Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE credits
Background: Treatment of harmful use of drugs and addiction to drugs, which herewith is named as Interdisciplinary Specialized Substance Abuse Treatment (ISSAT), is usually challenging enough in itself. I wanted by means of a qualitative study, to determine which experience the clinicians practicing substance abuse treatment have in the face of minority linguistic patients, in cases where there is language barrier between the clinician and the patient.
Methodology: A total of 18 multidisciplinary clinicians in the Department of Substance Abuse and Addiction Treatment at the Oslo University Hospital HF (OUH), were interviewed in the four focus groups. The interviews included questions to identify the manner of language barrier between clinician and patient, whether there are any obstacles or challenges in the practicing, in order to implement the principles of the hospital's governing guidelines for use by qualified interpreter within ISSAT, what are the decisive factors for providing minority language patients with an equivalent substance abuse treatment. The hospital's governing guidelines for use of qualified interpreter was used as a stimulation material for discussion in the focus groups. In the qualitative analysis the opinion content was categorized, and concentrated on key topics. Implementation Theory is selected as a parent theory for the survey, and the Ottawa Model is used as means to structure the results of this evaluation study.
The research question: What factors promote and inhibit implementation of the hospital's governing guidelines to use qualified interpreter in substance abuse treatment?
Results: In all focus groups the guidelines appeared as little known by the majority of the participants, prior to this study. The result section reveals three gaps between recommendations in the guidelines and the clinical practice. One negative gap in regard to the use of unskilled interpreters appears to be that the clinicians with multi-language skills assume an unfortunate double role as both an interpreter and a healthcare professional, although there is no assessment of how this practice is widespread. Another negative gap was revealed in the form of certain barriers for use of licensed interpreter in the group and activity therapy within ISSAT. At the same time, a positive gap concerns situations when patients speak “Norwegian a little”, and become offended by an offer to invite an interpreter, declining it due to various reasons. In such cases the clinician should consider to identify potential language barriers at an early stage in the treatment process. Then, the clinician would explain it by the own need to ensure the adequate information about the health is obtained, in order to provide a proper healthcare. In this way, the patients would have a good reason to give their consent, or still insist on denying the offer. The clinicians experience that the most of the patients would accept the offer to call for interpreter assistance when handled in this way. In addition, there are other various means to facilitate making the choice, e.g. using an interpreter over the telephone, which appear less stressful for some patients who would have to touch sensitive and often shame-covered topics.
Interpretation: The hospital's governing guidelines for use of an interpreter in substance abuse treatment is undoubtedly sharpening the awareness, on a condition of it is known by clinicians, and can to a certain extent, contribute to equivalent substance abuse treatment of the patient group. Still the clinicians in the study felt almost left alone to themselves with general legal formulations on one hand, and strong expectations for budget savings on the other, setting the clinicians’ professionalism to a test. Moreover, it seems there is no organized internal training in communication by use of interpreter in ISSAT by OUH. Clinicians call to their management for increased commitment at executive level, on the use of qualified interpreter.
Suggestions for further research: The closing discussion section in this study processes one positive and two negative gaps between the recommendations stated in the guidelines and clinical practice. The discussion leads to proposals for further research with a focus on insufficient use of qualified interpreter in the group and activity therapy, which may serve as a contributing factor for patients to abort the treatment. In addition, a research can be conducted to assess whether foreign language patients receiving substance abuse treatment, find the information about their rights to be assisted by a qualified interpreter sufficient.
Keywords: Norway, migration, public sector, equal opportunity substance abuse treatment, interpreter, minority language patients, implementation, clinical guidelines.
2016. , 70 p.