This document summarizes research on minority ethnic elders' access to statutory services in North Wales, with a focus on own language interpreting services. 45 minority ethnic elders participated in focus groups and discussion groups, representing Chinese, Portuguese, Indian, Irish and Zimbabwean communities. Key findings included language barriers negatively impacting healthcare access and understanding, with interpreting services not consistently provided. The research aims to advocate for improved understanding of translation needs to inform future service provision and policies. Statutory providers acknowledged the issues and demonstrated commitment to more equitable access. Working together with minority communities could help address initial barriers and reduce costs.
The document summarizes a report on access to statutory services from the perspective of minority ethnic elders and external organizations in North Wales. It discusses findings from interviews with 45 minority ethnic elders and providers of statutory and voluntary services. Key findings include language barriers like a lack of interpreting services make it difficult for minority ethnic elders to access healthcare, understand conditions like diabetes, and participate in screenings. The report aims to demonstrate needs and limitations to maximize understanding and present empirical evidence to improve services.
The document summarizes a research report on minority ethnic elders' access to statutory services in North Wales. It finds that:
1) Minority ethnic elders experienced a lack of access to interpreting services which poses risks to their health and well-being when accessing services like healthcare.
2) Both service users and providers reported a lack of awareness among frontline staff about the need for and process of requesting interpretation.
3) Improved training, multi-language options on websites, and a coordinated effort across agencies is needed to ensure equal access to services for all.
Access to Statutory Services: from the perspective of both Minority Ethnic Elders and External Organisations
Summary report written and produced by NWREN as part of the MEEA Project
NWREN, February 2015, Belinda Gammon
This document provides a guide for increasing meaningful involvement of people living with HIV/AIDS (PLHIV) in Country Coordinating Mechanisms (CCMs) that oversee Global Fund grants. It acknowledges that while PLHIV were initially excited by the Global Fund, their participation has varied in effectiveness. The guide aims to strengthen PLHIV roles through sharing best practices and universal principles of participation. It also reviews the Global Fund structure and CCM responsibilities to empower PLHIV representatives.
Disabled people in Barnet experience poorer life outcomes than non-disabled people. There are over 13,000 households that require support for physical disabilities and over 1,800 people require daily living assistance for neurological conditions. Barnet has adopted a social model of disability that focuses on inclusion, rights, choice and access to mainstream services rather than specialized care. Key priorities include increasing individualized budgets and partnerships with housing agencies. Barnet is also working to improve rehabilitation access and increase community-based therapy and vocational support.
This document provides an evaluation of the Minority Ethnic Elders Advocacy (MEEA) Project in Wales. It finds that the top challenges facing minority ethnic elders are:
1. Language and communication barriers, with over 35% having limited English skills. This impacts access to healthcare, employment, and finances.
2. Health and social care, as 22% experience poor physical health and 10% poor mental health. Access is complicated by language barriers.
3. Loneliness and social isolation, with 41% sometimes or often feeling lonely, especially in Asian communities.
The MEEA Project effectively addresses these challenges through diverse and intensive advocacy services, helping clients access healthcare, improve language skills and
The document summarizes a report on access to statutory services from the perspective of minority ethnic elders and external organizations in North Wales. It discusses findings from interviews with 45 minority ethnic elders and providers of statutory and voluntary services. Key findings include language barriers like a lack of interpreting services make it difficult for minority ethnic elders to access healthcare, understand conditions like diabetes, and participate in screenings. The report aims to demonstrate needs and limitations to maximize understanding and present empirical evidence to improve services.
The document summarizes a research report on minority ethnic elders' access to statutory services in North Wales. It finds that:
1) Minority ethnic elders experienced a lack of access to interpreting services which poses risks to their health and well-being when accessing services like healthcare.
2) Both service users and providers reported a lack of awareness among frontline staff about the need for and process of requesting interpretation.
3) Improved training, multi-language options on websites, and a coordinated effort across agencies is needed to ensure equal access to services for all.
Access to Statutory Services: from the perspective of both Minority Ethnic Elders and External Organisations
Summary report written and produced by NWREN as part of the MEEA Project
NWREN, February 2015, Belinda Gammon
This document provides a guide for increasing meaningful involvement of people living with HIV/AIDS (PLHIV) in Country Coordinating Mechanisms (CCMs) that oversee Global Fund grants. It acknowledges that while PLHIV were initially excited by the Global Fund, their participation has varied in effectiveness. The guide aims to strengthen PLHIV roles through sharing best practices and universal principles of participation. It also reviews the Global Fund structure and CCM responsibilities to empower PLHIV representatives.
Disabled people in Barnet experience poorer life outcomes than non-disabled people. There are over 13,000 households that require support for physical disabilities and over 1,800 people require daily living assistance for neurological conditions. Barnet has adopted a social model of disability that focuses on inclusion, rights, choice and access to mainstream services rather than specialized care. Key priorities include increasing individualized budgets and partnerships with housing agencies. Barnet is also working to improve rehabilitation access and increase community-based therapy and vocational support.
This document provides an evaluation of the Minority Ethnic Elders Advocacy (MEEA) Project in Wales. It finds that the top challenges facing minority ethnic elders are:
1. Language and communication barriers, with over 35% having limited English skills. This impacts access to healthcare, employment, and finances.
2. Health and social care, as 22% experience poor physical health and 10% poor mental health. Access is complicated by language barriers.
3. Loneliness and social isolation, with 41% sometimes or often feeling lonely, especially in Asian communities.
The MEEA Project effectively addresses these challenges through diverse and intensive advocacy services, helping clients access healthcare, improve language skills and
The global fund's new funding model : Early outcomes for regional Civil Socie...clac.cab
The document summarizes Eurasian Harm Reduction Network's (EHRN) experience as the first civil society organization to participate as a regional principal recipient in the Global Fund's New Funding Model pilot program. EHRN developed a regional HIV and harm reduction proposal for Eastern Europe and Central Asia and underwent the multi-step application process between April-January 2014. The document analyzes the challenges and opportunities EHRN faced at each stage of regional dialogue, concept note development, sub-recipient selection, and grant negotiations. It provides recommendations to strengthen civil society participation and regional applications focused on advocacy in the future.
This study assessed barriers to HIV/AIDS services for Latinos in 9 Southern states. Key findings included immigration status as a major barrier, as many Latinos avoided testing and treatment due to fears of deportation. Cultural norms around homophobia and stigma also prevented many from accessing care. The report recommends developing patient navigators and legal advisors to help Latinos overcome these barriers to HIV/AIDS services.
This document proposes a Patient Education Media Project (PEMP) to educate Medicaid patients in central North Carolina about healthcare access and health outcomes. The PEMP would utilize TV and radio advertisements, as well as waiting room videos, to teach the Medicaid population how to use their healthcare benefits and access services appropriately. The goal is to improve health outcomes and reduce costs by helping patients better navigate the healthcare system. The targeted Medicaid population has high rates of low health literacy and non-English speaking individuals. The PEMP aims to communicate important healthcare information to this population through accessible media formats.
This document summarizes the key elements and process of the Global Fund's new funding model. It outlines the steps including country dialogue, development of national strategic plans, concept note submission, final funding decisions, grant-making, and implementation. It emphasizes the importance of meaningful involvement of civil society, communities, and key populations throughout these stages. The document provides advice for how these groups can engage in country dialogue, contribute to concept notes, and participate in grant oversight to help ensure funding requests have the greatest impact.
Innovations conference 2014 leissa pitts the cancer good news projectCancer Institute NSW
This document describes the Cancer Good News project which aimed to address cancer stigma and promote help-seeking within Serbian and Macedonian communities in Illawarra, Australia. Formative research found that these communities strongly associated cancer with death and prevented open discussion. The project developed culturally appropriate resources emphasizing positive cancer facts, screening tests, and survivor stories. Evaluation found the resources increased discussion of cancer, promoted screening intentions, and built community capacity to address cancer issues. Partnerships with local organizations were important to the project's success in engaging the communities.
Cultural and Linguistic Competence Initiatives at Virginia Dept. of Behaviora...Cecily Rodriguez
This document discusses cultural and linguistic competence initiatives at the Virginia Department of Behavioral Health and Developmental Services. It defines cultural competence and linguistic competence, outlines federal laws requiring them, and presents strategies for implementing them, including hiring diverse staff, using interpreters, and providing materials in multiple languages. The document emphasizes planning and assessment, leadership support, and community partnerships as critical to effectively serving diverse populations.
