Effects on quality of care and health care worker satisfaction of language training for health care workers in South Africa

Most research into medical communication has been in a Western setting. Communication between non-language-concordant health care workers (HCWs) and patients adversely affects patient and staff satisfaction. To the best of our knowledge, no intervention studies have been conducted in Africa. Objective. To determine whether teaching Xhosa language skills and cultural understanding to HCWs affects patient satisfaction, HCWs’ ability to communicate effectively with Xhosa-speaking patients and HCWs’ job satisfaction levels. Design and setting. A before-and-after interventional study was performed at two community health centres and a district hospital in the Western Cape Province of South Africa. Participants. Fifty-four randomly selected patients (27 pre and 27 post intervention) assessed communication with HCWs and rated their satisfaction. Six non-Xhosa-speaking HCW participants completed pre- and post-intervention questionnaires. Intervention. HCWs completed a ten week basic language course comprising ten 120 minute interactive contact sessions developing basic Xhosa speaking and listening skills and cultural competence. Outcome measures. Questionnaires used a Likert scale to rate degrees of agreement or disagreement with statements. Patients assessed communication with HCWs, quality of care and rated their satisfaction. HCW questions were grouped according to themes, including ability to communicate, job satisfaction and staff interpersonal relationships. Results. Patient satisfaction showed significant improvements. Patients perceived HCWs to be more understanding, respectful and concerned, and to show better listening skills, after the intervention. Patients were better able to understand HCWs and their instructions. HCWs’ ability to communicate improved and HCWs experienced decreased frustration levels. Conclusions. Teaching language skills and cultural sensitivity to non-Xhosa-speaking HCWs in South Africa improves ability to communicate, increases patient satisfaction and decreases misunderstandings and frustration.