Title: Health Experiences of Asylum seekers and Refugees: how well are their interpretation needs met? (HEAR 2)
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Asylum seekers and refugees in Wales and the UK are entitled to NHS healthcare, including interpretation services, to meet any language needs they may have. This topic is under- researched, but exploratory studies have consistently found that, in practice, interpretation services are not offered or provided in a timely manner and in an appropriate language. Informal interpretation provided by family members or friends has been found inadequate or inappropriate, particularly for some conditions such as mental or sexual health. The recently completed HEAR study (Health Experiences of Asylum Seekers and Refugees in Wales) highlighted the need to improve interpretation as a priority within healthcare provision for asylum seekers and refugees. Aims: We aim to provide preliminary data about demand for, and experience and quality of interpretation services in primary and emergency care in Wales; and assess the feasibility of a comprehensive evaluation of provision of interpretation services in these settings across the UK. Plan of investigation: We will use mixed methods to produce a picture of need, demand, patient and practitioner experience, quality of provision, and the feasibility of a full evaluation of interpretation services in primary and emergency healthcare. We will develop a logic model to define the essential elements of effective interpretation service delivery, to identify key outcomes and explore ways to achieve those outcomes. We will carry out a survey of patients from the target population who have attended their GPs, attended the ED, or called 999, using two methods – a traditional postal survey, with translated questionnaires available in the most frequently used languages; and a community-based approach using peer researchers to administer questionnaires (successfully used in the completed HEAR study). We will carry out in-depth interviews with a sample of respondents, including people with a range of physical, emotional and mental health concerns, and with mixed experiences of being offered and receiving interpretation in primary or emergency care. We will interview nominated leads from each participating service and carry out focus groups or interviews with clinical, managerial and operational staff from participating services as well as providers of interpretation. We will survey NHS commissioners across the UK (n = 235), including Clinical Commissioning Groups in England, to understand interpretation procurement. Finally, we will explore and describe data sources for identification of this target population, and assess completeness and quality of data retrieved to assess the feasibility of a full evaluation across the UK. We will explore the potential, including the acceptability, of linking data anonymously in an evaluation to address longer term outcomes and health service resource use. Data analysis will be mainly descriptive and thematic, integrating quantitative and qualitative data. We will use a matrix approach - with multiple data sources - to assess quality of delivery of interpretation against published standards. Potential benefits include improvements in quality and safety of healthcare provided to this vulnerable group. Care provided appropriately in the preferred language of patients in primary and emergency care has potential to reduce adverse events and unnecessary healthcare contacts and thus to improve physical and mental health in the long term.

Lay abstract: People who are classified as Asylum Seekers or Refugees in the UK are entitled to NHS healthcare, including interpretation if needed to meet any language needs they may have. There has been very little research on this topic, but preliminary studies have reported that interpretation is often not offered or provided in the best language for the individual. Interpretation is often provided during consultations by family members or friends, but this has been highlighted as poor practice, particularly in some conditions such as mental or sexual health. One of the key findings of the recent HEAR study (Health Experiences of Asylum Seekers and Refugees in Wales), carried out by this research team, was the need to improve interpretation within healthcare provision for Asylum Seekers and Refugees. In the proposed study (HEAR 2) we aim to do two things: 1) Provide information about demand and patient experience; and evaluate the quality of interpretation services delivered in primary and emergency care in Wales 2) Assess the feasibility of a comprehensive evaluation of interpretation services in these settings across the UK, including a description of currently commissioned interpretation services We will use mixed methods to meet our study aims. This study will help to improve the care that this extremely vulnerable group receives, through describing current need and services offered. In addition, if we are able to demonstrate feasibility, we will develop and submit a proposal to the National Institute of Health Research, to carry out a large scale comprehensive evaluation of interpretation services in primary and emergency healthcare across the UK.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE