Communication – it’s just one word, but it affects every human being in many different ways. In healthcare, we’re taught that as students, and as professionals, we should pride ourselves on communicating well with others. Equally, the breast screening programme communicates with millions of women every year, and most of the time does it well – but is there room for improvement on all fronts? The WoMMeN team have been busy..
We all communicate, all day long, even when we don’t speak – one thing we’re taught in healthcare is that most communication between humans is by both body language and spoken/written language, and that we should pay close attention to both so that we fully understand what our patients are telling us. But what if you remove one part of this? What if you remove the spoken/written language? Logic tells us that our understanding of a situation diminishes, and I think this is true – let me tell you about my holidays.
Communicating on holiday
In my traditional north-west upbringing, the entire family including aunts, uncles, cousins and grandparents always went on holiday together. Carrying on in this tradition somewhat, but to a lesser degree, this year we went on holiday with not only the kids but my 17 year old niece – self-catering in France, and very lovely it was too.
One day we set off in the car with the kids to an all-day expedition to an adventure park, leaving niece behind at the apartment so that she could relax watching some awful TV and listening to some “music” (just noise, I tell you, all noise!). Phoning her on the way home I asked what she’d done, and what she’d eaten for her lunch. I am, after all, northern, and “what you’ve had for your dinner” is an expected daily conversation.
“I didn’t have any lunch”
“Why didn’t you have any lunch? I left you some money, just go to the shop”
“They’ll talk to me in French, I’m too scared, what if I don’t know what they’ve said!?”
Now this is someone who has just done her French GCSE. She went hungry all day rather than risk being judged stupid for not understanding the language or the situation that she was in. I did give her credit for at least not doing the typically English thing of speaking slowly and carefully in English, just a little louder, but at another level I was exasperated. At still another level, I totally got where she was coming from – what’s that great quote by Amy Chua?
“Do you know what a foreign accent is? It’s a sign of bravery”
I can just about get by in French, but I know that I have a natural aptitude for language, and I greatly sympathise with anyone who doesn’t.
So there we have someone in a different culture, needing to access a service but feeling unable to because they don’t feel that they fully understand what will happen, or what will be asked of them. Does this start ringing bells for anybody?
Communication in Breast Screening
See, I think this happens in healthcare too, and certainly in breast screening. People are put off from even attending for a mammogram because the communication they have with the breast screening programme is, at the first contact, in a language they can’t understand.
This is backed up by new research just published in the Radiography Journal – the professional journal of Radiographers. Sterlingova and Lunden interviewed women who had not attended for their mammogram in Sweden, trying to understand why they hadn’t. As we have found in the past (Robinson et al ) women get their knowledge about mammograms from previous experiences, word of mouth and communication from the programme. Sterlingova and Lunden found this too – a bad experience goes a long way – but they also discovered that a lack of active promotion, and a lack of personalisation and adaptation to individual needs were stopping women from attending.
One woman who did not speak Swedish reported that she didn’t attend after an experience where she didn’t understand at all what was going on. Most women who had decided not to attend again, did so because of the ‘assembly-line’ feel of a mass screening programme, which is where the lack of personalisation comes in.
To combat this, it has been suggested that we increase our “cultural competence” but what’s that? When we visited the EMCAM17 event, hosted by Can Survive UK we learned about it then. It’s acknowledging the differences in cultures and crucially, adapting services to meet all the different cultural needs.
It’s something that’s been written about before when looking at why people don’t access services – healthcare in particular – and here I’m referencing the paper by Betancourt, Green, Carrillo and Ananeh-Firempong, published in 2003. They identified that barriers to care happened at the leadership, procedural and clinical levels, and this all contributed to the very different measures of healthiness seen between majority and minority cultures in the USA.
They recommended changes at all levels, but the one that caught my eye was this:
Patient satisfaction and compliance with healthy behaviours is majorly affected when even a small language barrier is present.
Written communication in English explaining procedures or drug regimens is useless when not in the language that the patient understands, and compliance goes down.
And so it is for the breast screening programme. The invitations and leaflets are inevitably in English and it’s so very challenging for the mammographers on the front line to combat this, and help get rid of this invisible wall, but so very important that we do. Interpreters need to be encouraged, and ways of communicating the screening process need to be adapted, to give someone that personalised experience needed so that those in need of breast screening can access it with as few structural barriers as possible.
We’re a helpful bunch at WoMMeN, and to help we have had our infographic explaining the screening process translated into several different languages. We must pause here to thank the translators, who have given their time and effort to do this, and they’ve done a fabulous job. If you know anyone who speaks the languages we have got here – please point them towards the relevant infographic for us.
Please comment below, let us know any good ideas or any good practice that you’ve got going on in your departments to adapt and improve communication with our clients.
Sterlingova T, Lunden M (2017) Why do women refrain from mammography screening? Radiography http://dx.doi.org/10.1016/j.radi.2017.07.006
Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports. 2003;118(4):293-302.