Language barriers for primary care access in Europe: a systematic review

Abstract Background A recent increase in migration both inside Europe and from non-European countries has expanded the language profile of many European countries. As a result, there has been a significant increase in barriers to healthcare access experienced by linguistic minority migrants. This systematic review aims to explore language barriers in primary care, focusing on the experiences of linguistic minority migrants living in Europe. Methods PubMed, Embase, Scopus and Global Health were searched to identify studies published in English until May 2021. Qualitative and mixed methods studies on either linguistic minority migrants or healthcare workers working with linguistic minority migrants, exploring the impacts of language barriers in a primary care setting published were eligible. The studies were analysed using a Braun and Clarke's thematic analysis approach. Quality of the studies were assessed using the Mixed Methods Appraisal Tool. Results 16 studies from 14 different European countries were eligible. Participants in the studies included four groups: linguistic minority migrants (n = 11), healthcare workers (n = 10), interpreters (n = 1) and administrative staff (n = 1). Barriers identified included a lack of interpreters, limited cultural competence of practitioners, a lack of practitioner training and knowledge, a lack of accessible information for migrants, difficulties expressing emotions and building patient-practitioner relationships, and risks to women's bodily autonomy resulting from language barriers. Conclusions Linguistic minority migrants living in Europe face a number of barriers when accessing primary care. These barriers can risk patient safety, reduce the likelihood of seeking healthcare services, and impact patient experiences of healthcare services. There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff. Key messages • Linguistic minority migrants experience significant barriers to primary healthcare access across Europe. • There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff.


Background:
Health literacy (HL) is considered an important prerequisite for health. HL research often identifies migrants as vulnerable for low HL. However, in-depth data on HL among migrants and its determinants are still scarce, especially in Germany. Therefore, the analysis presents first time data on HL among migrants in Germany, specifically in the domains of health care, disease prevention and health promotion, considering migrant-specific and universal factors, such as social and psychological aspects. Methods: Around 1.000 first-and second-generation adult migrants from two of the largest migrant groups in Germany, from Turkey and former Soviet Union (FSU), were interviewed faceto-face in German, Turkish or Russian in late summer 2020. HL was measured using the HLS19-Q47 instrument. Bi-and multivariate statistical analyses were conducted. Results: More than half of the migrants have limited general HL on average. HL in disease prevention and health promotion was lower than in health care. Low social status, financial deprivation, low literacy skills and low self-efficacy were negatively correlated with each HL domain. Social integration, by contrast, goes along with a higher HL. Duration of stay in Germany and country of origin were only partly associated with HL.

Conclusions:
Our study goes beyond existing studies by analyzing HL in its domains and including the explanatory power of self-efficacy and social integration for migrants' HL. Moreover, we reveal that migrants can't generally be considered as vulnerable, as oftentimes outlined. There is need for targeted interventions, e.g. enhancing usability of health information, for the abovementioned subgroups regarding differences in domains.

Key messages:
HL among migrants varies across domains and is only partly linked to migrant-specific features but mainly associated with universal aspects. Measures to increase HL should consider differences in domains and address vulnerable subgroups including targeted interventions, respectively.

Background:
A recent increase in migration both inside Europe and from non-European countries has expanded the language profile of many European countries. As a result, there has been a significant increase in barriers to healthcare access experienced by linguistic minority migrants. This systematic review aims to explore language barriers in primary care, focusing on the experiences of linguistic minority migrants living in Europe.

Methods:
PubMed, Embase, Scopus and Global Health were searched to identify studies published in English until May 2021.
Qualitative and mixed methods studies on either linguistic minority migrants or healthcare workers working with linguistic minority migrants, exploring the impacts of language barriers in a primary care setting published were eligible. The studies were analysed using a Braun and Clarke's thematic analysis approach. Quality of the studies were assessed using the Mixed Methods Appraisal Tool. Results: 16 studies from 14 different European countries were eligible. Participants in the studies included four groups: linguistic minority migrants (n = 11), healthcare workers (n = 10), interpreters (n = 1) and administrative staff (n = 1). Barriers identified included a lack of interpreters, limited cultural competence of practitioners, a lack of practitioner training and knowledge, a lack of accessible information for migrants, difficulties expressing emotions and building patient-practitioner relationships, and risks to women's bodily autonomy resulting from language barriers.

Conclusions:
Linguistic minority migrants living in Europe face a number of barriers when accessing primary care. These barriers can risk patient safety, reduce the likelihood of seeking healthcare services, and impact patient experiences of healthcare services. There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff. Key messages: Linguistic minority migrants experience significant barriers to primary healthcare access across Europe.
There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff.

Background:
Public involvement in research is increasingly utilised, but has been problematised for lack of diversity. Involving representatives from seldom-heard groups, such as the migrant population, has the potential to transform health research for some of Europe's most disadvantaged groups.

Methods:
We have explored involvement of migrants in health research projects in Sweden, through a three-year longitudinal qualitative study with migrant contributors involved in a child mental health trial, and a series of behavioural observations of research meetings in several projects with migrant contributors.

Results:
The migrant contributors were initially hesitant to trust the researchers. However, through relationship-building and time, mutual trust was established. The contributors gained a social network in each other and the researchers, and their motivation for involvement changed over time, from focussing on individual benefits to societal change. They viewed their role as sharing their experiences, but saw researchers as in control of the final research decisions. Behavioural observations identified barriers to contributors' access to information in the meetings, such as academic terminology and difficulties in language interpretation. Enabling factors included balancing the presence of experts in the meeting as well as flexibility towards contributors' needs and initiatives. Additionally, transparency around the research process and providing feedback to the contributors functioned as enablers for involvement.

Conclusions:
This longitudinal qualitative inquiry paired with behavioural observations, revealed that when involving migrants as public contributors in research, time and resources should be focused on relationship building, to increase mutual trust and understanding, and careful planning undertaken to make the research process transparent and accessible for the contributors.

Key messages:
Involving migrants in research has great potential -but requires careful planning and consideration. Awareness of barriers and enablers can assist researchers in attaining meaningful involvement.

Background:
Chronic kidney disease (CKD) has increased progressively worldwide, however evidence on public awareness highlights gaps for a comprehensive public health strategy. This study aims to evaluate public knowledge and possible lack of awareness about CKD in Portugal.

Methods:
Cross-sectional study conducted through community based online survey (n = 1209). It was applied the CKD Knowledge Questionnaire and a score was calculated from 24 items categorized in 5 dimensions. Bivariate analyses was performed using one-way ANOVA and independent T-tests, at a 5% significance level, to compare the effect of independent variable and score.

Conclusions:
People living in Portugal revealed a middle knowledge level. Knowledge higher scores were observed in female, people with higher level of education, with experience imposed by health condition (e.g., risk factors or history disease), and access to health services. Future health education focused on 'Functions of kidneys perform in the body' might be an important contribution to increase health literacy about CKD. Key messages: Social vulnerabilities may be associated with lower levels of public knowledge of Chronic Kidney Disease. The evaluation of population's knowledge about CKD is an important instrument for public health policy-making.