This thesis contributes original knowledge through an inclusive design approach to lowering language and communication barriers in healthcare and suggests shifting the discussion from culture to context to lower intra-cultural hindrances towards learning English amongst some ethnic minorities. It offers an adaptable, scalable concept for gathering data on ethnic minorities (considering both different generations and religions) and employs a framework based analysis in design. Over the course of three studies grounded on theoretical insights from literature, primary research lead to the development and testing of innovative aids for communication, including educative and motivational elements. This research began by seeking to understand ethnic minority consumers (EMCs) perceptions of any barriers hindering their take-up of products or services in the UK, and their preferences. This is particularly significant as the UK s EMC population is predicted to double by 2051 and to diversify further, presenting challenges for social cohesion and planning future community goals. EMCs also represent a significant market for service and product providers. The research focussed on EMCs from the Indian Subcontinent based on religions and generations. It highlighted that first generation females lacking English and/or literacy (across religions and age groups) faced problems with services and issues around empowerment . The importance of improved access to healthcare was a strong theme. On investigating NHS staffs perceptions, five barriers were identified (Language barriers; Low-literacy; a Lack of understanding; Attitudes, gender and health beliefs; and Information retention) and that a female subgroup was particularly affected. This study sets out staffs perceptions of the aids currently employed and suggestions of what would help. It identified a (currently) low use of visual communication aids in adult-patient care and that pharmacist-patient communication in pharmacies was low. Ideally, staff would like patients to learn English and to use more low-cost visual communication aids. These findings lead to the development of innovative visual communication aids through inclusive and user-centred approaches and participatory design and brainstorming methods. This enabled the development of aids by considering the needs of NHS staff, EMCs lacking English and/or literacy and indigenous elderly people to promote better patient-staff communication including a take-away educational element for learning English at home.

Bakgrund: En del patienter som söker hälso- och sjukvård har ett annat modersmål än vad som talas i landet de söker vård. Det leder till svårigheter att erbjuda vård och problem med att tillgodose information om hälsoåtgärder till patienten. Tidigare forskning visar på de problem patienter upplever i sådana situationer. Problem: Missförstånd kan uppstå mellan sjuksköterska och patient när de inte talar samma modersmål. Patienter kan inte beskriva sina symtom vilket leder till svårigheter att få sina omvårdnadsbehov tillgodosedda. Detta kan leda till att patienter känner sig diskriminerade och upplever att de inte får den vård de har behov av. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av kommunikation i omvårdnadsarbetet med patienter som har ett annat modersmål. Metod: En allmän litteraturöversikt genomfördes med 11 artiklar, varav nio kvalitativa, en kvantitativ och en mixed method. Resultat: När översättning med tolk användes underlättades kommunikationen mellan sjuksköterskan och patienten. Missförstånd minskade i informationsutbytet vilket bidrog till att omvårdnaden förbättrades. Patienternas oro avtog då de delgavs information som de förstod. Det var likaså viktigt att avsätta tid för kommunikationen med patienterna med ett annat modersmål. Slutsats: När sjuksköterskor har stöd i kommunikationen med patienter med ett annat modersmål bidrar det till bättre omvårdnad. / Background: Some patients seeking healthcare have a different mother tongue than what is spoken in the country seeking healthcare in. This leads to difficulties in providing care and information on health measures to patients. Research shows the problems patients experience in such situations. Problem: Misunderstanding can occur between nurse and patients when the same language is not spoken. Difficulties in describeing symptoms can lead to difficulties in meeting patients caring needs. Patients can feel discriminated and experiencing not receiveing the care they need. Aim: The purpose was to describe nurses' experiences of communication when caring for patients who have a different mother tongue. Method: A general literature review was conducted with 11 articles, nine were qualitative, one quantitative and one mixed method. Result: Use of interpretor in translation facilitated communication between the nurse and the patient. Misunderstandings decreased in the information exchange, which contributed to nursing improvement. The patients' concerns subsided as they understood the information. It was important to set aside time for the patients with another mother tongue. Conclusions: When nurses have support in communication with patients with another mother tongue contribute to a better care.