This document provides a summary of feedback from over 150 participants representing local councils, partners, and other stakeholders in the West Midlands region of England. The feedback was gathered through interviews and focus groups to understand the leadership and culture change needs to achieve transformational improvements in public health. Key themes that emerged include the challenges of the financial environment, developing partnerships and relationships across a reorganized system, integrating health as everyone's responsibility, and ensuring health and wellbeing boards act as leaders rather than "talking shops." The document aims to support local councils in developing leadership and making progress on their public health goals.
This document discusses gaps in data, funding, and services for men who have sex with men (MSM) and transgender persons in addressing HIV/AIDS. It notes that while the 2011 Political Declaration specifically named MSM, it left out transgender persons. Many countries lack data on HIV incidence, access to treatment, and funding for MSM and transgender communities. The presentation focuses on 9 Asian countries and finds that most do not disaggregate data to show sexual transmission of HIV to MSM and transgender persons. It calls for improved surveillance, increased funding for prevention and treatment, and support for community-led interventions.
UNDP Sri Lanka Study on Stigma, KAPs and HIVNirupama Sarma
This document summarizes the key findings of a study analyzing media coverage of HIV and key affected populations in Sri Lanka. The study found that coverage was low overall but disproportionately focused on people who use drugs, despite this group accounting for a small percentage of HIV transmissions. Coverage of men who have sex with men and transgender people was especially low. Most coverage took the form of crime reports and positioned key populations as criminals. The study concludes that media coverage in Sri Lanka perpetuates stigma by promoting "grand narratives" that portray homosexuality, sex work and drug use in a negative light. It recommends strengthening media advocacy to create a more enabling environment for HIV prevention and care.
The document provides an overview of the EMPHASIS project which aims to address HIV vulnerability among mobile populations in South Asia. The project will work along mobility routes from Nepal and Bangladesh to India, setting up service networks to increase access to HIV prevention, treatment, and care. In the first year, the project will focus on building knowledge about the target populations to inform the design and delivery of effective HIV services tailored to their needs and experiences of mobility.
The Mental Health and Well Being of Black and Minority Ethnic EldersThink Ethnic
This document provides an introduction to a one-year national project in the UK aimed at promoting the mental health and well-being of black and minority ethnic (BME) elders. The project will produce practical resources to improve access and quality of mental health services for BME elders. It will partner with four voluntary organizations to develop culturally appropriate materials on depression, dementia and delirium through community consultation. The document establishes the need for the project by reviewing relevant policies and literature on BME elders' mental health. It also maps existing mental health projects and resources for BME elders nationally.
This document discusses Zambia Emory HIV Research Project's (ZEHRP) use of a "web of influence" model to combat stigma towards HIV/AIDS. The model trains community influential leaders and agents to recruit couples for voluntary counseling and testing through their social networks. Since adopting this model in 2004, the number of couples tested has increased significantly. Key findings show the model is successful in building trust and changing attitudes by utilizing community leaders. The document recommends a community-based, multi-sectoral approach drawing on influential leaders to spearhead HIV/AIDS sensitization and voluntary counseling and testing promotion.
The document summarizes the objectives, methodology, and results of an assessment conducted by the Indonesian UNGASS AIDS Forum to understand issues related to human rights, gender, youth, and leadership in Indonesia's national response to HIV/AIDS. The assessment was conducted through focus groups, interviews, and secondary data collection across six cities. Key findings will be highlighted in the results section to analyze human rights implementation, issues faced by vulnerable groups, experiences accessing services, and leadership challenges in the national HIV/AIDS strategy. The Forum aims to contribute these qualitative findings to Indonesia's UNGASS 2010 reporting on the national epidemic.
The document summarizes a stakeholder workshop on a Joint Strategic Needs Assessment (JSNA) for transport and health in Cambridgeshire. The workshop discussed what a JSNA is, background and aims of the transport and health JSNA, and key topics of access and health, active transport, and air pollution. Attendees provided input on local issues, initiatives, and solutions for each topic. Next steps outlined forming working groups to analyze data and produce the JSNA to inform local decision-making.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
The document discusses Zambia's Corridors of Hope III project, which uses a door-to-door strategy to provide HIV/AIDS counseling, testing, and treatment services in rural communities. It finds that the door-to-door approach has been successful in increasing access to and uptake of services by reaching people in their homes. The strategy involves engaging community leaders for approval, then having trained lay counselors and healthcare providers systematically visit each home to offer confidential testing and information. Over 11,400 people, or 16% of those tested, have been reached through this door-to-door strategy between 2009-2011. The approach provides greater convenience, privacy and reduces stigma compared to clinic-based services.
The document summarizes discussions from the Integration for Impact conference held in Nairobi, Kenya in September 2012 on integrating sexual and reproductive health and HIV services in sub-Saharan Africa. The conference included presentations on:
1) Strengthening health information systems, client management systems, and supply chain management to support integrated service delivery.
2) Different models of integrating family planning, maternal and child health, cervical cancer, and gender-based violence services with HIV services.
3) Policies, training, and perspectives of health workers and patients to enhance integration at scale.
4) Target populations including how to increase male involvement.
5) Tools to assess integration at health facilities, communities, and policies.
New Requirements And Challenges Joint Commission Cultural Competency Requir...mlw0624
The document discusses new requirements by the Joint Commission for hospitals to improve cultural competency and meet CLAS standards. It focuses on workforce and human resource issues, recommending that hospitals target diverse recruitment, provide cultural competency training to staff, and get staff input on improving care for diverse patients. Hospitals will be evaluated on these organizational supports and readiness factors during accreditation reviews starting in 2012.
Final report developing effective engagement for consultation with black and ...NWREN
The document discusses building inclusive rural communities through effective engagement with black and ethnic minority groups in rural areas of North Wales. It outlines the background and aims of the research project, which was to explore engagement between public services and ethnic minorities and enhance consultation strategies. The research evaluated consultation techniques, quality of life factors for ethnic minorities in rural areas, their ability to influence local policies, and developed consultation models with select agencies. Key findings included a lack of leadership and resources for consultation, as well as public services not being creative or innovative enough in their approaches. The research provided valuable insights into the experiences of ethnic minorities in rural communities.
The document discusses the establishment of the Everybody's Business Sub-Committee (EBS) in Darwin, Australia to improve culturally sensitive sexual and reproductive health services for migrant and refugee communities. It describes the demographics of migrants in Darwin and key health issues identified for refugee women. The EBS was formed in 2010 with diverse members from government and non-profits. It conducted successful Somali community workshops on female genital cutting and developed a project plan and action plan to continue its work, though it struggles with limited funding and capacity as an informal group. The EBS aims to fill gaps, share resources, and holistically address the needs of Darwin's changing migrant population.
The global fund's new funding model : Early outcomes for regional Civil Socie...clac.cab
The document summarizes Eurasian Harm Reduction Network's (EHRN) experience as the first civil society organization to participate as a regional principal recipient in the Global Fund's New Funding Model pilot program. EHRN developed a regional HIV and harm reduction proposal for Eastern Europe and Central Asia and underwent the multi-step application process between April-January 2014. The document analyzes the challenges and opportunities EHRN faced at each stage of regional dialogue, concept note development, sub-recipient selection, and grant negotiations. It provides recommendations to strengthen civil society participation and regional applications focused on advocacy in the future.
This study assessed barriers to HIV/AIDS services for Latinos in 9 Southern states. Key findings included immigration status as a major barrier, as many Latinos avoided testing and treatment due to fears of deportation. Cultural norms around homophobia and stigma also prevented many from accessing care. The report recommends developing patient navigators and legal advisors to help Latinos overcome these barriers to HIV/AIDS services.
This document proposes a Patient Education Media Project (PEMP) to educate Medicaid patients in central North Carolina about healthcare access and health outcomes. The PEMP would utilize TV and radio advertisements, as well as waiting room videos, to teach the Medicaid population how to use their healthcare benefits and access services appropriately. The goal is to improve health outcomes and reduce costs by helping patients better navigate the healthcare system. The targeted Medicaid population has high rates of low health literacy and non-English speaking individuals. The PEMP aims to communicate important healthcare information to this population through accessible media formats.
This document summarizes the key elements and process of the Global Fund's new funding model. It outlines the steps including country dialogue, development of national strategic plans, concept note submission, final funding decisions, grant-making, and implementation. It emphasizes the importance of meaningful involvement of civil society, communities, and key populations throughout these stages. The document provides advice for how these groups can engage in country dialogue, contribute to concept notes, and participate in grant oversight to help ensure funding requests have the greatest impact.
