Migrant communities living in the N etherlands and their use of MT in healthcare settings (2023)

Abstract: As part of a larger project on the use of MT in healthcare settings among migrant communities, this paper investigates if, when, how and with what (potential) challenges migrants use MT based on a survey of 201 non-native speakers of Dutch currently living in the Netherlands. Three main findings stand out from our analysis. First, most migrants use MT to understand health information in Dutch and communicate with health professionals. How MT is used and received varies depending on the context and the L2 language level, as well as age, but not on the educational level. Second, some users face challenges of different kinds, including a lack of trust or perceived inaccuracies. Some of these challenges are related to comprehension, which brings us to our third point. We argue that a more nuanced understanding of medical translation is needed in expert-to-non-expert health communication. This questionnaire helped us identify several topics we hope to explore in the project’s next phase.

## introduction access to health information has been recognized as essential @xcite , including in meeting the health-related sustainable development goals (united nations, 2020). evidence, however, suggests that language barriers remain a significant factor contributing to disparities in the quality of care @xcite @xcite . when health information is not available in a language that the patient can understand, most people resort to public online machine translation (mt) as the only available alternative @xcite . in the context of healthcare, mt can thus be seen as a potential facilitator of a "multilingual health system," where people from different cultural and linguistic backgrounds, such as migrants, can have access to health information and medical care in a language that they understand (e.g., torres-hostench, 2022:6). however, uninformed users with limited mt literacy may face potential risks when using this technology, such as assuming mt output is accurate without fully understanding its limitations @xcite or assuming that mt provides privacy @xcite . to tackle this topic, this paper reports on a specific use of mt to facilitate communication in healthcare settings between experts and non-experts in migrant communities in the netherlands. the paper first reviews related work on mt-mediated communication, with a special focus on healthrelated contexts; then describes the survey methodology adopted and reports the results. finally, the paper discusses the findings and shares conclusions. ## related work this section covers the work done in mt usability and mt in healthcare. ## methodology this study is part of a larger research project aiming to explore for the first time migrants' use of mt in healthcare settings in the netherlands. in the first phase, a questionnaire elicited data mainly on if, when, and how migrants use mt in healthcare settings and their (potential) main challenges. following this, 12 respondents participated in follow-up in-depth interviews to further explore the challenges identified in the first phase. our idea was to obtain qualitative data to understand not only the usage but also the participants' difficulties, emotions and mt training needs. to collect this data, we applied the vignette technique, which makes use of a short story to elicit perceptions, opinions, and beliefs to typical scenarios to clarify participants' decisionmaking processes and allow for the exploration of actions in context @xcite . this project has the long-term goal of co-creating training material with target community members as part of an action research initiative. for reasons of space, in this paper, we report the findings from the project's first phase. ## results in this section, we present the results from the questionnaire by grouping the findings into six areas: usage of mt, methods of mt usage, level of easiness and satisfaction, the importance of features, factors such as dutch language, age, and education, mt features of value and challenges when using mt. ## conclusion the responses from the participants shed some light on the use of mt by migrant communities in the netherlands. first and foremost, the majority of migrants use mt in several health contexts to access and understand health information presented to them in dutch, but also to communicate with health professionals. this usage is different depending on the situation. when the situation is asynchronous, for example reading a letter from the health ministry or the family doctor, they use the phone's camera function. when the communicative situation is synchronous, they use mt more in a face-to-face appointment than in emergency situations, opting to type in the app or to prepare beforehand using mt. participants find mt easy to use and are satisfied overall, with only a small percentage finding it difficult or extremely dissatisfying. this seems logical. mt is used then as a tool to communicate when there is a lack of knowledge of the source language and not as a tool to improve the speed of communication. they also care greatly about mt being accurate, free of charge, fast, easy to use, and to a lesser extent about privacy which is somewhat surprising but in line with previous research (see @xcite . the findings suggest then that, on the one hand, mt provided access to health information that perhaps otherwise would not have been possible. on the other hand, some users are facing specific challenges of various kinds. for example, they reported challenges such as perceived inaccuracy or lack of trust in mt output in healthcare settings. our findings also suggest that some migrants face comprehension difficulties associated with unclear translations but also understanding mt-mediated health texts. based on the users' statements, we argue that there is a need for a more nuanced understanding of migrants' needs regarding translated expert-to-non-expert communication that goes beyond a more literal translation of medical language and terminology, involving interlingual but importantly also intralingual translation. the second part of the project will certainly bring more qualitative data that will expand the information presented here. we are also aware of the limitations of this study, as we mentioned before, the number of participants (majority of portuguese, italian and spanish) are only a sample of all the migrant communities in the netherlands. this questionnaire helped us identify several topics to explore further in the follow-up interviews and we will address the issues identified and answer these new questions in our future work.