Introduction
Immigrant communities face a variety of challenges with regard to accessing healthcare services. Language barriers often make it difficult for individuals to communicate their concerns in a clinical context. Medical appointments often become difficult in scenarios where important concepts are lost in translation. This study aims to ascertain how the lack of interpretation services during medical appointments affects the health of Afghan refugee communities in the state of California. Interpretation services are a vital aspect of healthcare delivery among refugee populations.
In their study to evaluate how beliefs, perceptions, and behaviors impact the healthcare utilization of Syrian refugee children in the United States Alwan et al. (2020) found that the lack of translation services was an impediment to accessing healthcare services. The researchers noted that participants described the video and translator services as inadequate and inaccurate in emergency and clinic settings (Alwan et al., 2020). The aforementioned findings are supported by Kavukcu and Altlntaş (2019), who conducted a systematic review to evaluate the challenges healthcare providers in refugee settings face in the delivery of healthcare services. The researchers determined that communication challenges were among the most common issues faced when delivering care to refugees (Kavukcu & Altlntaş, 2019). In addition, the availability of translation services was associated with a higher uptake of healthcare services. Khan and DeYoung (2019) demonstrate the need for culturally competent in-person interpretation in the provision of maternal health services for refugee populations. This literature review is intended to demonstrate that the ability to convey specific messages regarding ill health determines the efficiency of treatment.
Search Strategy
A systematic review was conducted in four main databases accessible online. The first was the Medline database which featured content from the United States National Library of Medicine and various National Institutes of Health. The second was Science Direct which provided resources from Elsevier, and the third was the Scopus database. The final source of information was Google Scholar, which provided a wide array of articles that addressed critical research issues. The research criteria included search phrases such as ‘Afghan refugees,’ ‘in-person translators’, and ‘healthcare access.’ A truncation approach was applied, and the search phrases were combined using the terms “and’, and ‘or’ leading to the identification of 23 suitable articles. Articles that did not address how the lack of interpretation services during medical appointments affected a community’s health were eliminated, leaving 10 articles that were used in the literature review.
Epidemiological Review
Access to quality healthcare services is a universal human right. While the United States is capable of providing health services to all its residents, immigrant families face numerous challenges that limit their uptake of the services. It is estimated that approximately 70.8 million people are forcibly displaced globally, with more than 37,000 individuals losing their homes daily (Patel et al., 2021). According to the Center for Immigration Studies, there were 133,000 Afghan immigrants in the U.S. in 2019 (Camarota & Zeigler, 2021). California has the highest pupation of Afghan immigrants at 54,000, many of whom have been admitted for humanitarian reasons (Camarota & Zeigler, 2021). Many of the immigrants have low levels of education and are incapable of speaking English. It is worth pointing out that many Afghan households have limited income, which creates significant health access challenges.
Public Health Impact
In a literature review to evaluate communication experiences in primary healthcare settings with refugees, Patel et al. (2021) found that inaccuracies by translators dissuaded refugees and asylum seekers from seeking health services. The researchers noted that the client’s preference for same-sex translators further complicated the delivery of healthcare services (Patel et al., 2021). This highlights the challenges healthcare systems must contend with when addressing refugee challenges. Another issue is self-confidence, as demonstrated by Brandenberger et al. (2019), who conducted a literature review to evaluate challenges in healthcare delivery to immigrants. They ascertained that the need for translation frustrated older immigrants who functioned independently in their home countries and that patients preferred accurate translators because they relayed their issues in a precise manner (Brandenberger et al., 2019). It is evident that contextual factors impact access to healthcare among immigrant communities in developed countries.
In a study to evaluate barriers and facilitators to healthcare access among recently settled Afghan refugees, Reihani et al. (2021) noted that translators played a critical role in conveying specific perceptions regarding the willingness of the American community to accommodate Afghan refugees. Skilled in-person translators reduced the incidence of miscommunication, thus limiting frustration among healthcare seekers (Reihani et al., 2021). The impact of cultural factors is further explicated by Siddiq et al. (2020) who in their evaluation of cancer screening among resettled refugee women from Muslim-Majority nations found that refugee women underutilize preventive services. This was due to social and cultural factors that are often difficult to communicate through translators. The researchers recommend that healthcare providers should increase access to translators to articulate significant social and cultural issues that affect refugee women (Siddiq et al., 2020). Access to translation services is directly linked to the uptake of health services among immigrant communities.