Innovations conference 2014 leissa pitts the cancer good news projectCancer Institute NSW
This document describes the Cancer Good News project which aimed to address cancer stigma and promote help-seeking within Serbian and Macedonian communities in Illawarra, Australia. Formative research found that these communities strongly associated cancer with death and prevented open discussion. The project developed culturally appropriate resources emphasizing positive cancer facts, screening tests, and survivor stories. Evaluation found the resources increased discussion of cancer, promoted screening intentions, and built community capacity to address cancer issues. Partnerships with local organizations were important to the project's success in engaging the communities.
Cultural and Linguistic Competence Initiatives at Virginia Dept. of Behaviora...Cecily Rodriguez
This document discusses cultural and linguistic competence initiatives at the Virginia Department of Behavioral Health and Developmental Services. It defines cultural competence and linguistic competence, outlines federal laws requiring them, and presents strategies for implementing them, including hiring diverse staff, using interpreters, and providing materials in multiple languages. The document emphasizes planning and assessment, leadership support, and community partnerships as critical to effectively serving diverse populations.
This document provides a summary of feedback from over 150 participants representing local councils, partners, and other stakeholders in the West Midlands region of England. The feedback was gathered through interviews and focus groups to understand the leadership and culture change needs to achieve transformational improvements in public health. Key themes that emerged include the challenges of the financial environment, developing partnerships and relationships across a reorganized system, integrating health as everyone's responsibility, and ensuring health and wellbeing boards act as leaders rather than "talking shops." The document aims to support local councils in developing leadership and making progress on their public health goals.
This document discusses gaps in data, funding, and services for men who have sex with men (MSM) and transgender persons in addressing HIV/AIDS. It notes that while the 2011 Political Declaration specifically named MSM, it left out transgender persons. Many countries lack data on HIV incidence, access to treatment, and funding for MSM and transgender communities. The presentation focuses on 9 Asian countries and finds that most do not disaggregate data to show sexual transmission of HIV to MSM and transgender persons. It calls for improved surveillance, increased funding for prevention and treatment, and support for community-led interventions.
UNDP Sri Lanka Study on Stigma, KAPs and HIVNirupama Sarma
This document summarizes the key findings of a study analyzing media coverage of HIV and key affected populations in Sri Lanka. The study found that coverage was low overall but disproportionately focused on people who use drugs, despite this group accounting for a small percentage of HIV transmissions. Coverage of men who have sex with men and transgender people was especially low. Most coverage took the form of crime reports and positioned key populations as criminals. The study concludes that media coverage in Sri Lanka perpetuates stigma by promoting "grand narratives" that portray homosexuality, sex work and drug use in a negative light. It recommends strengthening media advocacy to create a more enabling environment for HIV prevention and care.
The document provides an overview of the EMPHASIS project which aims to address HIV vulnerability among mobile populations in South Asia. The project will work along mobility routes from Nepal and Bangladesh to India, setting up service networks to increase access to HIV prevention, treatment, and care. In the first year, the project will focus on building knowledge about the target populations to inform the design and delivery of effective HIV services tailored to their needs and experiences of mobility.
The Mental Health and Well Being of Black and Minority Ethnic EldersThink Ethnic
This document provides an introduction to a one-year national project in the UK aimed at promoting the mental health and well-being of black and minority ethnic (BME) elders. The project will produce practical resources to improve access and quality of mental health services for BME elders. It will partner with four voluntary organizations to develop culturally appropriate materials on depression, dementia and delirium through community consultation. The document establishes the need for the project by reviewing relevant policies and literature on BME elders' mental health. It also maps existing mental health projects and resources for BME elders nationally.
This document discusses Zambia Emory HIV Research Project's (ZEHRP) use of a "web of influence" model to combat stigma towards HIV/AIDS. The model trains community influential leaders and agents to recruit couples for voluntary counseling and testing through their social networks. Since adopting this model in 2004, the number of couples tested has increased significantly. Key findings show the model is successful in building trust and changing attitudes by utilizing community leaders. The document recommends a community-based, multi-sectoral approach drawing on influential leaders to spearhead HIV/AIDS sensitization and voluntary counseling and testing promotion.
The document summarizes the objectives, methodology, and results of an assessment conducted by the Indonesian UNGASS AIDS Forum to understand issues related to human rights, gender, youth, and leadership in Indonesia's national response to HIV/AIDS. The assessment was conducted through focus groups, interviews, and secondary data collection across six cities. Key findings will be highlighted in the results section to analyze human rights implementation, issues faced by vulnerable groups, experiences accessing services, and leadership challenges in the national HIV/AIDS strategy. The Forum aims to contribute these qualitative findings to Indonesia's UNGASS 2010 reporting on the national epidemic.
The document summarizes a stakeholder workshop on a Joint Strategic Needs Assessment (JSNA) for transport and health in Cambridgeshire. The workshop discussed what a JSNA is, background and aims of the transport and health JSNA, and key topics of access and health, active transport, and air pollution. Attendees provided input on local issues, initiatives, and solutions for each topic. Next steps outlined forming working groups to analyze data and produce the JSNA to inform local decision-making.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
The document discusses Zambia's Corridors of Hope III project, which uses a door-to-door strategy to provide HIV/AIDS counseling, testing, and treatment services in rural communities. It finds that the door-to-door approach has been successful in increasing access to and uptake of services by reaching people in their homes. The strategy involves engaging community leaders for approval, then having trained lay counselors and healthcare providers systematically visit each home to offer confidential testing and information. Over 11,400 people, or 16% of those tested, have been reached through this door-to-door strategy between 2009-2011. The approach provides greater convenience, privacy and reduces stigma compared to clinic-based services.
The document summarizes discussions from the Integration for Impact conference held in Nairobi, Kenya in September 2012 on integrating sexual and reproductive health and HIV services in sub-Saharan Africa. The conference included presentations on:
1) Strengthening health information systems, client management systems, and supply chain management to support integrated service delivery.
2) Different models of integrating family planning, maternal and child health, cervical cancer, and gender-based violence services with HIV services.
3) Policies, training, and perspectives of health workers and patients to enhance integration at scale.
4) Target populations including how to increase male involvement.
5) Tools to assess integration at health facilities, communities, and policies.
New Requirements And Challenges Joint Commission Cultural Competency Requir...mlw0624
The document discusses new requirements by the Joint Commission for hospitals to improve cultural competency and meet CLAS standards. It focuses on workforce and human resource issues, recommending that hospitals target diverse recruitment, provide cultural competency training to staff, and get staff input on improving care for diverse patients. Hospitals will be evaluated on these organizational supports and readiness factors during accreditation reviews starting in 2012.
Final report developing effective engagement for consultation with black and ...NWREN
The document discusses building inclusive rural communities through effective engagement with black and ethnic minority groups in rural areas of North Wales. It outlines the background and aims of the research project, which was to explore engagement between public services and ethnic minorities and enhance consultation strategies. The research evaluated consultation techniques, quality of life factors for ethnic minorities in rural areas, their ability to influence local policies, and developed consultation models with select agencies. Key findings included a lack of leadership and resources for consultation, as well as public services not being creative or innovative enough in their approaches. The research provided valuable insights into the experiences of ethnic minorities in rural communities.
The document discusses the establishment of the Everybody's Business Sub-Committee (EBS) in Darwin, Australia to improve culturally sensitive sexual and reproductive health services for migrant and refugee communities. It describes the demographics of migrants in Darwin and key health issues identified for refugee women. The EBS was formed in 2010 with diverse members from government and non-profits. It conducted successful Somali community workshops on female genital cutting and developed a project plan and action plan to continue its work, though it struggles with limited funding and capacity as an informal group. The EBS aims to fill gaps, share resources, and holistically address the needs of Darwin's changing migrant population.
This document provides an introduction and overview of considerations for better practice in language service provision. It discusses the growing linguistic diversity in Victoria as revealed in the 2011 Census. It outlines the purpose of the guide, which is to encourage continuous improvement in language services. It then defines language services and describes the methodology used to develop case studies of better practice. Finally, it discusses considerations that have emerged since the previous guide, including a focus on client and community participation, cultural competence, and health literacy.
Health literacies in marginalised communities LILAC 24.pptxPamela McKinney
A long presentation given at the LILAC conference 25th-27th March 2024 in Leeds. The presentation reports on a Knowledge Exchange project that took place in summer 2023 to co-produce research priorities for health information literacy with members of the Somali, Yemeni and Roma communities in Sheffield
This document summarizes the findings of a consultation report on aged care issues facing lesbian, gay, bisexual, transgender, intersex, queer and HIV+ people in the Australian Capital Territory (ACT). Key findings from a forum and survey of these communities identified fears of discrimination, a lack of provider understanding, and unique health needs as major concerns. Recommendations included anti-discrimination education for providers, advocacy services, addressing isolation, and ensuring appropriate health support. The report aims to inform policy and improve inclusive, respectful care for diverse aging populations in the ACT region.
