Antoon Cox

Effective communication is central in emergency settings, yet is still underexplored particularly in relation to the material and spatial resources through which care is delivered. Drawing on 30 hours of ethnographic observation in a Belgian geriatric emergency ward, this paper examines how everyday objects and ward layout perpetuate communicative asymmetries that can lead to exclusion among older patients. The paper draws on Goffman’s (1981) participation framework, embodied-and-material accounts of interaction (Goodwin, 2000; Mondada, 2019), Angouri and Humonen’s topographies of practice (2023), and Feuerherm et al.’s (2021) macro–meso–micro model of language as a social determinant of health, in order to explore how the ward’s material and spatial configuration shapes the conditions for communicative inclusion and exclusion among older patients. The discussion focuses on two events, each illustrating a distinct competence the ward’s configuration expects patients to possess without explicit instruction. In the first event, the competence at stake is recognising and operating the ward’s material objects without explicit instruction; older patients without this competence employ embodied substitutes. In the second, the competence at stake is reading and restructuring the spatial participation frames the ward’s layout enacts; patients who are not authorised to reconfigure that space are left to repair the frame with whatever resources they hold. Our findings show how in both events, the interpretive labour is shifted onto the patient, with a resulting risk of exclusion and subsequent health penalty.

Background Medical consultation is an interactive communicative process in which the doctor and the patient take turns to formulate and allow for the construction of the interaction. Communication challenges between patients and healthcare professionals during consultations can lead to miscommunication or complete breakdowns in interaction. Language barriers are a primary contributor to these difficulties. With increasing migration, the number of non-native language-speaking patients seeking medical care has risen substantially. Aim To explore the experiences of medical and allied healthcare professionals in Belgium when encountering language barriers during patient communication in clinical settings. Method A quantitative, multilingual, cross-sectional survey study was conducted in Belgium to examine the experiences of healthcare professionals during patient interactions involving language barriers. Results A total of 179 healthcare professionals completed the survey. All respondents reported encountering patients with whom communication was hindered by language barriers. Patients’ body language and lack of responsiveness were key indicators of these barriers. The professional role of respondents significantly influenced the type of alternative communication technique employed (p = 0.00171). Speech-to-text translation was the preferred strategy, reported by 54% (n = 97) of participants, followed by ad hoc interpretation by accompanying people or other staff members. Conclusion Language barriers impact all categories of healthcare providers, regardless of their professional role—whether during treatment, registration, discharge, or medication collection. Implementing strategies such as targeted communication training, greater use of professional interpreters, and culturally adapted health education tools may help mitigate these challenges and enhance patient–provider communication.

Objective To identify the factors that prevent or hinder access to mental healthcare services for refugees, asylum seekers and migrants. Design An umbrella review was conducted on scoping reviews, systematic reviews, meta-analyses and meta-syntheses published between January 2013 and December 2023. Data sources The databases searched (on 11 December 2023) included PubMed (via NCBI, including MEDLINE), Embase (via Embase.com), Web of Science Core Collection, Scopus and the Cochrane Database of Systematic Reviews (via Cochrane Library). Search strings were categorised as concepts, wherein concept one was population (refugees, asylum seekers and migrants), concept two was mental health services and concept three was the type of review (systematic review, meta-analysis, scoping review or literature review). Eligibility criteria for selecting studies Reviews were included if study participants were refugees, asylum seekers and migrants. Additionally, mental health-providing services or organisations and mental health providers were included. Excluded study participants were people with a migration background and second- or third-generation migrants. Data extraction and synthesis Two independent reviewers screened the identified articles on title and The 48 full-text articles were assessed in detail against inclusion and exclusion criteria by the two researchers and one person from the Belgian Superior Health Council. Results 18 reviews were included. The extensive literature review identified various factors that prevent and restrict access to mental healthcare services for individuals with a recent migration background. Among the eight concepts of barriers, the most frequently mentioned were stigma and stigmatisation, language and communication challenges, financial obstacles, cultural barriers (including religious beliefs and faith) and issues with service delivery. Additionally, differences in culture, education and gender were recognised as factors limiting access to mental health services. Recommendations for policy and practice included implementing a multidisciplinary and multi-agency approach to facilitate access for newly arriving migrants and refugees, increasing financial allocations for translation and interpretation services, enabling policies to promote mental health utilisation and introducing educational programmes at the grassroot level among migrants and refugees. Conclusion Policy implementation should address the identified barriers and be routinely assessed for efficacy in service delivery and uptake. Future research should focus on enabling the utilisation of mental healthcare services among migrants, asylum seekers, and refugees.

