Conceptualizing the Pathways and Processes Between Language Barriers and Health Disparities: Review, Synthesis, and Extension

Abstract

While many may view language barriers in healthcare settings (LBHS) as a simple, practical problem, they present unique challenges to theoretical development and practice implications in healthcare delivery, especially when one considers the implications and impacts of specific contextual factors. By exploring the differences of contextual factors in the US and Japan, this review explores and highlights how such differences may entail different impacts on patients' quality of care and require different solutions. I conduct narrative review through library database, Google Scholar, and CiNii (a Japanese library database) with multiple search terms, including language barriers, healthcare, medical interpreter, and immigrant. I first present a diagram to show the pathways and process between language barriers and health disparities, using the literature reported in the US. Then, I examined the literature reported in Japan and discuss the needs for re-conceptualizing LBHS. The implications for future research will be discussed.

Health behaviors of foreign mothers in Japan regarding their young children and the factors that affect these behaviors: A qualitative study

“…Finally, “Japanese language ability” did not appear to affect HBs greatly. This result contrasts with similar research that showed that the language barrier was the main difficulty for foreign residents when accessing health care (City of Yokohama, ; Terui, ; Uayan et al , ). The difference between this study's results and those of former research might be because this study's participants had lived in Japan for a longer period and because many of them had Japanese husbands.…”

Language-Related Disparities in Pain Management in the Post-Anesthesia Care Unit for Children Undergoing Laparoscopic Appendectomy

“…The reasons behind language-related differences in care—including the likelihood not to use objective measures of pain—are likely multifactorial and related both to interpersonal and systemic factors. Interpersonal factors may include conscious or subconscious bias against those who do not speak English (i.e., seeing LEP patients as outsiders, with their pain as less relatable) [ 6 ]; patients’ or clinicians’ differing cultural expectations or beliefs related to the experience of pain [ 33 ], with language serving as a proxy for those cultural beliefs; lower levels of health literacy and knowledge on the part of LEP parents to advocate for their child [ 6 ]; the perceived additional time and effort it would take to objectively assess a child’s pain and pacify them when a language barrier exists. On the last point, a clinician may perceive it to be easier or less time-consuming to treat a non-English-speaking child with medication rather than nonpharmacologic methods.…”

“…In the United States, race and language are intricately connected, with scholars describing the practice of linguicism (i.e., discrimination based on primary spoken (non-English) language) and expressing that “language is a social practice that shapes subjectivity and establishes power relations among members of different racial and class groups” [ 5 ]. English language proficiency, which may be correlated with race/ethnicity [ 6 , 7 ], is however less frequently considered in the study of health disparities among children. Language barriers have been described as increasing risk of adverse events for adult patients throughout the hospital encounter [ 8 ].…”

Barriers to the use of trained interpreters in consultations with refugees in four resettlement countries: a qualitative analysis using normalisation process theory

“…Informal responses to these challenges, such as the ad hoc use of family members and friends as interpreters, are common [8]. While pragmatic, this may lead directly and indirectly to inequitable health outcomes [9,10]. The gold standard recommended in the literature is to use trained interpreters who provide culturally aware, comprehensive and safe communication [11,12].…”