Bridging the Gap: Experiences of Healthcare professionals on Language Barriers

Bridging the Gap: Experiences of Healthcare professionals on Language Barriers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bridging the Gap: Experiences of Healthcare professionals on Language Barriers Mohamed Irfan, Antoon Cox, Heidi Salaets, Marc Sabbe, Birgitte Schoenmakers This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8337472/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Medical consultation is an interactive communicative process in which the doctor and the patient take turns to formulate and allow for the construction of the interaction. Communication challenges between patients and healthcare professionals during consultations can lead to miscommunication or complete breakdowns in interaction. Language barriers are a primary contributor to these difficulties. With increasing migration, the number of non-native language-speaking patients seeking medical care has risen substantially. Aim To explore the experiences of medical and allied healthcare professionals in Belgium when encountering language barriers during patient communication in clinical settings. Method A quantitative, multilingual, cross-sectional survey study was conducted in Belgium to examine the experiences of healthcare professionals during patient interactions involving language barriers. Results A total of 179 healthcare professionals completed the survey. All respondents reported encountering patients with whom communication was hindered by language barriers. Patients’ body language and lack of responsiveness were key indicators of these barriers. The professional role of respondents significantly influenced the type of alternative communication technique employed (p = 0.00171). Speech-to-text translation was the preferred strategy, reported by 54% (n = 97) of participants, followed by ad hoc interpretation by accompanying people or other staff members. Conclusion Language barriers impact all categories of healthcare providers, regardless of their professional role—whether during treatment, registration, discharge, or medication collection. Implementing strategies such as targeted communication training, greater use of professional interpreters, and culturally adapted health education tools may help mitigate these challenges and enhance patient–provider communication. language barrier communication patient-doctor relationship medical interactions experiences Background Medical consultation is characterized as an interaction primarily driven by doctors, who initiate an interaction and conversation by asking questions to which the patients respond, mainly verbally and less nonverbally or a combination of the two. Sociologists Heritage and Maynard described medical consultation as an interactive communicative process in which the doctor and the patient take turns to formulate and allow for the construction of the interaction (1). This communication allows for a basic conversation which involves interaction between a patient and a healthcare professional, where the ultimate objective is to improve the patient’s health and to deliver medical care (2). Communication and interactions between the healthcare professional and a patient follow the principle of common ground, which in the simplest of terms is the knowledge shared between the parties or the participants involved to allow for communication between them (3). Information exchange between the patient and the healthcare professional is the dominant communication model, with current approaches including patient-centered communication or shared decision-making (4). An essential feature of medical interactions is their ritual nature, in that they take place to considerable extent in a ritualized, prescribed manner. This perhaps is a necessity, in that medical encounters “accomplish a social role – the ‘provision’ of care and the maintenance of public health – and are therefore regulated by legal and social norms” (5). Good doctor-patient communication allows patients to share vital information essential for an accurate diagnosis of their problems, enables doctors to have a better understanding of their patient's needs and potentially lead to better symptom reduction (6). The 2-way communication between the patient and the doctor being reciprocal and dynamic is also an example of collaborative communication (7). In this approach, the doctor facilitates discussion and negotiation with patients according to their needs thereby evaluating possible treatment options (2). Communication skills extend beyond verbal exchanges to include the full range of nonverbal forms such as body language and written communication (8). In healthcare, strong communication abilities have been linked to greater patient enablement (9) and play a vital role in building trust with patients, their families, and other members of the healthcare team (8). Within the healthcare communication literature, the term ‘language barriers’ is commonly used to highlight difficulties in communication that may result in misunderstandings or breakdowns in communication (10). In its simplest form, miscommunication can be attributed to a mismatch between the speakers' intention and the hearer's interpretation (11). Coupland and his colleagues argue that miscommunication is a theoretically “slippery” construct—broad and multidimensional, and is subject to varying interpretations based on the definitional lens employed (12). A desirable way to overcome language barriers is to use a professional interpreter, as the gold standard technique (13-15). Nevertheless, studies have found an underuse of professional interpreters in