This document summarizes a research report on a consultation with diverse communities in the Langworthy area of Salford, England. The report was commissioned by the Langworthy Cornerstone Association to inform its 2016-2019 business strategy. The research had two aims: to inform amendments to current service provision and to inform the development of new provision considering local requirements. It employed a participatory research design using 10 community researchers from diverse backgrounds. The researchers conducted focus groups in multiple languages to understand how the association could better engage local communities and their needs. The findings will be used to improve and expand the association's services to reflect the area's increasingly diverse population.
Engaging House Ball Communities Utilizing Culturally Appropriate MethodsStephaun Wallace
The document summarizes engagement strategies for working with house ball communities on HIV/STD issues. It discusses establishing trust and respect within communities before engagement. Successful strategies included developing cultural competency, transparency, long-term partnerships, and capacity building. Specific projects like Project VOGUE in New York and REACH LA engaged communities through balls, workshops, and testing events. The BHAP conference in Texas addressed health disparities among house/ball and pageant communities in the South. A consultation formed a national coalition to develop an HIV clinical trials research agenda focused on house ball communities. Barriers to engagement included distrust, lack of access, and stigma, while facilitators included reciprocity, whole community involvement, and empowerment.
This document provides an evaluation report of a mass media campaign in Kenya run by Development Media International to improve maternal and child health in Nyanza Province from November 2010 to May 2011. It summarizes the campaign messages, study design, methods, results and conclusions. Specifically, it conducted a before-and-after cross-sectional survey to measure changes in knowledge, intended behaviors, and reported behaviors related to exclusive breastfeeding, oral rehydration therapy, antenatal care visits, and health facility deliveries. The results found statistically significant improvements in several indicators between the pre- and post-campaign surveys, suggesting the campaign was successful in increasing knowledge and some reported behaviors among the target population in Nyanza Province.
The project aimed to improve sexual and reproductive health for the Ngöbe indigenous people in Panama by strengthening family planning services and reducing maternal mortality. It trained local health workers, implemented education programs, and improved access to health facilities. Over the 5 year period, it helped empower local indigenous groups, build partnerships, and develop culturally-appropriate care, though challenges around sustainability remained.
The project aimed to improve sexual and reproductive health for the Ngöbe indigenous people in Panama by strengthening families and communities. It trained local health workers, improved access to health services, and conducted education campaigns around related issues. Over time, it helped reduce maternal mortality, empowered indigenous women, and influenced national policies, though sustainability remained a challenge due to factors like government priorities and poverty in the region.
The document discusses the advocacy achievements of the Bridging the Gaps global partners from 2011-2014. It describes the program's establishment in 2011 with funding from the Netherlands Ministry of Foreign Affairs to achieve universal access to HIV services for key populations. Through the efforts of global and local partner organizations, nearly 700,000 people received HIV services, over 200 organizations engaged in human rights advocacy, and key population services were integrated into nearly 100 health facilities. The document provides details on the program's approach and a theory of change to guide advocacy work.
- The study assessed factors influencing the utilization of voluntary HIV counseling and testing (VCT) services among youth in Awassa town, Ethiopia using a Health Belief Model approach.
- Through focus group discussions and interviews, the major factors found to inhibit VCT utilization were fear of stigma and discrimination, fear of coping with a positive HIV test result, and high HIV risk perception. The factors found to enhance utilization were having marriage plans, access to care and support including antiretroviral therapy, and persuasion by health professionals.
- HIV risk perception was a debated factor, with some seeing it as enhancing utilization by raising awareness, and others seeing it as inhibiting due to low perceived risk. Tailored interventions
A report on a project which aimed to increase the capacity of HIV services and organisations to work with culturally and linguistically diverse (CALD) communities, and to increase the inclusion of people living with HIV/AIDS (PLWHA) from CALD backgrounds in the strategic planning of HIV/AIDS services. This paper was presented by Nandini Ray from the Multicultural HIV/AIDS and
Hepatitis C Service at the AFAO HIV Educators Conference 2008.
1) The document discusses alternative ways of collecting data by engaging organizations of persons with disabilities. It emphasizes the benefits of collaborating with disabled peoples' organizations (DPOs) which provides more accurate and insightful information that has implications for policies and programs.
2) Mixed methods research conducted in partnership with DPOs and universities in multiple African countries found important findings on issues like access to health, education, and employment. Qualitative research helped identify previously unknown issues and gaps.
3) One example from Sierra Leone found through mixed methods that disabled women had similar reproductive health needs and desires as non-disabled women but faced barriers to services.
Developing gender-sensitive local services most important outcome of events such as this is the exchange they enable between participants from different countries. Clearly, we all share an agenda in the areas of social inclusion and service provision. Issues of quality, gender sensitivity, and accessibility are as challenging for people in the UK as they are for people in Africa, Asia and Central and Latin America.
We share concerns about the affordability and appropriateness of services – who pays for services, what user fees are acceptable, who delivers the services – and about accountability, principally the accountability of officials and elected representatives to citizens. Finally – and importantly – we want to identify approaches which could be useful to the European Union and the British government in their development co-operation programmes and policies. Alongside the set of shared agendas outlined above is another agenda which is equally important for this seminar. In 1995 the UK and the European Union, alongside most other countries in the world, signed agreements at the Fourth World Conference on Women in Beijing and the World Summit on Social Development in Copenhagen.
This year they have reiterated their commitment by signing agreements at the follow-up conferences, ‘Beijing + 5’ and ‘Copenhagen + 5’. Fundamental to these international agreements is gender equality and the commitment to women’s rights as human rights. The international community has also committed itself to certain international development targets which stem from the series of UN conferences that took place in the 1990s. One of those targets poses a challenge: to halve the incidence of poverty by 2015.
The UK and the European Union have very good gender policies in their development co-operation. Yet, as we all know, there are still huge inequalities in access to, and control over, services such as water, health care, education, sanitation, transport, roads, justice, and housing. In such a context it is difficult to see how women, men and children can enjoy and exercise their full human rights when they are denied access to some of the most basic essential services.
This document summarizes a project conducted in El Alto, Bolivia that aimed to prevent gender violence towards young women and teenagers in violent or at-risk relationships. The project provided psychological services, workshops in schools, and training for youth leaders. It found that sexual violence is often normalized in romantic relationships for adolescents. While the project faced some obstacles, it contributed to raising awareness of the issue and generating discussion through community activities and media outreach.
Lairmore_mHealth for Family Planning_finalKate Lairmore
Kate Lairmore's document outlines the potential for using mHealth strategies to improve family planning programs. It begins with background on the global unmet need for contraception. It then defines mHealth and discusses how client education and behavior change communication tools have been used. Six illustrative mHealth projects for family planning are described. The document concludes with six key considerations for developing and implementing successful mHealth interventions for family planning.
Healthlink Worldwide is an international NGO that focuses on communication for health and disability in developing countries. They work with local organizations to help communities identify health issues and communicate their needs. One of their projects is the International Memory Project, which uses memory work to encourage families affected by HIV to communicate. Memory work involves activities that improve parent-child communication, support disclosure of HIV status, assist with succession planning, and create memory books. Evaluations found the approach reduces stigma and increases confidence, communication, and future planning among families living with HIV. Key challenges to memory work include lack of funding, unsupportive laws and policies, and limited male involvement.
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1. Access to Statutory Services: from the perspective of both
Minority Ethnic Elders and External Organisations
Summary report written and produced by NWREN as part of the MEEA Project
NWREN, February 2015, Belinda Gammon
Promoting Equality · challenging discrimination · upholding human rights
Company No.: 5843319 Charity Registration No.: 1116970
The Minority Ethnic Elders Advocacy Project
(MEEA)
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Contents
Acknowledgements 3
The MEEA Project 4
About NWREN 4
Section 1a: Introduction to the Report 5
Section 1b: Overview 8
Section 2: The method 9
Section 3: The Results 12
Section 4: Conclusions and Recommendations 18
References 22
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This report was produced as part of the NWREN Minority Ethnic Elders Advocacy Project (MEEA):
a pan-Wales project funded by the BIG Lottery. The project would like to acknowledge the
invaluable support given by the following people:
Research Planning - Acknowledgments must first go to Mary Holmes without whose knowledge
and experience of both research and research methods and the Voluntary Sector, this survey
would not have been possible.
Introduction - Further acknowledgments are due to Mary Holmes for contributing the text for
the report’s Introduction (Section 1a).
