Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This PhD study investigated the organisational structure of medical communicative facilities and
the related communicative experiences of health care providers and patients in HIV and AIDS care
centres where there is language discordance between physicians and patients. Such discordance
refers specifically to communication in contexts where patients and health care providers speak a
number of different, mostly mutually unintelligible first languages (L1s) and where speakers have
varying levels of proficiency in a lingua franca such as English. This study considers key moments
within the organisational communication structure to assess how well the structure meets its
communicative aims.
The sites of care that provided empirical data in this study, were a public health clinic which is a
division of a state hospital, and a privately run day care clinic both located near Maseru, the capital
city of Lesotho. The participants were drawn from four categories, namely physicians, nurses, lay
interpreters and patients. Data collection was done through semi-structured interviews, focus group
discussions and direct observations of the study sites. The data was later transcribed interpreted and
analysed according to insights gained from Organisation Theory on the one hand and Thematic
Analysis and Qualitative Data Analysis on the other hand.
The most important result of the study is the recognition of organisational fragmentation of care
into different units which helps to facilitate communication where patients and physicians show
marked language discordance. Further results illuminate several challenges that are encountered by
participants in mediating and making meaning where language diversity is such that physicians’
linguistic repertoire does not match the repertoires of patients and local HCPs. The study highlights
several institutional and interpersonal strategies that are used to overcome these challenges and to
assure effective communication in the particular institutions. It also shows how some of these
strategies fail to fully address the communicative challenges identified. The findings of this study
suggest that in multilingual clinical contexts there is a need for more dedicated attention to
interpreting practices, to the kinds of material distributed among patients and, more generally, to
make consultative decisions on improved systems to put in place in order to facilitate
communication related to quality health care. / AFRIKAANSE OPSOMMING: Hierdie PhD-studie het die organisatoriese struktuur van mediese kommunikatiewe geleenthede en die
verwante ervarings van beroepsmense in gesondheidsorg van pasiënte in HIV-versorgingsentra
ondersoek, waar die taalvaardighede van dokters en pasiënte nie gesinchroniseer is nie. Die taaldissonansie
verwys spesifiek na kommunikasie in kontekste waar pasiënte en beroepsmense in gesondheidsorg 'n
verskeidenheid tale praat wat meestal onderling onverstaan-bare eerste tale (T1e) is van sprekers met
ongelyke vlakke van vaardigheid in 'n lingua franca soos Engels. Die studie vestig aandag op
sleutelmomente binne die struktuur van die kommunikasie van die organisasie om vas te stel hoe goed die
bepaalde struktuur sy kommunikatiewe doelstellinge verwesenlik.
Die terreine van gesondheidsorg wat empiriese data vir hierdie navorsing voorsien het, was 'n openbare
kliniek wat verbonde is aan 'n staatshospitaal, en 'n privaat dagsorgkliniek wat albei naby Maseru, die
hoofstad van Lesotho, geleë is. Die deelnemers behoort aan vier kategorieë, naamlik dokters,
verpleegpersoneel, leke-vertalers/-tolke en pasiënte. Data insameling is gedoen deur middel van semigestruktureerde
onderhoude, fokus groepbesprekings and direkte waarrneming by die betrokke instansies.
Die data is later getranskribeer, geinterpreteer en geanaliseer volgens insigte uit Organisasie Teorie aan
die een kant en Tematiese Analise en Kwalitatiewe Data Analise aan die ander kant.
Die belangrikste bevinding van die studie is herkenning van die organisatoriese fragmentering van die
sorg in verskillende eenhede wat help om kommunikasie te fasiliteer binne ‘n konteks waar pasiënte en
dokters merkbare taaldissonansie vertoon. Verdere bevindinge werp lig op verskeie uitdagings wat
deelnemers ervaar in die bemiddeling en skep van betekenis waar taaldiversiteit sodanig is dat die talige
repertoires van die mediese praktisyns nie aangepas is by die talige repertoires van die pasiënte of plaaslike
mediese beamptes nie. Die studie vestig aandag op verskeie institusionele en interpersoonlike strategieë
wat gebruik word om uitdagings te oorkom en om effektiewe kommunikasie binne die betrokke instansies
te verseker. Dit wys ook hoe sommige van hierdie strategieë misluk in die aanspreek van bepaalde
kommunikatiewe uitdagings. Die bevindinge bevestig dat in die omgewing van ‘n veeltalige kliniek daar
‘n behoefte is aan meer toegewyde aandag aan tolkingspraktyke, aan die soort materiaal wat onder pasiënte
versprei word, en in meer algemene terme, aan die neem van besluite gegrond op konsultasie sodat
verbeterde stelsels geimplimenteer kan word om kommunikasie wat verband hou met goeie kwaliteit
gesondheidsorg, te help bedien. / The African Doctoral Academy for financial support
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/80323 |
| Date | 03 1900 |
| Creators | Sobane, Konosoang Mabafokeng |
| Contributors | Anthonissen, Christine, Huddlestone, Kate, Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of General Linguistics. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Detected Language | Unknown |
| Format | 216 p. |
| Rights | Stellenbosch University |
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