Review

It’s good to talk

Communication and Health in a Multi-Ethnic Society
Mark Robinson
The Policy Press, 2002. £15.99

Sir Donald Acheson, in his Independent Inquiry into Inequalities in Health (1998), identified ethnicity as a key area for action. The subsequent white paper, Saving Lives: Our Healthier Nation, and other governement policies have set out a number of measures for improving the health of black and ethnic minority groups.

Communication is a key issue in any patient-doctor relationship and in the delivery and receipt of healthcare; it is even more important for patients whose first language is not English. The author has compiled and critically appraised research evidence published between 1989 and 2002 into communication between healthcare providers and healthcare users who lack fluency in English. The evidence includes both quantitative and qualitative studies.

Robinson identifies and discusses barriers to communication. He highlights existing beliefs around health care practice that may not translate to the transcultural context, and the stereotyping of ethnic groups. He shows how communication styles driven by culture and gender, and variations in the meaning of words and phrases within a language, are barriers to communication. Structural barriers — the organisation of health care, access, resource allocation boundaries, and the provision or lack of multilingual services and translators — may also have an impact upon awareness of or familiarity with services.

Two further structural barriers are lack of documentation on ethnicity to monitor equity of care, and the level of professional training. This section of the book provides a useful checklist for professionals reviewing their services to different ethnic communities.

The book also includes a useful summary of studies about communication issues in healthcare. Each is broken down into: subject; aims; rationale; methodology; intervention details; participants, dates and settings; outcome measures; results; the study author(s)’ interpretation; and this author’s evaluation of the study and of its interpretation.

This enables potential researchers to spot strengths, weaknesses and gaps in each piece of evidence. As the studies are also grouped under a series of topic specific headings, the reader can see where there are gaps in the available evidence.

Published evidence from interventions that have addressed service development includes provision of bilingual services and interpreters; provision of bilingual advocates and link workers; training; and health education programmes and resources.

For anyone working in this area of service delivery, the book should help to raise awareness of the issues that need to be considered, as well as providing some information on the existing evidence base. Addressing even some of the barriers to good communication should help to improve the health and health care of people living in multi-ethnic communities.