The Discussion Facilitators and Recorders - Susheela Lourie; Nayan Patel; Jenny Porter;
Idney Fernandes; Helga Uckermann; Gemma Hamblin; Nichola Roberts; Rita Jones and Lindsay
Sullivan. Thanks to the hard work, skills and experience of the Facilitators and Recorders, the
quality of response from the interviewees (MEEA project beneficiaries) exceeded expectations.
Grateful thanks also go to Susan Jones for facilitating the Question Time panel.
Service Providers from Statutory & Voluntary Sectors – who gave so freely of their time,
with special thanks for their honesty and dedication in taking part in the Question Time Panel and
Discussion Group.
Project Beneficiaries & Volunteer Champions – Grateful acknowledgements must go to the
project beneficiaries, without whom, this survey would not have been possible.
Editorial support – thanks go to Professor Robert Moore and Will Wain for editorial comment
and guidance.
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The MEEA project is a pan-Wales project, in which NWREN is working in
partnership with Lead partner, Race Equality First (REF), South East Wales
Regional Equality Council (SEWREC) and Swansea Bay Regional Equality
Council (SBREC). The Project in North Wales, having some 2,400 square miles
to cover, works across each of the six Local Authority areas: Anglesey;
Conwy; Denbighshire; Flintshire; Gwynedd and Wrexham.
The three-year project aims to provide an independent advocacy service to
Minority Ethnic Elders (MEE) aged 50+. It will empower and support MEE to
live the way they want to, ensuring their ability to access services which they
currently may not use due to lack of awareness and barriers of language,
confidence and physical ability. Working closely with organisations in the
statutory and voluntary sector which offer services to older people, the
Project will raise awareness of the particular needs of MEE. Importantly, it
will ensure that MEE are able to influence practice and general improvements
in local services by telling service providers what they actually want and need.
A choir has been established across the North Wales region to learn,
choreograph and video the NWREN MEEA Project’s own cover version of
Pharrell’s ‘Happy’ song at iconic locations across North Wales. The choir has
been dubbed “The Happy Choir” and further plans include learning an
international version of Amazing Grace, along with songs from the project
beneficiaries’ cultures. As more beneficiaries join the project, event planning
will be done on a group by group basis.
About NWREN
The North Wales Regional Equality Network (NWREN) works across all areas
of equality with a range of partners. As a charity we are committed to:
working towards the elimination of discrimination and disadvantage in all its
forms; promoting equality of opportunity and good relations between all
through understanding and addressing issues of discrimination and equality;
working towards upholding the human rights of all people. NWREN mainly
operates across Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd and
Wrexham. Current projects include: BIG Lottery Funding; People and
Places Project which has 3 main strands - the Anti-Hate Crime Project, the
Equality Centre Project and Development of a North Wales Voluntary Sector
Equality and Human Rights Forum across North Wales. Also BIG Lottery
Funding, the Community Voice Project, aimed at helping people to get
their voices heard.
The iDENTiTY Project is a Welsh government funded initiative targeting
young people across Wales who identify with the protected characteristics of
race, sexual orientation and gender reassignment, supporting them through
adolescence to adulthood.
The MEEA Project
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Section 1a: Introduction
This report examines the perspective of MEE groups and individuals (for this
survey, 45 BME individuals took part) and statutory providers, within North
Wales, with regard to the importance and difficulties in the provision of own
dialect interpreting services. This report is an initial step in a longitudinal
study, with the aim of bringing together both the perspectives of service
providers and their MEE clients. It has explored, with reference to own
dialect interpreting provision, the difference between the experience of MEE
when accessing statutory services and the intentions of the providers
delivering those services.
The report hopes to promote better understanding of the issues around MEE
accessing statutory services and to present clear empirical evidence of need
and service limitations. Together, the data are intended to demonstrate need
rather than elicited criticism. The findings in this report are not unique to
North Wales, and they would appear to correlate with replicated findings
across Britain. What may be a unique asset to North Wales is the tangible
level of genuine engagement and co-operation from the participating
statutory and voluntary service providers.
An estimated 4 million older people in the UK (36% of people aged 65-74 and
47% of those aged 75+) have a limiting longstanding illness. This equates to
40% of all people aged 65+ 1
(Office of National Statistics 2013). As in all
populations, the likely prevalence of disease and chronic health conditions
increases with age, so it is no surprise that the primary focus of the
participants within this study was on the health care system. (Minority Ethnic
Elders Advocacy project (50 years +)) There was also recorded evidence of a
secondary focus on comparative translation needs within the Criminal Justice
System.
This sometimes rhetorical and fragmentary debate on the importance of
language and own dialect translation services is historically and currently well
documented in both academic and ‘grey’ literature.
As reported by Stevenson and Roa (2014), there are marked differences in
ethnic population vs the white indigenous population when accessing health
care. They suggest ‘intrinsic’ cultural differences, such as language and
literacy, as well as organisational factors in health services, as possible
explanatory factors for this disparity in uptake. They point out that research
on cardiovascular care has shown repeatedly that BME communities have
poorer access to hospital care, although studies on health care seeking
1
The estimate is for the UK, based on Great Britain data from the General Lifestyle
Survey 2011; Office for National Statistics, 2013.
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behaviour have found that they may have a greater likelihood of seeking
immediate care compared with their white counterparts.
Diabetes and associated problems can become more prevalent with the
ageing process. The Department of Health Health Survey for England 2003
(2004) highlighted significant gaps in BME patient knowledge, understanding
and confidence in managing diabetes. These gaps were more pronounced for
ethnic minorities than the white population. Language was featured as a
major barrier to accessing services.
Factors such as modesty; fear; embarrassment relating to examination
particularly by male staff; differing attitudes, perceptions and beliefs of health
and health service; language difficulties – both English proficiency and literacy
in own language – are reported as contributory factors to low uptake by BME
individuals in screening for breast and bowel cancer. (Bansal, et al 2012). The
same language barriers are reported in uptake of cervical screening (Thomas,
Saleem and Abraham 2005).
Gynaecology and obstetric procedures are personal and often emotive. The
director of BME Health Forum Nafsika Thalassis reports that in the study
carried out in 2013 there were “many instances where women who are not
fluent English speakers are not offered interpreters and that even when they
request this service, their request is refused. For the two women in this
project who were not fluent English speakers, this led to a number of
profound misunderstandings about their choices, which have cost implications
as well as resulting in poorer care for the women. This inconsistent use of
interpreting services has negative implications for safeguarding women and
children as well as clinical care.”
These phenomena are not limited to secondary care, Primary Concern, a
report by the BME Health Forum (2008) focuses on understanding barriers
experienced by BME regarding GP access. One of the main issues highlighted
are ‘Communication problems, caused by language and cultural barriers
impede on the doctor-patient relationship. Interpreting services are not widely
available and waiting for an interpreter to be booked limits access to services.
Many people use unofficial interpreters, including children thus jeopardising
the clinical outcome of the consultation.’
To put the issue of need versus provision in context there are a further two
critical factors to consider, primarily the Race Relations (Amendment) Act
2000.
The Act came into force on 2nd
April 2001 and requires public authorities to
make the promotion of racial equality central to all activities. The duty is
obligatory, not optional, and a list of specific duties is listed by the Equalities
and Human Rights Commission.
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The general duty of the Act also expects public authorities to take the lead in
ensuring equal access to all: ‘By providing widely accessible interpretation and
translation services we are taking steps to minimise the risk of language
difficulties becoming a barrier to individuals understanding of their own
healthcare needs and treatment.’ This dynamic is further reinforced by the
NHS’s ‘Improving access to Psychological Therapies’ (IAPT) – ‘Non-English-
speaking people may not be able to communicate their needs effectively if an
IAPT service lacks appropriate language capacity. This could mean that
proper and correct assessments may not be made.’
The second consideration is that of cost as statutory budgets are curtailed by
austerity measures (Health in Austerity) 2013. This particularly applies in rural
areas where the density and diversity of the BME groups and individuals
challenges the urban solutions of economies of scale in the provision of
translators.
Within a global economy and the push/pull factors within the European
States, demographic change is inevitable and the evolution of appropriate
services should be pre-equipped rather than reactive in order to cater for
these changes. According to the Black and Minority Ethnic (BME) Leadership
Forum, the UK is set to overtake the USA as the most diverse society in the
western world over the next 35 years. ‘While socially and culturally we have
made great strides in first accepting and then celebrating our diversity, some
parts of our healthcare system have been slow to react to the changing
demographic landscape’.