Bakgrund: I Sverige har antalet invånare med utländsk bakgrund ökat de senaste åren vilket medför att hälso- och sjukvården vårdar allt fler patienter som inte kan det svenska språket. Informationsutbytet mellan patienten och sjuksköterskan är en viktig del av vårdandet. Arbetet inom hemsjukvården kan vara utmanande då allt fler patienter vårdas hemma, och sjuksköterskor ska kunna leva upp till de krav som ställs på att ge alla patienter god vård på lika villkor. Språkliga hinder kan vara en utmaning för sjuksköterskor i mötet med patienter. När kommunikationen inte fungerar på grund av språkbarriärer riskerar patientens vård att drabbas negativt. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av språkbarriärer vid mötet med patienter i hemsjukvården. Metod: Studien genomfördes med en kvalitativ induktiv ansats med åtta semistrukturerade intervjuer. Tre distriktssköterskor, en specialistsjuksköterska inom vård av äldre samt fyra sjuksköterskor deltog. Datainsamlingen analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier och tio underkategorier. Sjuksköterskorna använde sig ofta av olika strategier för kommunikation, genom kroppsspråket samt anhöriga och vårdpersonal som tolkar. Vidare upplevde sjuksköterskorna utmaningar i vårdarbetet vid språkbarriärer, där mer tid avsattes för patienterna. Även förutsättningar för god vårdrelation samt bedömning försvårades vid språkbarriärer. Sjuksköterskorna upplevde även skillnader i vårdmötet när ett gemensamt språk saknas, där kunskapen om olika kulturer upplevdes bristande. Språkbarriärer påverkade även sjuksköterskornas arbetsbelastning samt patienters förväntningar på hemsjukvården. Slutsats: Det krävs en fungerade kommunikation för att skapa en god vårdrelation. Att använda auktoriserad tolk är inte alltid optimalt inom hemsjukvårdens verksamhet då det krävs mer planering. Ofta tolkar anhöriga och kollegor istället. Det upplevdes ta mer tid att vårda patienter som inte talar svenska, önskemål fanns om att verksamheten anställer fler sjuksköterskor. Bristande kunskap om olika kulturer upplevdes, mer utbildning inom kulturella skillnader var önskvärt för att vårdrelationen med patienten kan förbättras. Förväntningarna på hemsjukvården upplevs höga från patienter som inte talar svenska, genom lättillgänglig skriftlig information på olika språk om hemsjukvårdens verksamhet kan rätt information nås ut till patienterna. / Background: In Sweden the number of residents with a foreign background has increased, and as a result it is becoming more common in the health care to care for patients who cannot speak the Swedish language. The exchange of information between the patient and the nurse is an fundamental part of the care. The work within home care can be challenging as more patients are cared for at home and nurses must be able to live up to the requirements that are set, for all patients to receive good care on equal terms. Linguistic barriers can be a challenge for nurses when meeting patients. When the communication does not work due to language barriers, the patient's care risks being affected negatively. Aim: The aim of the study was to describe nurses' experiences of language barriers when meeting patients in home care. Method: The study was conducted with a qualitative inductive approach with eight semi-structured interviews. Three district nurses, one specialist nurse in the care of the elderly and four nurses participated. The data collection was analyzed based on a qualitative content analysis. Results: The analysis resulted in three main categories and ten subcategories. The nurses often used different strategies for communication, through the body language, and relatives and nursing staff as interpreters. Furthermore, the nurses experienced challenges in the health care by language barriers, where increased time was spent for the patients. Prerequisites to establish a good care relationship and nursing assessment were more difficult due to language barriers. The nurses also experienced differences in health care meeting when a common language is missing, where the knowledge of cultural differences was felt to be lacking. Language barriers also affected the nurses' workload and patients' expectations of home care. Conclusion: A well-functioning communication is required to create a good care relationship. Using an authorized interpreter is not optimal within the home care, as more planning is required. Instead relatives and colleagues are used as interpreters. It was perceived to take more time to care for patients who do not speak Swedish, therefor there was a wish that more nurses should be hired. Lack of knowledge in cultures was experienced, more education in cultural differences was desirable to improve the care relationship. The expectations of home care were high from patients who dont speak Swedish, through easily accessible information about home care in different languages can the right information reached to the patients.