Hadziabdic and Hjelm (2019) sought to evaluate the use of interpreting services in healthcare contexts in Sweden. The researchers noted that the absence of an interpreter was associated with a high frequency of adverse events (Hadziabdic & Hjelm, 2019). As a result, refugees expressed a reduced interest in seeking healthcare services. These findings aline with those by Khatri and Assefa (2022) who studied the factors that impact healthcare access among linguistically and culturally diverse communities. They determined that inadequacies in interpreter services were directly linked to low healthcare access. The study revealed that limited access to interpreters was associated with challenges in accessing healthcare services (Khatri & Assefa, 2022). Jaeger et al. (2019), in their study to assess professional interpreter use in primary healthcare contexts, found that family members and friends were the most common means of overcoming language barriers (Jaeger et al., 2019). They also note that even though the use of professional interpreters was low, they offered more accurate translations.
Conclusion
The evidence evaluated in this literature review demonstrates the impact of communication in the healthcare context. While the literature search provided evidence from national contexts, information that was specific to the research area was limited. There is an evident gap in research that this study aims to fill by explicating how the lack of interpretation services during medical appointments affects the health of Afghan refugee communities in the state of California.
References
Alwan, R. M., Schumacher, D. J., Cicek-Okay, S., Jernigan, S., Beydoun, A., Salem, T., & Vaughn, L. M. (2020). Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children. PLOS ONE, 15(8), 1–16.
Brandenberger, J., Tylleskär, T., Sontag, K., Peterhans, B., & Ritz, N. (2019). A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries-the 3C model. BMC Public Health, 19(1), 1–11.
Camarota, S. A., & Zeigler, K. (2021). Immigrants from Afghanistan: A profile of foreign-born Afghans. In Center for Immigration Studies (Issue September). Web.
Hadziabdic, E., & Hjelm, K. (2019). Register-based study concerning the problematic situation of using interpreting services in a region in Sweden. BMC Health Services Research, 19(1), 1–8.
Jaeger, F. N., Pellaud, N., Laville, B., & Klauser, P. (2019). The migration-related language barrier and professional interpreter use in primary health care in Switzerland. BMC Health Services Research, 19(1), 1–10.
Kavukcu, N., & Altlntaş, K. H. (2019). The challenges of the health care providers in refugee settings: A systematic review. Prehospital and Disaster Medicine, 34(2), 188–196.
Khan, A., & DeYoung, S. E. (2019). Maternal health services for refugee populations: Exploration of best practices. Global Public Health, 14(3), 362–374.
Khatri, R. B., & Assefa, Y. (2022). Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: Issues and challenges. BMC Public Health, 22(1), 1–14.
Patel, P., Bernays, S., Dolan, H., Muscat, D. M., Trevena, L., Mwanri, L., Gesesew, H., Fauk, N. K., & Mude, W. (2021). Communication experiences in primary healthcare with refugees and asylum seekers: A literature review and narrative synthesis. International Journal of Environmental Research and Public Health, 18(4), 1–18.
Reihani, A. R., Zimmerman, H. G., Fernando, N., Saunders, D. R., Edberg, M., Carter, E., Projects Manager, S., George, P., & Director, C. (2021). Barriers and facilitators to improving access to healthcare for recently resettled Afghan refugees: A transformative qualitative study. The Italian Journal for Interdisciplinary Health and Social Development, 6, 59–72.
Siddiq, H., Alemi, Q., Mentes, J., Pavlish, C., & Lee, E. (2020). Preventive cancer screening among resettled refugee women from Muslim-Majority countries: A systematic review. Journal of Immigrant and Minority Health, 22(5), 1067–1093.