health-care settings (13, 15). In routine health care encounters where language barriers are present, communication commonly proceeds without professional interpreters or by use of non-professionals or family members (16). This has been described in the literature as ‘getting by,’ whereby practitioners depend on nonverbal cues and a limited repetition of words in the target language (16-18). The getting by approach has the potential for miscommunication, which may lead to inappropriate or inadequate care provision and patients’ needs being unmet. A difference in the linguistic knowledge of the participants involved, notably communication discordance has been attributed to language barriers (14). Language discordance between patients and healthcare providers can obstruct effective communication, thereby compromising the quality of care (14). Research has demonstrated that perceived language barriers are associated with a range of adverse health related outcomes, including: i) impaired understanding of medication instructions, including dosage and usage, as provided by physicians or pharmacists (19); ii) prolonged hospital stays, both in inpatient and emergency care settings (20); iii) an increased risk of hospital readmission (21); iv) critical communication errors and omissions (22); and v) a heightened risk of serious medical events (23). As the de facto capital of Europe and a hub of migration, Brussels presents a highly diverse linguistic landscape. This diversity, which varies significantly across regions, offers a compelling context for examining the communicative experiences of healthcare professionals in their interactions with patients. As of 1st January, the total population in Belgium with a migration background was 4 million (34% of the total population) 1 , residing across the different regions of the country. The 1963 Language Use in Administration Act cemented Belgium’s division into distinct language regions, requiring public administrations to operate exclusively in the official language of their respective areas 2 . It enshrined the territorial use of its languages Dutch in Flanders, French in Wallonia, German in the German province, and Brussels region being Bilingual with French and Dutch, making it a key step in the foundation of Belgium’s multilingual structure. While there is no specific legislative law in Belgium, The Belgian Patients’ Rights Act of 2002 ("Wet betreffende de rechten van de patiënt " / "Loi relative aux droits du patient") 3 is a key legal framework that establishes and protects the rights of patients in healthcare settings across Belgium. It came into effect on October 6, 2002, and applies to all healthcare providers and institutions. Although the law does not explicitly require multilingual services, the right to understandable information indirectly requires that communication should be adapted to the patient's language and comprehension level. The goal of this study was to examine the experiences of healthcare professionals (HCPs), both medical and allied in Belgium on encountering language barriers in clinical settings, when communicating with patients. The research questions thus formulated were: What is the effect of language barriers on healthcare professionals when interacting with Foreign Language (FL) speaking patients during a medical interaction ? and How do healthcare professionals perceive the impact of language barriers on their ability to execute their services when interacting with FL speaking patients? Methods Study Design The purpose of this study was to investigate communication due to language barriers when encountered by working healthcare professionals (HCPs). We were interested in investigating to what extent they were able to overcome the language discordant situation and maintain communication during patient interactions; and to gain insight into the alternative techniques or methods they used. Critical clinical parameters in line with the study goal were: 1) professional branch in healthcare, 2) work profile and tenure, 3) language fluency, and 4) self-perception of estimating the patients understanding them and their medical advice. Additionally, we also addressed whether any of these factors predicted the use of a professional interpreter by the clinician. This study employed a quantitative cross-sectional survey design to assess the experiences of HCPs in interactions with patients when encountered with language barriers. The study aimed to collect standardized data on personal and professional experiences encompassing communication challenges, coping strategies, and the impact of language barriers on patient communication and care as experienced by health care professionals. To maintain the quality of the survey, the CHERRIES checklist (Checklist for Reporting Results of Internet Surveys) was followed (24). Survey Development: A multi-lingual structured questionnaire survey was designed using Microsoft Forms to ensure ease of access and data collection. The survey was developed in three languages: Dutch, English, and French. The questionnaire was developed based on existing literature of communication experiences of HCPs in scenarios of language discordance or no language commonality. To check on its content validity, expert consultation was done by members of the research team, which comprised of two practicing doctors and two linguistic professionals. The survey consisted of 28 questions which were divided into 5 segments: 1) study information and informed consent (Q1), 2) respondent demographics (Q2 – Q5), 3) professional profile (Q6 – Q9); 4) language knowledge and language barrier cases (Q10 – Q17), and 5) Likert scale