background
The increase in international and internal migration in recent years has led to growing cultural and linguistic diversity worldwide. Germany, China and South Africa are among the 20 countries with the highest number of international migrants (1).
Migration can be associated with various stressors before and after arrival in the host country, including by cultural alienation, lack of support, socio-economic challenges, isolation, integration difficulties, discrimination and unemployment (2-5). This can affect migrants' physical and mental well-being (6). Research has shown that migrants, especially those who have been forced to leave their country, have a higher prevalence of mental disorders such as depression, anxiety and post-traumatic stress disorder compared to people without migration experience (6).
At the same time, migrants may face language and cultural barriers to accessing the (mental) health care system in the host country (5,7,8).
In a study conducted in the Netherlands, almost 40% of the hospital patients who took part and who belonged to an ethnic minority group reported that they had limited communication skills in the dominant language (9). In South Africa, where there are 12 official national languages, more than 80% of medical consultations take place despite language barriers; only 6% of medical interactions are fully or partially in the patient's native language (10,11). In Romania, 13% of migrants respondents reported limited access to health services due to language barriers (12). In China, there are asymmetries in terms of health, health care and access to health care for the different groups of migrants living there (13-16). About 37% of migrants who have been in Germany for 11 years or more report low German language skills, and 12% of migrant patients in outpatient oncological or psychiatric treatment do not speak enough German for regular consultation (17,18).
Language barriers affect not only access to care, but also assessment, diagnosis, treatment and overall quality of care (19-21). Confusion due to language discordance between patients and health care professionals about diagnosis and treatment can lead to reduced treatment adherence, worse outcomes and premature treatment discontinuation (22-24). Although the problem of language barriers for migrants in health care is well known, addressing and improving the situation remains largely neglected in research, education and practice. Many countries implicitly or explicitly expect migrants to learn the dominant language (25,26).
A number of informal practices have emerged in many health care contexts around the world, including the use of family members or staff as interpreters. Other practices include the use of gestures, facial expressions and increased volume, or ‘receptive multilingualism’. The use of such practices is understandable in the absence of alternatives. However, these approaches can lead to translation errors or the omission of sensitive information (27-31).
Although language barriers have been studied primarily in wealthier countries with migrants from poorer countries, they are equally important in low and middle-income countries, where functional interpreting services may be lacking, and receptive multilingualism is relied upon (29,31). Difficulties in communication can lead to patients being labelled and stereotyped by hospital staff, and the potential for successful communication in situations of linguistic discordance is often overlooked and needs systematic research (32).