Implications of language and cultural differences on the quality of healthcare provided by expatriate healthcare practitioners in Lesotho public hospitals: Development of an intervention

Abstract

Globalization has coincided with increased migration, as people move from their home countries to other parts of the world for a variety of reasons, such as business, economic opportunities, security, and to escape civil wars (Czaika & Reinprecht, 2022). The healthcare sector is no exception to this general trend. There is an increasing demand for healthcare professionals worldwide to address the increasing global demand for healthcare service professionals (Ghorbani, 2021). Many governments have been forced to recruit healthcare professionals from different parts of the world to provide healthcare services to their respective citizens due to the severe shortage of staff in healthcare facilities witnessed in most countries (Aluttis et al., 2014; Mandeville et al., 2016). This strategy has been shown to pose some communication challenges due to linguistic and cultural differences between healthcare practitioners and patients. Many international studies indicate that the presence of language and cultural differences in healthcare is likely to lead to several negative outcomes. Chiehi et al. (2017) and Royski (2015) point out that cultural incompetence and lack of language concordance between patients and healthcare practitioners are likely to lead to poor relationships and promote medical errors, leaving patients at risk of delayed treatments, incorrect prescriptions, misdiagnoses and sometimes death. In light of this challenge, the study aimed to explore the implications of language and cultural differences on the quality of healthcare provided by healthcare practitioners who do not share a common language and culture with patients in healthcare facilities. There were three secondary objectives which were as follows: to provide a scoping review of existing literature on the implications of language and cultural differences on the quality of healthcare provided by healthcare practitioners who do not share a common language and culture with patients in public healthcare facilities, to qualitatively explore the implications of language and cultural differences on the quality of healthcare provided by expatriate healthcare practitioners to Basotho patients in Lesotho public hospitals as well as strategies that they recommend be employed to reduce the noted adverse implications in these facilities and to develop an intervention to limit the adverse implications of language and cultural differences on the quality of healthcare provided by expatriate healthcare practitioners to Basotho patients in Lesotho public hospitals. To address the first secondary objective, the researcher undertook a scoping review following the Arksey and O'Malley (2005) framework. A scoping review is a methodology that aims to provide an overview of a broad and complex topic (Pham et al. cited in Peterson et al., 2016). It was found that the presence of language and cultural vi differences between patients and healthcare practitioners adversely affected the delivery of quality healthcare, particularly by being associated with poor communication, delayed diagnoses, and treatments, failure to build rapport, decreased empathy, mistrust, poor patient compliance, increased stress and anxiety, increased patient frustrations, increased avoidance behavior, non-disclosure of medically relevant information, and the commission of medical errors. For the second secondary research objective, the researcher undertook a qualitative exploration of the implications of language and cultural differences on the quality of healthcare provided by expatriate healthcare practitioners in Lesotho public hospitals, as well as strategies that they recommend be employed to reduce the noted adverse implications It is a method for understanding and exploring the meanings that individuals or groups attribute to a social issue (Creswell 2014). Findings indicated that the presence of language and cultural differences resulted in miscommunication, poor patient assessment, negative emotional responses, patients’ resistance to undertaking suggested treatments and medical procedures, avoidance behavior, and queueing of patients. In terms of strategies that could be used to mitigate these outcomes, patients and expatriate healthcare practitioners pointed out that it should be ensured that being multilingual expatriate healthcare practitioners is a requirement, that expatriate healthcare practitioners should receive an orientation to Basotho language and culture, that medical interpreting curricula should be developed and presented in schools, and that professional interpreters should be hired. For the third secondary research objective, the researcher developed an intervention to assist expatriate healthcare practitioners working in Lesotho public hospitals with the opportunity to acquire basic skills in Sesotho and improve their cultural competencies, as this will increase the likelihood of the provision of quality healthcare. Intervention mapping was used to guide intervention development. It is a protocol that guides decision-making for the development, implementation, and evaluation of health problems (Van Mol et al., 2017). This study has shown that the presence of language and cultural differences between patients and healthcare practitioners adversely affects the delivery of quality healthcare in healthcare facilities both in international contexts, as well as within the selected hospitals in Lesotho. The study points out that the presence of these discordances is associated with the failure of the two parties to satisfactorily communicate vital information vii about illness symptoms and history, existing illnesses, current medication plan, and lifestyle, all of which were needed for correct diagnoses. This led to an array of unfavorable outcomes that in turn resulted in poor quality healthcare delivery in these facilities. In a bid to address these challenges, the researcher developed an intervention outline of a cultural immersion program for expatriate healthcare practitioners. It is aimed at equipping them with the basic communication skills required to reduce the adverse implications of the presence of language and cultural differences between themselves and patients on their ability to deliver quality healthcare while also increasing chances of attaining consequent enhanced healthcare-related outcomes.