The objective of this dissertation is to describe a systematic approach to effectively treat common mental health disorders, which involves integrating care managers and mental health specialists into the primary care treatment team. Despite an extensive body of evidence demonstrating the effectiveness of collaborative care, implementation in various “real world” settings presents a number of barriers. Successful clinical trials have failed to result in widespread changes in practice. Gaps in the literature persist as to what the clinical, organizational and financial barriers to integration are. As a result, dissemination of the model lags far behind. This dissertation sought to contribute new information to the literature on integrated health care by examining various elements of dissemination efforts. The first article examined the experience among a group of health care providers in Texas who were attempting to integrate physical and behavioral health care. This article identified the barriers that they have encountered in addition to the strategies they have used to integrate mental and physical health services, and to determine whether the strategies reflect an evidence-based model of care delivery. In addition, the perceived clinical, organizational and financial barriers to integration were evaluated. The second article for this dissertation examined quantitative clinical outcomes of an integrated health care program in a community-based clinic with a low-income, uninsured population of Hispanics, a portion of which were Spanish-speaking. A socio-culturally adapted model for the provision of comprehensive health services may have a significant impact on the health and mental health outcomes of minority, non-English speaking populations. The third article offers an in-depth case study of an interdisciplinary collaborative care treatment team. Understanding the details of program implementation and the elements of the model that community based providers found useful, and those they found challenging, has implications for widespread implementation efforts. This qualitative article offered an analysis of how the treatment team organized itself to perform as a coordinated, high functioning effort that fit well with the needs of patients, and had each professional doing what they do best. / text

Bakgrund: Kommunikation är en tvåvägsinteraktion där information överförs mellan parterna. Att kommunicera, verbalt eller icke-verbalt, innebär att förmedla budskap, dela information och att etablera, förstärka eller påverka relationer. Informationen överförs via språk, ljud eller en kod där det sistnämnda innebär bland annat kroppsspråk. Dessa faktorer är grundläggande för kommunikationen men också för att sjuksköterskor skall kunna utföra en god och säker vård. Därav är det intressant att undersöka faktorer som påverkar kommunikationen och synliggöra dessa för att trygga sjuksköterskors fortsatta arbete med evidensbaserad omvårdnad. Syfte: Litteraturstudiens syfte var att beskriva faktorer som påverkar kommunikation mellan sjuksköterska och patient utifrån sjuksköterskans perspektiv. Metod: En litteraturöversikt med induktiv ansats. Resultat: Resultatet framkom från nio vetenskapliga artiklar av kvalitativ design. Artiklarna sammanfattades och presenterades i fyra huvudteman; språkförbistring, tolkning vid språkförbistring, icke-verbal kommunikation samt sjuksköterske-patienten relationen. Slutsats: Språkförbistring är en faktor som påverkar kommunikationen. En strategi är att använda tolk. Vid ickeverbal kommunikation används andra strategier, framförallt kroppsspråk men även hjälpmedel. Möjligheten till en bra kommunikation påverkas av relationen mellan sjuksköterska och patient. Tiden är en bristvara när svårigheter i kommunikationen uppstår mellan sjuksköterska och patient. / Background: Communication is a two-way interaction where information is transmitted between the parties. Communicating, verbally or non-verbally, involves communicating messages, sharing information and establishing, enhancing or influencing relationships. Information is transmitted via language, audio or code as body language. These factors are essential for communication, but also for nurses to be able to perform good and safe care. Hence, it is interesting to investigate factors that affect communication and make them visible to ensure the nurses' continued work with evidence-based nursing. Purpose: The aim of the literature review was to describe factors that influence communication between nurse and patient based on nurse perspective. Method: A literature review with inductive approach. Result: The result emerged from nine scientific articles of qualitative design. The articles were summarized and presented in four main themes; language barriers, interpretation at linguistic confusion, non-verbal communication and nurse-patient relation. Conclusion: Language barriers is one factor that affects communication. A strategy is to use an interpreter. When using nonverbal communication, other strategies are used, especially body language but also utility aids. The opportunity for a good communication is influenced by the relation between nurse and patient. When difficulties occur in the nurse-patient communication, time becomes a shortcoming.

