Background
Methods
Study design/site
Survey instrument
Linguistic assessment
Survey administration
Data analysis
Results
Participant characteristics (Table 1)
Characteristics | Healthcare Providersan = 234 | Healthcare Consumersbn = 483 |
---|---|---|
Continuous variables: median (IQR) | ||
Age (year) | 31 (26–35) | 36 (29–50) |
Work experience (month) | ||
Current Department | 41 (14–90) | NA |
Current Hospital | 72 (27–120) | NA |
Healthcare | 88 (36–136) | NA |
Living time in Chaoshan region (month) | 334 (276–396) | 360 (264–549) |
Categorical variables: n (%) | ||
Sex | ||
Male | 60 (25.6) | 249 (51.6) |
Female | 174 (74.4) | 234 (48.4) |
Birthplace | ||
Chaoshan region | 196 (83.8) | 387 (80.1) |
Non-Chaoshan region | 38 (16.2) | 96 (19.9) |
Mother tongue (Native or first language) | ||
Mandarin | 21 (9.0) | 23 (4.8) |
Chaoshan | 192 (82.0) | 386 (79.9) |
Othersc | 21 (9.0) | 74 (15.3) |
Competent dialect | ||
Mandarin | 36 (15.4) | 87 (18.0) |
Chaoshan | 0 (0) | 81 (16.8) |
Bilinguald | 198 (84.6) | 315 (65.2) |
Education | ||
Primary school or lower | NA | 101 (20.9) |
Middle school | NA | 243 (50.3) |
High school | NA | 72 (14.9) |
College or higher | NA | 67 (13.9) |
Job Position | ||
Chief Physician/Nurse | 1 (0.4) | NA |
Assoc. Chief Physician/Nurse | 9 (3.8) | NA |
Assist. Physician/Nurse-in-charge | 70 (29.9) | NA |
Resident/Nurse | 139 (59.4) | NA |
Intern | 15 (6.4) | NA |
Dialect competence and usage in clinical encounters (Table 1 and Fig. 2)
Impact of dialect barriers in healthcare communication, delivery, and consumption (Fig. 4)
The dynamics of dialect barrier over time with healthcare providers (Fig. 5 and Table 2)
Communicating in Mandarin | Communicating in Chaoshan | |||||
---|---|---|---|---|---|---|
Beta | 95%CI | P | Beta | 95%CI | P | |
For Mandarin-speaking healthcare providers | ||||||
Time living in Chaoshan region (mo)a | - 0.002 | - 0.012 ~ 0.009 | 0.745 | - 0.013 | - 0.20 ~ - 0.006 | < 0.0001 |
Being male | 0.029 | - 0.910 ~ 0.968 | 0.950 | 0.337 | - 0.267 ~ 0.940 | 0.264 |
Older age (year)a | 0.072 | - 0.060 ~ 0.204 | 0.276 | 0.070 | - 0.014 ~ 0.155 | 0.101 |
Higher rank of job positionb | 0.792 | - 0.082 ~ 1.665 | 0.074 | 0.355 | - 0.206 ~ 0.917 | 0.207 |
For Bilingual healthcare providers | ||||||
Time living in Chaoshan region (mo) | - 0.002 | - 0.003 ~ -0.001 | 0.001 | - 0.003 | - 0.005 ~ - 0.002 | < 0.0001 |
Being male | 0.003 | - 0.175 ~ 0.181 | 0.974 | 0.010 | - 0.238 ~ 0.259 | 0.936 |
Older age (year)a | 0.020 | - 0.002 ~ 0.042 | 0.074 | 0.029 | - 0.001 ~ 0.060 | 0.060 |
Higher rank of job positionb | - 0.030 | - 0.183 ~ 0.123 | 0.703 | 0.088 | - 0.125 ~ 0.302 | 0.415 |
Discussion
Dialectal preference during clinical encounters
Impact on healthcare delivery and consumption due to communication difficulties
“A Chaoshan-speaking patient and her companion visited the EMD at a late-night hour. I got panic as none of us could understand them because they spoke Chaoshan only; I had to call one off-duty nurse for help. That 15-20-min waiting time was terrible and so risky.” (Physician in-charge, Emergency Dept.)
“I was unable to communicate with a patient under critical condition because my senior who could speak Chaoshan was not with me.” (Young physician)
“I am confused every day during ward rounds. My doctor-patient communication skill is zero.” (Young physician)
“I was refused directly by the patients for any medical diagnosis or treatment because I cannot speak the local dialect.” (Migrant physician)
“I cannot explain the professional terms in Chaoshan.” (Bilingual physician)
“I have a lot of pressure from the widespread use of Chaoshan dialect at work.” (Newly appointed clinician)
Since clinical communication is a two-way interaction between the patients and clinicians, it was unexpected and interesting to find that they differed significantly in perceiving the dialect impact. While the clinicians recognized the dialect barriers as a jeopardy to the entire healthcare delivery process, the patients felt none on the receiving end.“Patients didn’t understand and cooperate with me for physical exams.” (Clinician)
“The doctor spoke something unclearly and I didn't understand; when I asked him to repeat, his attitude became bad.”
On the other hand, miscommunication as a psychological stressor was reported by one clinician:“The staff only spoke the local dialect and was impatient to explain when asking for more explanation.” “Communication is not convenient, and I felt discriminated by the local culture”.
Therefore, as discussed previously [22], miscommunication could be a potential flashpoint of patient-clinician conflict from misunderstanding. The study participants` subjective stories could be just the tip of the linguistic problems in ensuring quality healthcare, such as excess healthcare services, health burden, and healthcare cost, and compromised patient safety as reported before [1, 2].“I may have made the patient’s relatives misunderstand that I am impatient to give them instructions.”