It should never be said that the “one size fits all” philosophy or “we treat
everybody the same way”, is an equitable or non-discriminatory approach to
translation. Across Britain, there is a plethora of researched and developed
practical translation practices. There appears to be no collation of these
practices as to their overall efficacy, application and possible economic and
social impact. The inherent difficulties and shortcomings of translation
services are sufficiently documented to illustrate the need for convergent
solutions. This does not mean rhetorical “best practice”, but rather the
shared development of generic, tested and peer reviewed multi-platform
materials that reduce the initial barriers to information and the statutory
services.
With the clear dialogue and the open commitment demonstrated by those
responsible for the ‘equalities’ from the statutory sectors across North Wales
and the MEEA Project beneficiaries in conducting the research for this Report,
there is the opportunity to make achievable and maintainable impacts.
Working together with BME individuals and populations, to provide more
equitable access to services and an improved knowledge of provisions
available, is in itself a preventative measure. If issues of language and
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miscomprehensions are addressed at an initial stage, (for both BME and
indigenous English/Welsh speaking populations) it may reduce both costs for
service providers and anxiety of the individuals concerned.
1. Background Information
The research was carried out by NWREN as part of the MEEA Project and
summarises the research findings on experiences of Minority Ethnic Elders
(MEE) across North Wales on accessing healthcare and other statutory
services with a focus on provision of own dialect interpreting services.
1.1 Review of the Existing Literature
Existing literature shows that provision of own dialect interpreting provision to
ethnic minority individuals has been an issue for many years: the report,
“Access to Health: A Minority Ethnic Perspective” dated April 1994 and carried
out in Aylesbury and Milton Keynes, revealed a deficiency in supply. In 2006,
the report, “Health and Care Consultation with the Chinese Women’s Society”
conducted in North Wales, revealed a “need for an interpreter service
standing out as key to services for those with language problems. The
provision of professional interpreters trained to work within the health service
is the king pin of a policy for equal access to health services.”
1.2 The Local context
There are six Local Authority areas in the North of Wales. Regarding Health
Care and Criminal Justice, each of the six LA areas come under a North Wales
centralised management body: Betsi Cadwaladr for Health Care and North
Wales Police respectively. In this research, Gwynedd, Denbighshire and
Wrexham, three out of six Local Authority areas of North Wales were
represented by the Voluntary Sector, North Wales Police and Betsi Cadwaladr.
The Project Beneficiary Participants (45) came from Chinese, European
Portuguese, Hong Kong Chinese, Indian, Irish, and Zimbabwean communities
based in Gwynedd, Denbighshire and Wrexham. Dialects spoken (12)
included Cantonese, Mandarin, Hakka, Malay, German, European Portuguese,
Gujurati, Hindi, Urdu, Punjabi, Swahili and Zimbabwean.
Section 1b: Overview
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2.1 Method
Design –
This was a three-phases Qualitative piece of research
i. Initial focus groups
ii. Semi-structured discussion groups with beneficiaries
iii. Semi-structured discussion groups with service providers
Both semi-structured discussion groups ii. and iii. were run in parallel.
2.2 The Participants
The Project beneficiary participants came from Gwynedd & Môn, Denbighshire
and Wrexham. The Project Beneficiary Participants (45) included Chinese,
European Portuguese, Hong Kong Chinese, Indian, Irish, and Zimbabwean
communities based in Gwynedd, Denbighshire and Wrexham. Ages ranged
from 50 to 80. Dialects spoken (12) included Cantonese, Mandarin, Hakka,
Malay, German, European Portuguese, Gujurati, Hindi, Urdu, Punjabi, Swahili
and Zimbabwean.
Service providers represented came from the Voluntary Sector, North Wales
Police and Betsi Cadwaladr University Hospital (BCUHB).
For the first phase, contact was made through monthly NWREN MEEA project
Advocafé meetings. Phase 2 took place at the 2014 NWREN MEEA
conference, held at a central location in Llandudno. Project beneficiaries and
service providers attended this conference, during which both groups took
part in a 30 minute discussion group.
2.4 Phase 1
Phase one of the research was carried out via semi-structured focus groups
2.3 Aims and Objectives
1) to formally collate, the incidence of poor access to own dialect interpreting
provision, and
2) to ascertain the possible impact/s on minority ethnic elders deriving from the
difficulties encountered with comprehension and translation.
Both of the above objectives relate to accessing statutory services.
The aims of this research are to use the collated data to advocate and promote a
better understanding of the translation needs of Minority Ethnic Elders (MEE)
with a view to informing future provision and policy decisions across Wales.
Section 2: Method
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which took place in 2014: the first in Wrexham with seven participants, the
second in Gwynedd with 12 participants. The questions posed were:
Which, out of the following, are most important to you:
Social/Leisure/Recreation; Personal Advocacy Services; Health/Fitness; Get
Together Mornings; Adult Education; Welfare/Benefits; Financial/Budgeting;
Personal Grooming; Housing/maintenance; Religious/Cultural; Transport;
Other? The results from this phase were used to guide and develop the
questions for the semi structured discussion groups in phases ii and iii groups
B and C.
2.5 Phase 2
The second phase was carried out during the NWREN MEEA Project
conference, amongst two different groups of participants: project
beneficiaries and service providers. The project beneficiaries, Group A,
numbered 30 participants from Gwynedd, 13 from Wrexham and 2 from
Denbighshire. Languages spoken “on the floor” at the conference included
Cantonese, Mandarin, Hakka, Malay, European Portuguese, German, Gujurati,
Hindi, Urdu, Punjabi, Swahili, Welsh and English. Not all project beneficiary
participants speak English, however, amongst those who do, English speaking
skills vary greatly.
In the service provider group, Group B, there were six service provider
participants, representing Betsi Cadwaladr University Health Board (BCUHB);
Gwynedd County Council; Wrexham County Council; North Wales Police;
North Wales Community Health Council (CIC). The method used during the
conference consisted of semi-structured discussion groups, each led by a
facilitator and a recorder.
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2.6 Phase 2 — The Questions
The following four questions were discussed with the project beneficiary respondents (Group
A):
1. In your experience, what have been or could be the consequences of not having own
dialect interpreting when accessing Health or other Statutory services?
2. In your experience, what have been or could be the consequences if patients and
practitioners are not able to understand one another?
3. In your experience, what has been or could be the impact on patients and their families if
they cannot explain their situation to their families?
4. In your experience, what have been or could be the consequences for patients on their
overall health through not being able to understand their prognosis?
The service provider respondents discussed the following questions (Group B):
1. What are the difficulties you, as a statutory agency face in providing translation services?
2. What suggestions can you think of to overcome current difficulties or improve the current
provision? Please include successful practices that you currently implement.
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3.1 Phase 1
The results across all groups showed perception of a clear gap, reflected by
each group of participants, in provision of interpreting services for minority
ethnic elder community members when accessing statutory services. In
addition, in the few cited examples of service providers supplying interpreting
services, the wrong dialect was used, resulting in, at best, poor service with
accompanying frustration and distress, at worst, leading to a possible life-
threatening situation.
These initial Data were instrumental in the decision to take the research
further and after discussion with the participants and line-management, the
decision was taken to stage a conference at which both Group A and Group B
would take part in a more detailed second phase of research.
3.2 Phase 2 – Project Beneficiaries
For simplicity the questions within this report had sub-divisions but on the
ground, the data captured was all interrelated and co-dependent. Thus the
results have been split into the following categories Physical;
Psychological/Emotional; Financial; Practical.
3.2.2 Physical
i One of the more poignant examples disclosed by Group A was of a family
who had to wait 15 years for an appropriate service: “if you have difficulty
with your GP in primary care – there is no way you’ll ever get to secondary
care”. If you are not understood within the primary care system, you’ll never
even reach secondary care to know if there are problems or not. This raises
the question of the prevalence of incidences of un-diagnosed health problems
which exist in ME populations.
ii One participant reported a case of a complicated pregnancy which, due to
lack of available translation services, was compounded by a delay in advising
termination of the pregnancy, causing potential undue suffering to the foetus
with potential to threaten the wellbeing of the mother. In this case, there
were strong criticisms of wasting time whilst waiting for interpreting support,
leading to deterioration of patient's health.
iii Receiving treatment: participants disclosed some examples of diabetes
sufferers in hospital not understanding the menu and having to wait for family
members to visit them in hospital in order to translate for them. Support was
required for both explaining to hospital staff that they were diabetic and for
translating instructions regarding medicines and/or procedures prescribed.
The situation led to patients being presented with inappropriate food, which
in some cases led to undesirable fluctuations in blood-sugar levels.
Section 3: The Results – Project Beneficiaries (Group A)
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iv Lack of interpreting provision was found to affect both in-treatment and
discharge aspects of the process, as evidenced by one participant’s disclosure.