Patient companions (PCs) can have an ambiguous impact on the quality of communication during multilingual medical consultations and therefore on health outcomes. Studies of multilingual medical consultations have focused mainly on PCs’ role as interpreters, with less regard to other roles they may take up. This paper uses mixed methods to investigate PC role dynamics in multilingual PC-mediated consultations and how they affect the management of a patient’s Lifeworld, a crucial element for history taking and rapport building. Nine recordings of multilingual PC-mediated consultations from a Brussels emergency department, complemented with ethnographic notes and clinician interviews, were subjected to linguistic-ethnographic analysis and a codification of communication patterns and PC roles to explore the link between PC roles and Lifeworld management. PC roles were grouped into four stances (Linguistic agent, Lifeworld agent, System agent, and Principal). The communication patterns were grouped into three categories (“strictly medicine”, “Lifeworld heard/included”, and “Lifeworld interrupted”). In ED consultations, patients’ Lifeworld frequently remains inadequately addressed, primarily due to physician interruptions. Significant associations are observed between roles taken up by PCs and the way patients’ Lifeworld is managed. Successful integration of Lifeworld aspects is best supported by PCs taking up the role of System agent, possibly because it allows them to link the Lifeworld directly to medical issues. Linguistic-ethnographic analysis reveals how language barriers, PC role changes and Lifeworld management strategies are taking shape organically (often implicitly) determined by a wide range of situational factors, such as the complexity of the topic, the available (non)verbal linguistic repertoire, the level of meta-communication, explicit role negotiation and timing. Since poor Lifeworld management negatively impacts care, clinicians should be trained to detect and manage role dynamics and relevant situational factors in PC-mediated multilingual consultations to protect patients’ right to high-quality communication and healthcare.

The aim of this article is to illustrate the goals, process and results of the first stage of a European project: MentalHealth4All. Partners from 9 different European countries have worked together to design a multilingual validated repository targeted at third-country nationals with limited language proficiency (LLP TCNs) and healthcare providers, which contains resources to improve this population’s knowledge and understanding of how to access interlinguistic support in mental healthcare services in the main languages of the countries involved in the project. The present article provides a detailed overview of the assessment process of resources and its main results.

In this chapter, we consider social care as the provision of help, care and protection from harm to people who need additional support. This support can take a wide variety of forms and is often carried out informally by relatives, but here we primarily focus on variants of social care that occur within institutional contexts and we zoom in on situations in which the presence of an interpreter is required. These situations have thus far not been studied very extensively and in the literature, attention is mainly drawn to interpreting quality and the need for training of interpreters as well as social care providers. Next to these topics, a number of critical issues emerge, namely (1) the specific complexity and consequences of the choice to use professional interpreters or to draw on alternatives; (2) the implications of the fact that many multilingual professionals engaged in social care assume a double role; (3) the challenge of establishing rapport, which is crucial in social care contexts, but which is described as difficult when a third party is present and (4) the issue of interpreters as potential gatekeepers in social care interactions. A few concluding remarks will close this chapter.

More than half of the world’s displaced population has moved to urban or peri-urban areas, and in Brussels, the superdiverse Belgian and European capital, the emergency care sector provides an important setting for analysing the multilingual challenges faced by health practitioners. To gain a better insight in the interactional dynamics of emergency department consultations with immigrant patients, this paper focuses on multilingual strategies that include ‘ad hoc’ communicative solutions used in the absence of professional interpreters (lingua franca use, non-verbal communication, medical translation software, language mediation through companions or hospital staff). Despite their efforts, the participants in our two case-studies lacked the linguistic and interpreting subtleties needed to perform complex linguistic-interactional tasks, and in this way, a form of ‘false fluency’ was created. Ad hoc multilingual solutions, significant as they are, require additional language support to avoid diagnostic insecurity. At the level of patient management, a ‘linguistic assessment’ of patients could potentially be integrated into the triage process, and clinicians should be trained on how to recognise and remediate communication problems under the specific conditions of the emergency department.