Lost in translation: exploring therapists’ experiences of providing stroke rehabilitation across a language barrier

Abstract

Purpose: This study sought to explore English-speaking therapists’ experiences of providing stroke rehabilitation to non-English speaking individuals in an urban area. Methods: This was a qualitative study using focus groups. Two focus groups were conducted. Participants included physiotherapists, occupational therapists, speech and language therapists and a psychotherapist (n = 13). A grounded theory approach was used to analyse data. Results: Factors affecting rehabilitation were categorised under themes of engagement, practicalities and social context. Subtle communication was identified as a core category that ran through all themes, illustrating therapists’ use and interpretation of subtleties and nuances which a language barrier impeded. Providing rehabilitation across a language barrier was found to present significant challenges. Therapists perceived that assessment and treatment are likely to be delayed and limited in scope, especially regarding cognition and neurological communication disorders. A conceptual model of factors involved in rehabilitation across a language barrier was generated. Conclusions: Therapists perceive that rehabilitation is affected by a language barrier. The conceptual model illustrates the interrelationship between factors affecting rehabilitation provision when there is a language barrier. Subtle communication was found to be an important therapeutic tool which was lost across a language barrier, and may have broader relevance to therapeutic relationships in the field of rehabilitation. Further research is needed to gain insights into experiences of individuals receiving rehabilitation across a language barrier and to identify how to enhance the efficacy of rehabilitation for them.

Implications for Rehabilitation

• As it appears rehabilitation is affected by a language barrier, this is likely to impact on the outcome of an individual’s rehabilitation.

• The concept of “subtle communication” should be recognised as a vital component of therapeutic skills.

• Improving access to formal interpreters, extending their role and introducing training could reduce practical barriers.

• The conceptual model could be utilised by clinicians as a tool for reflection or education.

• Communication
• engagement
• ethnicity
• health inequalities
• interpreters
• language
• stroke
• therapy

Acknowledgements

The author would like to thank the study participants for discussing their experiences. The research was conducted at Homerton University Hospital NHS Trust, and their role in allowing their staff to participate, as well and providing space to conduct the focus groups, is acknowledged.