questions on their self-perceived assessment of patient interactions (Q18 – Q28). The survey questions were designed to assess participants perceived abilities during encounters and factors influencing their communication. Segment 1 outlined the study’s purpose, duration, and obtained consent, allowing only consenting participants to continue. Segments 2–5 included mostly single-answer and Likert-scale questions, with some open responses on language proficiency and strategies for overcoming language barriers. Survey piloting: A test version of the survey was distributed within the research unit of the project partners, to check for its workability and accessibility. The research unit is comprised of researchers from the field of medicine and allied healthcare field (pharmacists, nurses, midwives, dentists, physiotherapists). The test version was online for 3 weeks from 14 th May 2024, access for which was through the web-link sent by email. Within the three weeks, 16 responses were received. Feedback received from the respondents was positive with regards to the working, distribution, access, and response of the survey. Following this, the definitive version of the survey was made ready for distribution. Survey Participants and Distribution: The survey targeted HCPs working across Belgium, in the regions of Brussels, Flanders, and Wallonia. Participants were recruited through professional healthcare networks and institutional email distributions to ensure a diverse and representative sample. Eligible participants were required to be actively practicing HCPs with direct patient contact. Individuals employed in healthcare-related roles without patient interaction—such as administrative financial staff or laboratory personnel without direct patient contact—were excluded. To maximize geographic and professional reach, the survey was digitally disseminated via multiple channels: a) university and general hospitals located in various provinces across Belgium; b) registered membership organizations representing healthcare professions, including pharmacists, dentists, midwives, nurses, general practitioners, and emergency medical personnel; c) professional medical journals and websites that publish healthcare-related content within Belgium. In addition to digital outreach, physical posters of the survey to encourage wider participation were strategically placed in areas of participating hospitals, like staff social rooms, doctors' changing rooms, cafeterias frequented by HCPs, and meeting rooms. The survey was open for responses from July 25, 2024, to February 23, 2025, following its distribution through the identified networks, organizations, and hospital sites. Data Analysis After data collection, all survey responses—across all languages—were compiled into a Microsoft Excel worksheet. To enable structured analysis, a predefined coding tree was developed based on thematic patterns identified in the responses. These codes were applied to the data and converted into numerical values in Excel, facilitating subsequent quantitative analysis. Descriptive statistics were used to summarize the characteristics of the survey respondents, their experiences, and challenges in communicating with patients, and the strategies they employed to improve communication. Statistical analyses were conducted in R via RStudio 4 , comprising descriptive statistics and regression modeling 5 . Segments 2 and 3 of the survey were analyzed descriptively. To explore potential factors influencing the frequency with which respondents encounter language barriers and the types of alternative techniques they used to overcome these barriers, a series of Pearson’s Chi-squared tests were conducted for four independent variables of the respondents: sex, professional role, years of work experience, and number of languages spoken. Ethical Considerations Ethical approval of the study was received in line for project MaLBUC by the ethics committee of UZ Leuven, Gasthuisberg (study number S- 67908). On accessing the survey, the participants were informed about the purpose of the study. It also gave information about the survey duration, and their right to withdraw from the survey at any time. Anonymity and confidentiality were guaranteed all through the survey, as no personal data in any form was recorded. Ethics Approval and Consent to participate: Informed consent was obtained by all participants who accessed the survey. Results A total of 192 respondents accessed the survey. Most responses were in Dutch (181). Eleven respondents (6%) declined participation, leaving 181 completed surveys (94%): 176 in Dutch, 3 in French, and 2 in English. The two English responses were excluded after review, as the respondents showed limited knowledge of Belgium’s national languages, creating a language bias. The final sample analyzed consisted of 179 responses. a. Participant Demographics (questions 2 - 5) Of the 179 respondents, 117 (65%) were aged 25–44 years, 46 (26%) were 45–64 years, 7% were 18–24 years, and 4 (2%) were 65+ years. Women represented 64% of the sample, men 35%, and one respondent did not disclose gender (table 1). Table 1: Participant Demographics Demographic variable Category N % Age 18-24 13 7 25-44 116 65 45-64 46 26 65 years or more 4 2 Gender Female 113 64 Male 65 35 Prefer not to say 1 1 Place of Residence Antwerp 33 18 Brussels 6 3 East Flanders 42 23 West Flander 9 5 Limburg 16 9 Walloon Brabant 2 1 Flemish Brabant 70 39 Other 1 1 Place of Work Antwerp 27 15 Brussels 5 3 East Flanders 45 25 West Flander 7 4 Limburg 8 4 Flemish Brabant 87 49 b. Professional Profile (questions 6 - 9) The survey included a diverse range of healthcare professionals. General physicians (n=43, 24%) and hospital doctors (n=43, 24%) formed the largest groups, followed by hospital nurses (n=33/18%) and pharmacists (n=26, 15%). 