Access to cardiac rehabilitation and the role of language barriers in the provision of cardiac rehabilitation to migrants

Abstract

Background Cardiac rehabilitation (CR) has proven health benefits and, according to international guidelines, CR must be offered to all eligible patients. Studies have reported lower uptake of CR among migrants, and migrants are known to face several barriers in their access to healthcare, of which language is the most common. The aim of this study is to examine the provision of CR core components for migrants; and the role of language barriers in the provision of CR in Danish hospitals and municipalities. Methods This is a descriptive study based on repeated nationwide surveys conducted in 2013 and 2015 by the Danish Cardiac Rehabilitation Database. The surveys collected information on provision and organization of CR in hospitals ( n = 35) and municipalities ( n = 98) in Denmark. The survey in 2015 had additional items related to migrants, such as provision of interpreter services and multilingual information material. Results Not all CR core components were provided by hospitals to non-Danish speaking patients. There was no improvement from 2013 to 2015. Hospitals had full coverage (19/19) of interpreter services compared to 84% (26/31) of municipalities. Provision of multilingual information material was low in hospitals 32% (6/19) and in municipalities 3% (1/31). Conclusion This study found language-related barriers in migrants’ access to CR, in the form of inadequate provision of CR core components for non-Danish speaking patients at some Danish hospitals and suboptimal provision of interpreter services in municipalities. The findings call for increased attention to language barriers and further studies are needed to map the extent of the problem. Electronic supplementary material The online version of this article (10.1186/s12913-019-4041-1) contains supplementary material, which is available to authorized users.

Are survivors of cardiac arrest provided with standard cardiac rehabilitation? – Results from a national survey of hospitals and municipalities in Denmark

“…Previous studies found that organisational factors (e.g. health care region, population size of the catchment area, and classification according to geography) influenced the provision of cardiac rehabilitation 9,20,21 .We only found a few statistically significant differences in the organisational factors. This is likely explained by the small sample size, in particular for hospitals.…”

“…Our hypothesis was that cardiac rehabilitation is not systematically provided to Danish survivors of cardiac arrest. Based on earlier findings 9,20,21 , we further hypothesised that organisational factors would influence the provision of cardiac rehabilitation to this population..…”

Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers

“…Analysis of a large US based registry showed that compared with white patients, minorities, particularly Black, Hispanics and Asian patients, were 20%, 36% and 50% less likely to receive CR referral after an MI [40]. Barriers in communication are a likely contributor to this discrepancy [50,51]. The inability to speak English as a native language can lead patients to feel marginalized, excluded, and anxious -resulting in lower enrollment and higher drop-out rates among minorities.…”

Use of reperfusion therapy and time delay in patients with ischaemic stroke by immigration status: A register‐based cohort study in Denmark

“…Although adjustments were made for a wide range of clinical and sociodemographic factors, other unmeasured confounders such as a physician's implicit bias about immigrants, knowledge of stroke symptoms, language barriers, cultural norms, body mass index and alcohol use may explain the lower chances of reperfusion therapy seen in immigrants. For example, language barriers in non‐Danish speaking patients have indeed been found to hinder provision of care at some Danish hospitals [24]. Despite not observing a difference in clinical outcome between immigrants and Danish‐born residents in patients eligible for reperfusion therapy, a study in the USA has previously reported that every 15‐min increase in door‐to‐needle times was significantly associated with poor stroke outcome [28].…”