Bakgrund: Kommunikation är grundläggande för att bemötandet inom omvårdnad ska fungera. Om kommunikationen brister och orsakar en inkorrekt informationsöverföring, riskeras inte bara patientsäkerheten utan också att felaktig vård ges till följd av misstolkningar. Med samhällsutveckling och ökande global migration sker en kontinuerlig förändring av förutsättningar för hälso- och sjukvården. Förändrade förutsättningar innebär att hög kompetens krävs av sjuksköterskan. Sjuksköterskan bör inneha kunskap till att identifiera hur kulturella faktorer kan inverka på upplevelser av och förväntningar på vård och behandling samt vara införstådd om hur deras sätt att kommunicera påverkar och uppfattas av patienter. Syfte: Syftet var att belysa mötet mellan omvårdnadspersonal och patient vid kommunikationsbarriärer ur ett transkulturellt perspektiv. Metod/Design: En allmän litteraturöversikt. Resultat/Slutsats: Kommunikationsbarriärer inom omvårdnad består främst av lingvistiska och kulturella hinder. Kulturmedvetenhet och kulturkompetens hos sjuksköterskan ökade förutsättningarna att möta kommunikationshinder. Tolkanvändning presenterades som ett positivt och negativt hjälpmedel att tillgå vid språkbarriärer men visades vara komplext i många avseenden. Med personcentrerad vård kan sjuksköterskan övervinna kommunikationshinder då det främjar patientens individualitet och delaktighet. Förslag på fortsatt forskning: Ytterligare forskning behövs inom området för att stärka kulturkompetensen hos sjuksköterskor samt för att kunna implementera det i klinisk praxis. / Background: Communication is fundamental for the approach of nursing to work properly. If communication fails and causes an incorrect transfer of information, not only is patient safety at risk but also that wrong care is given due to misinterpretations. With the development of society and increasing global migration, there is a continuous change in the conditions for health care. Changed conditions mean that high skills are required of the nurse. The nurse should possess knowledge to identify how cultural factors can affect the experiences and expectations of care and treatment as well as be aware of how their way of communicating is influenced and perceived by patients. Aim: The aim was to illuminate the encountering between healthcare professionals and patients in communication barriers from a transcultural perspective. Method/Design: A general literature review. Results/Conclusion: Communication barriers in nursing consists mainly of linguistic- and cultural barriers. Cultural awareness and cultural competence of the nurse increased the conditions for addressing the communication barriers. The use of an interpreter was presented as a positive and a negative resource when language barriers appeared, since it was found to be complex to use out of many aspects. With person-centered care, the nurse can overcome communication barriers as it promotes the individuality and participation of the patient.

Language barriers in eyewitness testimonies may pose threats toward witnesses’ accuracy, and consequently on the outcome of judicial procedures. The present study aims to investigate the credibility and the extent of reported detail information of eyewitnesses’ testimony of a crime event, when the testimony is given in witnesses’ first language, second language, or second language through interpreter. Moreover, the study examines whether eyewitness suggestibility is affected by the language to which the testimony is provided. Participants (N=60) were exposed to a mock crime event and subsequently performed memory tests about that event. Results showed no differences in accuracy of suggestibility between experimental conditions. The personality trait social desirability showed no relation to suggestibility or the extent of inaccurate detail information provided in the present study. The findings are discussed in the context of implications, limitations and future directions.

Bakgrund: I samband med ökad globalisering och kulturell mångfald i slutenvården riskerar patientsäkerheten att hotas till följd av den bristande kommunikations- och informationsöverföringen. Detta kan leda till utmaningar i vårdprocessen som påverkar den personcentrerade vården på grund av språkbarriärer. Syfte: Att beskriva hur patienter och vården påverkas av språkbarriärer inom slutenvården. Metod: Litteraturstudie baserad på 18 vetenskapliga artiklar som publicerats mellan år 2014– 2019. Sökningarna har skett via databaserna Google scholar, CINAHL och PubMed. Resultat: Resultatet bygger på patientens och vårdpersonalens upplevelse av kulturell förståelse, påverkan på patienten och kommunikativa strategier. Språkbarriärerna inom hälsooch sjukvården påverkar vårdpersonal, patient och anhöriga genom att god vård på lika villkor inte uppfylls och kan leda till ökat lidande för patient och en ökad risk för vårdskada. Slutsats: Vårdpersonal och patienter är medvetna om att språkbarriärer påverkar vården för patienten negativt genom ökat lidande och risk för vårdskada och vårdskada. Kroppsspråk och gester används för att kommunicera och för att kunna ge personcentrerad vård. / Background: With the increased globalization and cultural diversity within inpatient care the patient safety is threatened because of communication and information difficulties. As a result of language barriers between health-care professionals and patients Aim: To describe how patients and the healthcare are affected by language barriers within inpatient care, and how healthcare staff are affected in their work by communicative language barriers. Method: A literature review based on 18 articles, published between 2014 - 2019. A literature search was made in databases as Google scholar, CINAHL and PubMed. Results: The results are based on patients and healthcare staff experiences of cultural diversity, effects on the patient and communicative strategies. Language barriers in healthcare affects, healthcare staff, patients and their relatives by not provide good care on equal terms. This can lead to increased suffering and an increased risk for healthcare injuries. Conclusion: healthcare staff and patients are aware that language barriers affect the care for patients negatively by increasing suffering and risk for healthcare injuries. Body language and gestures are used to communicate by healthcare staff to provide person-cantered care.