84 respondents (47%) were affiliated with a university hospital, while 48 (27%) worked in group practices and 24 (14%) in private practices. In terms of work schedules, 126 professionals were working full-time (70%), while 44 reported (25%) working 51–80%. Among the respondents, 35 (20%) had less than 3 years of work experience, while the largest group, 43 (24%), reported 4–7 years of experience. Smaller proportions were observed in the other categories, including 17 (9%) with 8–10 years, 25 (14%) with 11–15 years, 17 (9%) with 16–20 years, 15 (8%) with 21–25 years, and 27 (15%) with 26 years or more (table 2). Table 2: Participant professional profile Work Profile Category N % Healthcare Role General Physician 43 24% Administrative work 8 4% Hospital Doctor 43 24% Hospital Nurse 33 18% Nursing Centre Nurse 1 1% Dentist 1 1% Pharmacist 26 15% Midwife 4 2% Physiotherapist 1 1% Psychologist 4 2% Ambulance 5 3% Dispatch Staff 5 3% Others 5 3% Work Facility Private Practice 25 14% Group Practice 48 27% General Hospital 12 7% Regional Hospital 6 3% University Hospital 84 47% Multiple clinics 4 2% Working Schedule Part Time (less than 30%) 2 1% Part Time (31 – 50 %) 7 4% Part Time (51 – 80 %) 44 25% Full Time (100 %) 126 70% Work Experience Less than 3 years 35 20% 4 – 7 years 43 24% 8 – 10 years 17 9% 11 – 15 years 25 14% 16 – 20 years 17 9% 21 – 25 years 15 8% 26 years or more 27 15% Language knowledge (question 10) In terms of languages spoken fluently or with expert proficiency, all respondents reported proficiency in Dutch, English, and French, with 67.6% also speaking German (n=121). Other languages included Spanish (n=61)), Italian (n=33), Arabic (n=5), and Turkish (n=4). 115 respondents (64%) reported speaking up to five languages, while 39 (22%) spoke up to three languages, and 23 (13%) spoke up to seven languages (table 3). c. Language Barrier (LB) Cases (questions 11 - 17) Most respondents reported frequent LB cases, with 59 HCPs (33%) encountering up to five cases weekly and 64 HCPs (36%) handling more than five per week. In the last 7 days, 124 HCPs (69%) had recent LB cases, while 31 HCPs (17%) reported last LB cases between 7–14 days, and 15 LB cases (8%) between 2–4 weeks. Most language barrier cases were identified through the patient’s stature and body language (72 cases, 40%), or mentioned during registration process (41 cases, 23%), or with input from an accompanying person (24 cases, 13%). For confirming understanding from the patient, body language (71 cases, 40%) and fluent responses (58 cases, 32%) were identifying elements, while some used the teach-back method (32 cases, 18%). Regarding consultation time, 71 HCPs (40%) took longer time but that did not disrupt their schedules, whereas 53 said they (30%) required two appointment slots and 46 reported (25%) delays caused to subsequent appointments (table 3). Table 3: Languages knowledge and Language Barrier Case frequencies Languages and Case Experiences N % Self-Assessed Language Knowledge Dutch 179 100% English 179 100% French 179 100% German 121 67.6% Spanish 61 34% Italian 33 18.4 Arabic 5 2.7% Turkish 4 2.2% No. of Languages spoken Upto 3 languages 39 22% Upto 5 languages 115 64% Upto 7 languages 23 13% More than 7 languages 2 1% Case Frequencies due to LB Less than 2 cases per month 7 4% 2 to 5 cases per month 49 27% Upto 5 cases per week 59 33% More than 5 cases per week 64 36% Most recent case of LB Last 7 days 124 69% Between 7 – 14 days 31 17% Between 2 – 4 weeks 15 8% More than 4 weeks ago 6 3% More than 6 mnths ago 3 2% Identifying cases of LB Stature and body language of the patient 72 40 Noted during registration 41 23% Informed by accompanying person 24 13% Patients unresponsive to doctor 17 9% Patient uses translation app or device 25 14% Confirming from Patient Teach back Method 32 18% Patients’ response is fluent and clear 58 32% Stature and body language of patient 71 40% Patient nods his/her head 18 10% Consultation Duration Time same as regular consult duration 9 5% Time more than regular consult, no effect on following appointments 71 40% Time more than regular consults, two appointment slots needed 53 30% More time consuming, hampers following appointment schedule 46 25% Alternative Techniques About the use of alternative techniques, the most common method was speech-to-word translation devices or applications, reported by 97 HCPs (54%). Other notable approaches included use of ad hoc interpreters (n=24, 13%), professional interpreters (n=15, 8%), and online or app-based services (n=13, 7%). Less frequent methods were tele-interpreting (n=9, 5%), or using pictures or graphics (n=5, 3%) or use of AI tools like ChatGPT (n=1, 1%) (table 4b). Across different providers, speech-to-word translation devices were by far the most widely used (97 cases), especially among hospital doctors (24), nurses (21), pharmacists (15), and general physicians (20). Ad hoc interpreters were used in 24 cases, mainly by general physicians (8) and hospital doctors (6), while professional interpreters were engaged in 15 cases, most often by psychologists (2) and hospital doctors (5). Online interpreting services were less frequent (13 cases), with small contributions across physicians, nurses, pharmacists, and others (table 4). Table 4: Alternative techniques for communication Alternative Techniques n % The use of an ad hoc interpreter 24 13% The use of a professional interpreter 15 8% Use of an interpreting service: tele-interpreting 9 5% Using online interpreting