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Like Canada, Wales, UK is a bilingual nation: the Welsh language is an important part of its national identity and legislative framework. This has implications for the delivery of public sector services, particularly in the context of health and social care, where responding to the language needs of service users is fundamental to quality health care provision. Nevertheless, despite the strengthening policy commitment for a whole-system approach towards enhancing Welsh language services, there is a paucity of evidence to guide best practice in organizational planning in health care settings. This commentary outlines the context and significance of bilingual health care provision in Wales and the implications for building and embedding the evidence base. It calls for further work to translate our knowledge and understanding of language-appropriate practice to provide more effective and sensitive health care services; and to close the implementation gap between evidence and practice. Given the relevance of this challenge for health care providers in Canada who plan and deliver services for French-language minorities, this approach has resonance across our research communities. Thus, in our common pursuit to establish integrated knowledge translation research for language-appropriate health care systems, this commentary offers a focus for reflection, discussion and collaborative action.

Aims and Objectives: The increasing status and regard of indigenous minority languages across Europe, means the advantages of bilingualism for individuals and communities are now well established. We set out to elicit parents' and health professionals' views of the role of health visitors and midwives in promoting bilingualism in the family and to consider whether health professionals acknowledge the contribution that bilingualism makes to public health., Background: A three-year study was completed to measure the impact of a language transmission initiative which depends on the input of midwives and health visitors with new parents and how its effect could be improved. This paper reports on one element of that study., Design: A qualitative approach was used., Methods: Six focus group interviews were conducted with health visitors and midwives and 33 postnatal interviews were completed with parents across four counties in Wales. Thematic content analysis was undertaken by two researchers, a third trailed decision processes and scrutinised categories and themes., Results: Findings suggest that health visitors and midwives perceive their roles relating to the promotion of bilingualism differently. Influences on their involvement include their language profile, contact with parents, personal experience, timing of the interaction and time in their workload. The relationship between promoting bilingualism and public health was accepted by some and denied by others. Data from the interviews with parents suggested that few health professionals discuss issues of language transmission with new parents., Conclusions: Some individual health visitors and midwives are willing to promote bilingualism with parents. However, there are challenges in enlisting the support of health visitors and midwives to discuss language transmission and bilingualism with parents., Relevance to Clinical Practice: These findings challenge practitioners to consider their role in promoting bilingualism and its effect on public health and suggest the need for more defined responsibilities., (© 2010 Blackwell Publishing Ltd.)

Current evidence demonstrates that language awareness in nursing contributes to high quality patient care. Although language awareness amongst qualified nurses has been considered, there is a dearth of literature that examines how student nurses respond to language sensitivity in the healthcare setting. The critical incident technique was used to elicit the perceptions of student nurses regarding language awareness. Twenty students produced written descriptions of incidents that they had encountered during clinical practice and they subsequently reflected on these incidents. Data were analysed using framework analysis whereby meaning units were organised into themes and categories. Four distinct themes emerged from the analysis; namely, facilitating language choice, vulnerable groups, quality of care and student learning. Each theme was characterised by a number of subcategories. Student nurses identified positive and negative instances of language matters in health care that are driven by personal and organisational strategies and impact on patient care and student learning. Student nurses were conscious of the influence of language awareness on patient care and noted that structural and process elements relating to language awareness were in play in the healthcare setting. Moreover, they indicated that the consequent outcomes of these elements influenced the quality of care and student learning.

Aim: This paper reports on the second phase of a national study in Wales. The research aimed to assess the level of Welsh language awareness amongst healthcare professionals across Wales, and to identify the factors that enhance language choice within service delivery., Background: The literature suggests that language sensitive healthcare practice is central to ensuring high quality care. However, it is evident that language barriers continue to compromise the quality of care within nursing and other health services. One issue that has received little attention is the level of language awareness that healthcare professionals currently demonstrate. Furthermore the factors that influence language choice for bilingual/multilingual speakers are not well explored in the literature., Methods: The study involved semi-structured interviews with a range of healthcare professionals in acute and community settings across Wales. Using a systematic sampling matrix, a purposeful sample of 83 professionals was selected to participate. Twenty-seven of the respondents were nurses, health visitors and midwives. The interviews focussed on the factors that facilitate or impede language sensitive healthcare practice. All interviews were audiotaped and, using a framework analysis approach, conceptual codes were developed and defined and categories and sub-categories were constructed to create thematic charts., Findings: Three main themes were identified: care enhancement, which focussed on the process and outcome of offering language choice to bilingual patients; organizational issues, which reflected issues relating to the infrastructure of service provision; and training implications, which focused on Welsh language learning in health care., Conclusions: Complex dynamics of language use are in operation within bilingual healthcare settings and organizational as well as individual factors are important in facilitating appropriate language use. Many of the issues highlighted are not peculiar to the Welsh context, but apply to healthcare settings across the world, where other minority languages are in use.

Abstract: Background: The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. Objectives: This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. Design: The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. Participants: A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. Results: A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (); language attitudes (); and language region (). Mean language attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. Conclusions: In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is therefore recommended as a way of enhancing care delivery for minority language speakers. [Copyright &y& Elsevier]