While in hospital for an operation, she was not given any explanation of the
procedure she was about to undertake, nor, after her operation, was she
given any aftercare information: this led to the patient experiencing
complications after her discharge.
v The above examples highlight participants’ experiences of some of the
dangers inherent both at point of accessing support and receiving treatment.
However, many highlighted fears concerning the transition from hospital or
centre-based health care to home and resumption of self-care, particularly
when an individual is required to continue with specific, prescribed self-
administered health-care routines or prescribed medicines.
The issue of difficulties in patient-to-professional communication during
transitions from hospital to home, was further highlighted by anecdotal
evidence of patients not realising the seriousness and consequences of their
diagnosis, to the extent of discharging themselves and later requiring re-
admission through Accident and Emergency.
3.2.3 Psychological/Emotional
i Poor translation affects not just the individual but the whole family and at
times the whole Community. In one participant’s disclosure above, of
patients receiving no treatment or when the condition remains undiagnosed,
family members are often asked to translate, including children or young
adults in inappropriate situations, causing embarrassment and distress.
Participants discussed fears of the dangers inherent in such situations, of mis-
translation of medical terms – thereby placing further stress on the family
member called upon to translate.
ii Participants discussed fears that, during later stages in the health-care
process, the family may worry because they do not know or understand the
prognosis and the patient can become angry and anxious, with raised stress
levels adding to and further exacerbating the patient’s original condition,
causing distress amongst the family.
iii The patient mentioned at 3.2.2.iv was not given any explanations of the
treatment she was about to receive nor any post-op information and on
returning home experienced post-op complications. In the discussion group,
she spoke of how frightening she found this experience.
iv GPs have been known to send patients away because of language
difficulties: one participant disclosed an anecdote of patients having to go
“home” to their country of origin (in some cases, flying up to 6,000 miles) in
order to get consultation and appropriate treatment.
v Other participants spoke of their frustrations, fears and feelings of exclusion
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brought about by not being able to understand or be understood, saying that
this experience is not just limited to accessing the Health Service, but to every
other local authority service. Participants spoke of experiencing such
difficulties when they were given access to interpreting provision in the wrong
dialect, for example, being given Brazilian Portuguese instead of European
Portuguese translation.
vi Many participants made references to the handling of appointments
concerning gender specific problems which are very private for both men and
women, at which a family member is often expected to translate (due to lack
of or inadequate interpreting provision), bringing about embarrassment and
distress for both the patient and their family interpreter – all respondents felt
it entirely inappropriate that relatives are called upon to bear the brunt of
such awkward situations.
vii Several participants expressed lack of trust in the health system, because
they, as individuals, were not understood and in turn they do not understand
medical terminology used by health professionals in relation to their
conditions. It is not difficult to envisage the worry and depression that stems
from this and circulates within the family. It also causes conflict within the
family and an unfair dependency on the immediate community: this is
especially the case where the same few voluntary community interpreters are
very often called upon at all times of the day or night.
viii Participants spoke of how community interpreting relies upon the
goodwill of these few people and the actual translation at times has to travel
through three languages. It is not hard to appreciate how the margin for
error increases, with sometimes dire consequences.
ix One participant told of how a diabetic was very frightened because they
could not explain to the staff that they needed to self-medicate and had to
wait until a family member arrived: a situation that caused considerable fear
and frustration.
3.2.4 Financial
In the example quoted above of GPs sending patients “home” because of
language difficulties, leading to patients, in some cases, flying up to 6,000
miles in order to get consultation and appropriate treatment, this can incur
huge expense, being absent from work and in some cases leading to loss of
employment. Upon return to the UK, they find themselves in the position of
having to re-build their lives from scratch: this has obvious effects on
immediate family.
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3.2.5 Practical
i Appointments have been missed as there was nobody to translate, thereby
leading to further delays in consultation, diagnosis and appropriate treatment,
as well as a waste of resources.
ii One of the biggest problems is, “telling the doctor about your illness and
the medication you are taking”. Participants told of how, in some cases, the
patients come away from surgery and the pharmacy with little or no idea how
and when to take the medication. In certain circumstances, this might easily
be construed as clinical negligence.
iii GPs do not always have awareness of ethnic-specific conditions. For
example: the more holistic perspective held within European and Asian
cultures towards menstruation. Females from both communities in the focus
groups reported difficulties in getting their GPs to comprehend this
perspective. They also reported that it was both unfair and embarrassing to
ask their husbands/partners to help with the translation on such personal,
gender-specific matters.
iv Participants spoke of the assumptions made on behalf of children who
speak English/Welsh, that they would be able to take the place of appropriate
interpreting provision. However, in many cases, children may not have
sufficient knowledge of their parents’ mother tongue to translate or
understand both sides of the communication.
v There were three examples, given by participants, of service user needs
being misunderstood, resulting in the inappropriate interpreter being
provided: namely inappropriate choice of Chinese and Portuguese languages,
with no reference to the correct dialect spoken, when accessing both the
Criminal Justice and Health Care systems.
vi Participants disclosed that they did not know what services or help were
available to them.
vii Within the secondary care system, there were complaints (3.2.2.iv) that
the operating procedure was not explained nor aftercare addressed. In one
case, this led to complications and the patient had to be re-admitted via
Accident and Emergency.
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3.3.1 Difficulties faced by Service Providers
i Uppermost in the discussion were concerns related to feeling at a
disadvantage due to lack of knowledge in the languages being spoken by
ethnic minority groups. These concerns included: fear of things being lost in
translation between GP, patient, translator. Providers expressed a lack of
confidence in accessing the services due to this disadvantage, when using
interpreters, along with uncertainty as to which interpreters would provide the
most reliable and trustworthy service, community interpreters, or only
professional interpreting services.
ii There was a perception amongst Group B participants that providing the
right level of interpreting provision can be time consuming, and a habit of
over-professionalising everything adds to this.
iii Participants stated that, from a health-care point of view, if a GP does not
flag up the need for a translator when referring to hospital, the hospital will
not be able to prepare. This inevitably leads to a waste of resources, in terms
of both time and (public) money, with appointments needing to be
rearranged and therefore wasted. The opinion in the group was that nobody
benefits from this.
iv The participants expressed awareness of a knowledge gap with regards to
speech therapy in non-English/Welsh speakers, for example after a
stroke/brain trauma.
v Group B participants discussed the critical issues of language requirements
at job centres. This has previously been reported by NWREN in the report,
“It’s Just a Feeling” (2008). There is contemporary evidence of these issues
still commonly occurring. They are aware of difficulties faced by individuals
from ethnic minority communities, not given access to own dialect
interpreters when visiting the Job Centre when trying to explain why they are
unable to work. Group B participants referred to how the Job Centre service
“being an insensitive service already”, becomes at times the focus of a
traumatic experience for ethnic minority elders who, not being able to
articulate the reasons behind their obstacles to work find themselves trapped
in difficult circumstances compounded by lack of financial support. Group B
participants believe there to be a correlation between poverty and not
obtaining what is needed and fulfilling the rights of (ethnic minority elder)
individuals.
vi Group B participants spoke of facing hidden dynamics when considering
interpreting provision – not just those of language, culture and gender
sensitivity but differences of dialect, education, and social class: all factors
which relate to the experience of using interpreters.
3.3 Phase 2 - Service Provider discussion group (Group B)
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vii There was awareness, amongst Group B participants that frontline staff
members of their organisations are not aware of their organisations’
commitment to the provision of interpreting services and in cases where
frontline staff were aware, there is a lack of knowledge concerning their
professional and fair use.
3.3.2 Suggestions for Improvement
i More work needs to be done to ensure frontline staff in local authority
organisations are aware of the interpreting services available, along with
training in fair and professional conduct when working with interpreters.
Group B participants also felt that more needs to be done to build trust with
interpreting services.
ii Welsh Government must address ESOL provisions, which at present do not
meet the needs of the community and do not fulfill the requirements of the
Well-being of Future Generations (Wales) Bill. There is an opportunity whilst
trying to implement this Act also to facilitate community cohesion and
relations with community and public bodies.
iii “Language and understanding is at the heart of every social issue”: Group
B participants felt that, in order to enable and empower communities, it is
essential that these needs are addressed.
iv With the merging of local authorities and consequent expected cuts to
budgets, there must be protection of translation and language services. Local
authorities must communicate this with third sector organisations to make
sure minority voices do not go unheard.
v Similar levels of patient protection to those given to deaf and visually
impaired individuals, should also be applied to people who experience
language barriers. We should not wait for a High Court case to highlight the
dangers and risks that can occur because of these.
vi There was much evidence of passionate commitment among the Group B
participants to driving forward the issues discussed in their group. However,
they all expressed real fears that, with austerity times and resultant budget
cuts, the number of people remaining in post to progress this work, e.g.
equality and diversity officers/managers, is decreasing every year. It was
claimed that because of cuts, with resultant redundancies or retirements,
those roles are not being re-advertised, leading to fewer equality and diversity
roles remaining in place. With the resultant reliance on Third Sector time-
critical projects, like the MEEA Project, to progress work on these issues,
there were concerns that without sufficient sustainability built in to such
projects, any progress made will be lost and forward movement on the issues
discussed during this survey will dwindle.