services like applications or websites 13 7% The patient records the diagnosis to ask peers or family members at home 3 2% Using a speech to word translation device or application 97 54% Through the use of pictures and graphics 5 3% Through the use of AI applications like Chat GPT 1 1% Other 12 7% 179 100% Self-perceived assessment of patient interactions (questions 18 – 28) The Likert scale results reflect respondents’ perceptions of their ease in interacting and communicating with patients when language barriers were present. Mean scores ranged from 6.36 to 7.33, with standard deviations between 1.96 and 2.32, suggesting relatively consistent, though not entirely uniform, response patterns. The highest-rated activities were advising or informing patients about dietary or lifestyle changes (M = 7.33, SD = 1.96) and assessing patient health literacy (M = 7.30, SD = 1.96), followed closely by advising patients on treatment options (M = 7.15, SD = 1.97). Conversely, informing patients about follow-up appointments (M = 6.36, SD = 2.31) and providing information regarding laboratory or radiological examinations (M = 6.39, SD = 2.26) received comparatively lower ratings (table 5). Table 5: Self perceived ability of healthcare professionals: Statements 1 to 3 4 to 7 8 to 10 Mean SD Understanding the chief complaint of the patient 13 61 105 6.56 2.32 Informing about referring or transfer to another doctor or clinic 9 57 113 6.87 2.16 Informing the patient about the diagnosis of chief complaint 9 59 111 6.84 2.16 Advising the patient about treatment options 5 45 129 7.15 1.97 Informing the patient about laboratory testing or radiological exam 12 76 91 6.39 2.26 Giving the patient information about medication and dosage 12 60 107 6.73 2.15 Giving the patient information about follow up appointments 19 73 87 6.36 2.31 Assessing the health literacy of the patient 4 50 125 7.30 1.96 Advising to follow the prescribed medication 14 57 108 6.70 2.19 Advising or informing about the dietary or lifestyle changes that are deemed necessary for the condition or treatment that they need 8 42 129 7.33 1.96 In response to the Likert scale question assessing how often language barriers among patients affect appointment scheduling (1 = very rare; 10 = very often), the average score reported by participants was 7.10. Significance testing of variables affecting Language Barriers and Alternative Techniques For language barrier frequency, none of the examined variables were found to be statistically significant, gender (p = 0.659), professional role (p = 0.119), work experience (p = 0.092), and number of languages spoken (p = 0.511) all demonstrated non-significant associations. In contrast, when examining the use of alternative techniques, one variable emerged as significant. Professional role showed a statistically significant association with the use of alternative communication techniques (p = 0.002). This finding indicates that the professional role of respondents influenced the type of alternative techniques they employed to overcome communication barriers. Other factors: gender (p = 0.343), work experience (p = 0.051), and languages spoken (p = 0.430)—did not show significant effects. This finding suggests that communication strategies vary substantially across professional groups (table 6). Table 6: HCP characteristics on Language Barrier frequency and Alternative Techniques Variable Outcome Variable X² df p-value Significant? Gender Language Barrier Frequency 4.1313 6 0.6589 No Professional Role Language Barrier Frequency 66.451 54 0.1191 No Work Experience Language Barrier Frequency 26.374 18 0.09151 No Languages Spoken Language Barrier Frequency 5.2632 6 0.5105 No Sex Alternative Techniques Used 17.676 16 0.3432 No Professional Role Alternative Techniques Used 198.74 144 0.00171 Yes Work Experience Alternative Techniques Used 65.055 48 0.05101 No Languages Spoken Alternative Techniques Used 16.333 16 0.43 No Discussion We found that healthcare professionals (HCPs) encountered cases of language barriers on variable frequencies, in line with their work profile. This finding is consistent with earlier studies (4-6) and is of practical relevance, given the importance of providing just and appropriate care and treatment to all patients. Communication, and medical communication in particular lies on the give & take and exchange of information between patients and HCP personnel to understand each other (3). The alternative techniques used by professionals to overcome the communication deficit also gave insight into what they preferred and their self-perceived ability to understand patients. Language Barriers as Cases: Regarding identification and management of language barrier cases, the survey reveals reliance on non-verbal cues and initial patient interactions. Patient stature and body language were the primary indicators of potential communication difficulties (40%), followed by information obtained during the registration process (23%) and through accompanying people (13%). These findings align with previous studies emphasizing the adjunct role of non-verbal communication and contextual cues in clinical encounters when language proficiency is limited (25, 26). Similarly, confirmation of patient understanding was also grounded in both verbal and non-verbal communication. Body language (40%) and fluent responses (32%) were commonly used to assess comprehension, while the teach-back method was employed less frequently (18%). This suggests that while HCPs utilize intuitive and interactive methods to ensure understanding, structured strategies such as teach-back may be underutilized, despite evidence supporting its efficacy