The hospital experience of elderly patients with limited English proficiency.

PurposeOver half a million Australians (561,413) speak limited English, with 29 per cent of those being aged over 65 years (ABS 2006). Little research has been conducted into the acute hospital experience of elderly patients with limited English proficiency.This thesis examines, in an acute hospital setting, the subjective experience of a consecutive convenience sample of 258 elderly acute or emergency patients from nine language groups, who prefer to speak a language other than English.MethodTrained bilingual staff investigated communication methods used by hospital staff with participants in a multilingual telephone survey (MTS). Information for validation was obtained from a medical records audit (MRA). Hospital statistical information was linked with MTS and MRA data. The agreement between the MTS and the MRA was analysed using descriptive and inferential statistics. A score, the 'Communication Complexity Score' (CCS), was developed to reflect patient clinical complexity, and the association between this score and interpreter usage was assessed. Seven language-specific focus groups were conducted to identify factors associated with a positive, a negative, or a very negative experience. Constructivist grounded theory was used to analyse the discourse in the focus groups.ResultsThirty-one per cent of patients reported using professional interpreters. Concordance was present between the MTS and MRA. A positive association was found between clinical complexity and interpreter usage. The CCS had good psychometric properties. Many patients reported positive experiences; however, a theme of powerlessness was identified. Language barriers, poor patient and family involvement, staff shortages or incompetence, and inattention to cultural mores were all factors associated with negative experiences. Some patients discounted their negative experiences and were reluctant to assert their healthcare rights. An explanatory construct for this phenomenon, the 'Happy Migrant Effect,' was developed. Contributing factors for this effect include: powerlessness; positive assessment of Australian healthcare compared with the patient's country of origin; patriotism; cultural norms proscribing acceptance; politeness; desire for social acceptability; self-denigration for not learning English; and fear of reprisals following complaint.ConclusionThis research has important implications for healthcare policy and service delivery associated with the quality of care and safety of patients with limited English