patients) and control group 2 (non-German-speaking patients treated without the tool) are recruited starting from the first study phase. In the second study phase, an intervention group is additionally recruited, i.e. non-German-speaking patients with whom the tool is used. The primary outcome of the clinical trial is improved communication with non-German-speaking patients in emergencies by means of the communication tool. The secondary outcome is an improved quality and quantity of the collected information. We exploratively observe on-scene times, demands for emergency physicians, and the usage of the intervention. By recording patients’ clinical parameters, we consider the severity of the health restrictions. Discussion Our study is an innovative research project in paramedic healthcare comprising the development of a digital communication tool to overcome language barriers in emergency medical services and investigating its usability, acceptance, and effect on communication, in short, its usefulness and value for paramedic care. Additonally, we expect to gain comprehensive information on rescue operations. Trial registration German Clinical Trials Register, DRKS00016719 , registered 08 February 2019, World Health Organization Trial Registration Data Set, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00016719