in improving patient comprehension and adherence (2). In their study to acknowledge the effect of teach-back method during discharge process, they confer that the teach back method had a positive retention of discharge information on short term basis with regards to follow up, medications and department transfer (27). Verbal instructions when provided to patients were preferred over written discharge details, as the patient found it engaging to further ask questions to follow up (28). Consultation time was affected in a proportion of language barrier cases. Forty percent of respondents reported longer consultations without disrupting schedules, whereas 30% required double appointment slots and 25% experienced delays impacting subsequent appointments. The increase time for the consultation can reflect to the principle of good patient-doctor communication for understanding each other (2, 6). These findings highlight the operational challenges posed by language barriers, including potential workflow disruptions and resource allocation issues, which must be addressed through strategic planning and support, such as interpreter services or multilingual staff deployment (21). Alternative Communication Technique: The findings reveal a clear dependency on speech-to-word translation devices among HCPs (54%), indicating a strong preference for rapid, technology-mediated solutions to address linguistic diversity in clinical encounters. This trend may reflect the increasing availability and perceived efficiency of such tools in facilitating basic communication; however, their use raises concerns regarding the adequacy of conveying complex or culturally competent information (28). The reliance of digital tools for translation and assistance throughs apps and websites has prompted studies in the past to check for their accuracy and efficiency in clinical practice, along with user satisfaction levels (29). One study assessed translations of 10 common pre anesthetic assessment questions from English into 10 languages, reporting considerable variability in accuracy: Vietnamese and Polish scored the lowest (10%), while Spanish was highest (80%) (30). Another study of 10 medical phrases across 26 languages found an overall accuracy of 58%, with substantial variation by region: African (42%), Asian (46%), Eastern European (62%), and Western European languages (74%) (31). The relatively low uptake of professional interpreters (8%) and online or app-based services (7%) suggests that structural or logistical constraints—such as cost, time limitations, or lack of institutional support—hamper the routine integration of formal language support services into healthcare practice (15, 32). The use of interpreters as an alternative techniques is the gold standard and should be embedded in health care as a standardized and quality-assured procedure (13-15). However, its use is subject to factors like healthcare providers own knowledge and access of such services, economic costs, availability and time constraints, both logistical and service oriented (33). The persistence of ad-hoc interpretation (13%), often involving family members or bilingual colleagues, underscores an enduring reliance on informal communication strategies despite evidence of associated risks to confidentiality, accuracy, and patient autonomy (21, 22). Similarly, the limited employment of AI-based tools (1%), such as ChatGPT, indicates that innovative or multimodal approaches to multicultural communication remain underutilized. In contrast the gaining reliance on automatic translation with app, translation devices or websites do bring attention on their use (34). These patterns collectively highlight a tension between the practical need for immediate communication and the ethical imperative of culturally and linguistically competent care (35). To support effective multicultural healthcare interactions, institutions might consider improving access to professional interpreting services, offering staff training on the culturally sensitive use of translation technologies, and exploring emerging digital tools that can enhance both linguistic accuracy and cross-cultural communication 1 . The correlation on the use of alternative communication techniques was significantly associated with professional role (χ² = 198.74, df = 144, p = 0.0017), suggesting that the type of healthcare provider influenced the likelihood of employing strategies such as translation devices, professional interpreters, or ad hoc interpreters. In contrast, no significant associations were observed for sex (χ² = 17.68, df = 16, p = 0.34), work experience (χ² = 65.06, df = 48, p = 0.051), or the number of languages spoken (χ² = 16.33, df = 16, p = 0.43), indicating that these factors do not strongly predict the use of alternative techniques in clinical interactions. The absence of significant effects for work experience and multilingual capacity may suggest that access to, or familiarity with, communication tools is more depended upon by professional role and responsibilities than by individual characteristics. From the Likert scale analysis, we observe the greater ease of HCPs in delivering patient education information, particularly with respect to dietary or lifestyle guidance (M = 7.33) and assessment of health literacy (M = 7.30), indicating a focus on long-term health management (22, 36). Conversely, procedural communication tasks, including the explanation of follow-up appointments (M = 6.36) or laboratory investigations (M = 6.39), received lower ratings, identifying areas more susceptible to disruption by language barriers. The mean score of 7.10 regarding the influence of language