18. MEEA Project Language Report
18
As outlined in the review of the existing literature, there has long been
evidence of a deficiency in the provision of adequate interpreting services for
BME individuals. Even a cursory literature review reveals persistence of such
deficiencies since at least 1994.
Conclusion 1
In the research results above, it is clear that there are indications of a
correlation between lack of access to interpreting provision and risk to health
and well-being. Service providers are aware, at a strategic level, of their duty
of care to provide interpreting services: “Language is not a choice, it is a
need. People do not choose their language or their circumstances”.
(Thomas, 2014)
It was pointed out, by participants from both Group A and B, that there are
many different languages spoken in North Wales and within those languages
there are specific dialects. These dialects are not homogenous. For example:
a translator who speaks Mandarin may not be appropriate for many of the
Chinese dialects, ie; the service user may not understand Mandarin. Similarly,
an interpreter who speaks Brazilian Portuguese would not be appropriate for
a service user speaking European Portuguese. Indeed, throughout Phase 2,
there were many reports of a “one size fits all” approach to interpreting
provision, in terms of dialect, culture and ethnicity of interpreter offered.
Recommendation 1
There is a need to recognise that North Wales, with regard to all populations’
demography, economic makeup and geographical location, is different from
that of South Wales. Distance alone prohibits North Wales from accessing
facilities, resources and benefits that are taken for granted in parts of South
Wales. Sometimes North Wales has to develop more localised solutions. For
instance, in order to facilitate smooth and clear communication at the MEEA
Project Conference, simultaneous translation was required: this involved
procuring the services of interpreters competent in simultaneous translation
of Cantonese and European Portuguese. Due to the complete absence of an
appropriate translation and interpretation service in North Wales, interpreters
had to travel from South Wales, which had obvious financial implications.
Conclusion 2
The experience amongst the Group A participants was that there is little
realisation, on the part of frontline service provision staff, in both Primary and
Secondary Care, that time, translation and outcome are conjoined. It would
appear that this lack of awareness is universally documented across all
statutory sectors in North Wales, with the Group B participants reporting
concerns that their commitment, at strategic level, to the provision of
interpreting services as a duty of care, is not carried out by frontline staff.
4. Conclusions and Recommendations
19. MEEA Project Language Report
19
With their focus leaning towards the health-care sector, Group A participants
disclosed anecdotal examples of how this manifests at each of the three
critical points of progress through the healthcare system. For example, point
of entry – accessing support and assessment; receiving treatment or support;
lastly, the transition from hospital/health-centre based support to home-based
support or home-based maintenance of any new self-care routine.
Recommendation 2
The above conclusion points to a need for training within and across all levels
of the health-care system. There is a need to develop feasible, economically
practical and appropriate bespoke awareness-raising training solutions
focussing on all aspects across the range of Protected Characteristics as listed
under the Equality Act of 2010 (age; disability; gender reassignment;
marriage and civil partnership; pregnancy and maternity; race; religion and
belief; sex; sexual orientation). It would be worthwhile for all statutory and
voluntary sector organisations across North Wales to explore this possibility.
Conclusion 3
Group A participants reported that, in order to apply for a translation service,
the service user must be able to read and understand written English/Welsh:
participants disclosed that they did not know what services or help were
available to them. (It must be stated that this information is available on
BCUHB website – but only in English and Welsh.)
Recommendation 3
Group A participants asked for multi-language buttons on the BCUHB website,
that would enable service users to make an Application for Interpreting
Provision when they wish to access the health service. The cost of translating
such a small set of instructions into a multitude of languages is small and
would allow service users to progress their enquiry to the next level.
Conclusion 4
Section 2, introducing the participants (p.9), describes the levels of English
proficiency amongst Group A participants as varying greatly. This group
stated during the research, that even though they do speak English, when
they are unwell they naturally prefer to communicate in their first language.
Meanwhile, Group B participants expressed concerns that ESOL provisions do
not meet the needs of the community or the Well-being of Future Generations
(Wales) Bill: it is important to note that whilst this report emphasises a lack of
own dialect interpreting provision, a short-term need, there is also a need, in
the longer-term, for further investment, by the Welsh Government, in
increasing provision amongst BME communities of ESOL classes. This group
felt that such joint commitments would provide opportunities for facilitating
community cohesion.
20. MEEA Project Language Report
20
Recommendation 4
There needs to be a better understanding with regard to the provision of
ESOL classes: in these difficult times, even though ESOL has parity with
Essential Skills training, safeguarding of funding for ESOL classes is essential.
In the case of elders who have joined their families in Wales, there is an
obvious cost implication, with the possible added cognitive disadvantage of
having to learn a new language as an elder. The recommendation is that
provision of ESOL should be reviewed at both regional and Welsh Assembly
Government level. In addition, lack of language skills/fluency is often cited as
a reason for the mentality of ghettoisation or lack of integration.
Conclusion 5
The shortage of interpreters was universally commented upon, which
surprised the agencies who were making their best efforts to meet this need.
In her opening speech, Sally Thomas from BCUHB outlined their current
interpreting provision.
“The Health Board provide interpretation services via a contract with
Wales Interpretation and Translation Service (WITS). The Health
Board have developed a protocol to guide staff using this service.
WITS was created in 2009 following Welsh Assembly Government
supported research. (2007/8) Historically there had been difficulties
in securing high quality and cost efficient linguistic services across
Wales.
The WITS service is designed to provide a "one-stop-shop" to
improve access to public services for people whose first language
may not be English or Welsh. BCUHB reported that staff awareness
of the policy requirement is raised regularly. BCUHB recognise that in
practice interpretation support is not always actioned in a timely
manner: they are working to address this.”
As suggested by BCUHB, their existing ongoing mandatory training is striving
to further strengthen the extent to which equality is understood and
integrated into work across the organisation. Increased engagement with
people with protected characteristics creates a better understanding and can
inform improvements.
Recommendation 5
The disparity between the findings and the activities of agencies (such as the
BCUHB and others) is important data. It illustrates a need for the
development of a generic protocol across agencies to encourage and
empower service users to request interpretation services. As in the case of
21. MEEA Project Language Report
21
Health, the need was highlighted for increased awareness with General
Practitioners and frontline staff in primary care in ensuring that, together with
service users, the correct language and dialect is identified. (2014)
The North Wales Public Sector Equality Network (NWPSEN) work together to
deliver shared objectives. This forum could provide an excellent forum in
which to address some of these issues.
Conclusion 6
In carrying out this research, we attempted to take an innovative approach
that would challenge the concept of the “one-size fits all” philosophy by
bringing together service users and service providers to discuss difficult issues
that stand on opposite sides of the same coin. What transpired was a clear,
open and honest communication, wherein it was found that the service users’
difficulties reflected the service providers’ worries and concerns.
Recommendation 6
Using and building on this experience of open, honest and clear
communication, we would strongly recommend that the statutory and
voluntary agencies tackle issues of lack of interpretation services in a joined-
up and unified fashion. This would involve all sectors under one united
agenda, with clear agreement on how it will be funded, ensuring that the
issues are informed by the existing expertise within both the voluntary sector
and local communities, for example; establishing a bank of trained community
interpreters from across the region. All present at the conference agreed to
reconvene on 11th
November 2015: further, earlier sessions are urgently
recommended prior to this date to continue dialogue and build on connections
made on 9th
December 2014.
Closing Comments
Crystal (1999) defines dialect as: “A language variety in which the use of
grammar and vocabulary identifies the regional or social background of the
user.” Professor Crystal outlines the different ways in which dialect can
define the speaker: regional dialect “conveys information about the speaker’s
geographical origin; a social dialect conveys information about the speaker’s
class, social status, educational background, occupation or other such
notions.” There are also rural and urban dialects: the point being that
dialect is a broad term which, within itself, holds many possible permutations.
The author of this report considers that this demonstrates the importance,
when giving BME elders language support in North Wales, of providing
appropriate own dialect interpreting services: the overwhelming message
from Group A participants was that “a one-size fits all philosophy is wholly
inappropriate” and indeed has long been out of date.
22. MEEA Project Language Report
22
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