Cultural differences have always been the ground to barriers within communication. Due to globalization this is becoming an increasingly important aspect of how business communication is done.  Therefore, there is a need for organizations to have the skillset to deal with the cultural differences that a cross-cultural business environment entails.  To understand the effect of cultural differences in business communication, more specifically the Swedish and the Filipino culture at OnlineFactory.asia, a qualitative research approach was used to conduct a case study. Interviews with two employees were conducted, one of Filipino descent and the other with both Swedish and Filipino roots. The study has followed the structure as can be seen in the frame of reference according to the studies three main subjects: globalization, culture and communication and business communication.    The data gathered through the interviews showed that cultural differences have a significant impact on business communication, as can be seen through the study done at OnlineFactory.asia. The two cultures that were studied differ in cultural values which in turn had an effect on their communication. The Hofstede framework was used to analyze the differences between the two cultures and used as guidance throughout this study. Factors like language barriers, adaptability and cultural values have shown to have an impact on the way that the two employees communicate within business. OnlineFactory.asia’s educational program is a way to use cultural differences and turn them into their competitive advantage. Having an understanding of each other's cultural differences, provides the tool needed to minimize miscommunications that often occur in a cross-cultural workplace.

Bakgrund: Språkbarriärer inom vårdmöten leder till många utmaningar som hälso- och sjukvårdspersonal måste hantera dagligen. Det är vårdgivares ansvar att se till att patienter oavsett kultur och språk får få jämlik vård. Det har visat sig att språkbarriärerna har lett till att hälso- och sjukvårdspersonal har haft svårt att kunna tillgodose behovet av god vård till alla. Syfte: Syftet med denna litteraturöversikt är att beskriva hälso- och sjukvårdspersonals erfarenheter av språkbarriärer i kommunkation med patienter. Metod: En litteraturöversikt har genomförts i enlighet med Friberg (2017) och översikten har baserats på tio kvalitativa vetenskapliga artiklar. Två olika databaser användes för datainsamling: CINAHL Complete och PubMed. De sökord som användes var:"Communication barriers" "Nurse" "Experience". Resultat: Resultatet presenterades i fyra teman "Språkbarriärer tar tid och belaster", "Språkbarriärer hindrar ett gott vårdmöte", "Språkbarriärer trots tolkanvändning", "kommunikationsstrategier för att motverka språkbarriärer". Sammanfattning: Slutsatsen visar att språkbarriärer var ett hinder i utförandet av vården. De upplevde att effektiv och verksam vård inte kunde ges på grund av tidsbrist, arbetsbelastning samt att det hade varit utmanande även om tolk hade anväts. / Background: Language barriers in healthcare meetings have led to many challenges that health care professionals have to deal with every day. it is the caregiver's responsibility to ensure thatpatients, regardless of culture and language,receive equal care. it is shown that the language barriers have led to health and medical staff having difficulty finding good care for everyone. Aim: The aim of this literature review is to describe the healthcare personnel's experiences of language barriers in communication with patients. Method: A literature review has been conducted according to Friberg (2017) and it has been based on ten qualitative scientific articles. Two different databases were used to collect data: CINAHL Complete and PubMed. The keywords used were: " Communication barriers" "Nurse" "Experience". Results: The results presented four main themes. "Language barriers take time and strain", "Language barriers prevent a good care meeting", "Language barriers despite the use of interpreters", "Communication Strategies to counteract language barriers". Summary: The conclusions shows that the experience of health care professionals was that obstacles in the performance of care were the language barriers. They felt that effective and efficient care could not be provided due to lack of time, workload and that ithad been challenging to use an interpreter.