barriers on appointment scheduling further emphasizes their frequent impact on routine clinical operations. This indicates that procedural communication tasks may receive less attention relative to treatment- and education-focused interactions. Collectively, these results underscore the value of structured communication support, such as professional interpreters or translation technologies, in facilitating both educational and procedural interactions within multilingual healthcare contexts (21, 37). Strengths and Limitations This survey provides valuable insights into the experiences of HCPs across Belgium when communicating with patients due to language barriers. One of the key strengths of the study lies in its broad scope: it was designed to include professionals from all healthcare fields who come in contact with patients, capturing a wide range of perspectives from physicians, nurses, and allied health workers. The nationwide distribution of the survey further enhances its relevance, ensuring geographic diversity and representation from various healthcare institutions and linguistic regions. This comprehensive approach strengthens the applicability of the findings to healthcare systems operating in multilingual and multicultural contexts. Another positive aspect was that all the responses were complete, thereby implying the intention of the participants to complete the survey fully. However, several limitations should be acknowledged. The reliance on self-reported data may introduce recall bias or socially desirable responses, potentially affecting the reliability of the results. Although the survey was made available in three languages to improve accessibility (Dutch, English, and French), subtle differences in translation may have influenced how respondents interpreted questions. Additionally, the use of a predefined coding tree, while useful for structured analysis, may have constrained the richness of qualitative responses by fitting them into fixed categories. Finally, the analyzed sample may not fully represent the entire spectrum of HCPs working in multilingual settings, which limits the generalizability of the findings. There were more responses from the Dutch speaking regions of Belgium as opposed to the French speaking regions, thereby the results cannot be generalized through all of Belgium. Conclusion This study aimed to examine the perspectives and experiences of HCPs across Belgium in their interactions with patients who face language barriers. The findings demonstrate that language barriers affect all categories of healthcare providers, irrespective of their professional role or stage of patient interaction—whether during registration, clinical consultation, discharge procedures, or medication dispensing. Across these encounters, respondents highlighted several recurring concerns, including accuracy in understanding patient complaints, the degree of patient cooperation, the duration of appointments, and the ability to confirm patients’ comprehension of communicated information. The survey results further illustrate that communication in multilingual settings—often complicated by varying levels of health literacy—constitutes a significant and persistent challenge for HCPs. Respondents reported moderate to high levels of difficulty across most communication tasks, as reflected in Likert scale responses. These responses also suggest that HCPs can differentiate between tasks perceived as relatively straightforward and those deemed more complex. Notably, particular difficulties were associated with explaining complex medical information, assessing patients’ health literacy, and delivering lifestyle counseling in a manner that ensures comprehension and engagement. Overall, these findings highlight the influence and presence of linguistic and cultural diversity on clinical communication within the Belgian healthcare system and the need for targeted, evidence-based interventions. Strategies such as specialized communication training, systematic use of professional interpreters, and culturally tailored health education materials could enhance equity and effectiveness in patient–provider interactions. Future research should further investigate context-specific barriers through qualitative inquiry and assess the impact of targeted communication interventions in multilingual healthcare settings to inform policy and practice. Abbreviations LB’s: Language Barriers HCP’s: Healthcare Professionals FL: Foreign Language Declarations Ethical approval and consent to participate: Ethical approval for this study was obtained as part of the MaLBUC project (Managing Language Barriers in Unplanned Care) from the Ethics Committee of UZ Leuven, Gasthuisberg (study number S-67908). In accordance with the principles of the Declaration of Helsinki, all ethical considerations, including confidentiality and respondent anonymity, were fully addressed. The first segment of the survey contained the study information, its purpose along with the consent question. Informed consent was obtained from all individuals who voluntarily completed the survey. Clinical Trial Number: Not Applicable Consent for publication: Not Applicable Availability of data and materials: The dataset used for this particular study is available upon reasonable time of request from the first author. Competing interests: None. Funding/Support : The authors have not received a specific grant for this paper. The study was conducted with the internal funding of KU Leuven (IDN: ZKE2482-00-W01). Authors’ contribution Idea and concept: MI, BS Data processing: MI Data Analysis: MI, BS Writing of the manuscript: MI Reviewing and commenting on drafts: AC, MS, HS, BS Acknowledgements: Not applicable References Heritage J, and D.W. Maynard. Introduction: Analyzing Interaction between Doctors and Patients in Primary Care Encounters’. Communication in Medical Care Interaction between Primary Care Physicians and Patients: Studies in Interactional Sociolinguistics; 2006. Longnecker JFHN. Doctor-Patient Communication: A Review. The Ochsner Journal. 