From barrier to bridge Digital decision support to overcome language barriers and enhance communication outcomes with migrant patients

Migrant patients with limited proficiency in the host country’s language (LLP) often face communication issues caused by language barriers during medical consultations. This can lead to unmet cognitive needs, e.g., misunderstandings of treatment plans, and unmet affective needs, e.g., unresolved emotional distress. To overcome language barriers, healthcare providers should use communication strategies, e.g., professional interpreting services and digital translation tools, to support these patients. However, this is often done insufficiently due to a lack of a structured conversation about language barriers. This dissertation introduces and evaluates MediLanguage, an eHealth intervention designed to facilitate shared decision-making between LLP migrant patients and healthcare providers, enabling structured discussions of language-support needs. MediLanguage is a web application featuring five components, with the primary component being the Language Support Starter, a digital decision aid that helps patients assess their language-support needs before consultations. The development involved a user-centred approach, including input from patients, healthcare providers, and caregivers through needs assessments, expert reviews, and usability testing using think-aloud methods. The effectiveness of MediLanguage’s Language Support Starter was tested in a clustered randomised controlled trial. Results showed that patients found it attractive, easy to use, and comprehensive. However, it did not significantly enhance communication outcomes such as self-efficacy or perceptions of shared decision-making. Only patient satisfaction showed significant improvement. Overall, the results remain inconclusive, and further research is needed. While this study did not definitively demonstrate improved communication during consultations, MediLanguage represents an innovative intervention that could support informed decision-making and help bridge language barriers in healthcare.