2010;10(1):38 - 43. Kuziemsky CE, Varpio L. Describing the Clinical Communication Space through a Model of Common Ground: 'you don't know what you don't know'. AMIA Annu Symp Proc. 2010;2010:407-11. Landmark AMD, Svennevig J, Gerwing J, Gulbrandsen P. Patient involvement and language barriers: Problems of agreement or understanding? Patient Educ Couns. 2017;100(6):1092-102. Bigi S, Rossi MG. Considering Mono- and Multilingual Interactions on a Continuum: An Analysis of Interactions in Medical Settings. In: Hohenstein C, Lévy-Tödter M, editors. Multilingual Healthcare: A Global View on Communicative Challenges. Wiesbaden: Springer Fachmedien Wiesbaden; 2020. p. 11-37. Dorr Goold S, Lipkin M, Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14 Suppl 1(Suppl 1):S26-33. Feudtner C. Collaborative communication in pediatric palliative care: a foundation for problem-solving and decision-making. Pediatr Clin North Am. 2007;54(5):583-607, ix. Hobgood CD, Riviello RJ, Jouriles N, Hamilton G. Assessment of Communication and Interpersonal Skills Competencies. Academic Emergency Medicine. 2008;9(11):1257-69. Pawlikowska TR, Walker JJ, Nowak PR, Szumilo-Grzesik W. Patient involvement in assessing consultation quality: a quantitative study of the Patient Enablement Instrument in Poland. Health Expect. 2010;13(1):13-23. Tweedie MG, & Johnson, R. C. Medical English as a Lingua Franca De Gruyter; 2022. Milroy L. Comprehension and Context: Successful Communication and Communicative Breakdown. In: Trudgill P, editor. Applied Sociolinguistic. London: Academic Press; 1984. Nikolas Coupland HG, John M. Wiemann. Miscommunication' and Problematic Talk. Newbury Park: Sage Publications; 1991. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. Jama. 1996;275(10):783-8. Foster H, Moffat KR, Burns N, Gannon M, Macdonald S, O'Donnell CA. What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature. BMJ Open. 2020;10(1):e033481. Jacobs EA, Shepard DS, Suaya JA, Stone EL. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866-9. Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-62. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020;35(2):e122. Villarruel AM, Portillo, C. J., & Kane, P. Communicating with limited English proficiency persons: implications for nursing practice. Nursing Outlook. 1999;47(6). Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800-6. John-Baptiste A, Naglie, G., Tomlinson, G. et al. The effect of English language proficiency on length of stay and in-hospital mortality. J GEN INTERN MED 2004;19:221-8. Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5(5):276-82. Flores G, Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. J. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6 - 14. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005;116(3):575-9. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. Betancourt J, Green A, Carrillo J. Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches. Field Report. 2002. Gerwing J, Dalby AM. Gestures convey content: an exploration of the semantic functions of physicians' gestures. Patient Educ Couns. 2014;96(3):308-14. Slater BA, Huang Y, Dalawari P. The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions. J Emerg Med. 2017;53(5):e59-e65. Shoeb M, Merel SE, Jackson MB, Anawalt BD. "Can we just stop and talk?" patients value verbal communication about discharge care plans. J Hosp Med. 2012;7(6):504-7. Panayiotou A, Gardner A, Williams S, Zucchi E, Mascitti-Meuter M, Goh AM, et al. Language Translation Apps in Health Care Settings: Expert Opinion. JMIR Mhealth Uhealth. 2019;7(4):e11316. Nguyen-Lu N, Reide P, Yentis SM. ‘Do you have a stick in your mouth?’– use of Google Translate as an aid to anaesthetic pre-assessment. Anaesthesia. 2010;65(1):96-7. Patil S, Davies P. Use of Google Translate in medical communication: evaluation of accuracy. BMJ. 2014;349:g7392. O’Daniel M RA. Professional Communication and Team Collaboration. In: RG H, editor. atient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. Hagan MO. Massively Open Translation: Unpacking the Relationship Between Technology and Translation in the 21st Century. International Journal of Communication. 2016;10:929 - 46. Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. Journal of the American Medical Informatics Association. 2024;31(3):611-21. Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research. 2014;14(1):99. Schyve PM. Language differences as a barrier to quality and safety in health care: the Joint Commission perspective. J Gen Intern Med. 2007;22 Suppl 2(Suppl 2):360-1. Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023;23(1):886. Footnotes https://statbel.fgov.be/en/themes/population/structure-population https://www.docu.vlaamserand.be/node/12981#:~:text=The%20establishment%20of%20the%20linguistic,of%20a%20system%20of%20facilities . https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/wet_van_22_augustus_2002_betreffende_de_rechten_van_de_patient_onofficiele_coordinatie.pdf R Core Team (2025). _R: A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing, Vienna, Austria. < https://www.R-project.org/%3E . Csárdi G (2019). _pkgconfig: Private Configuration for 'R' Packages_. doi: 10.32614/CRAN.package.pkgconfig < https://doi.org/10.32614/CRAN.package.pkgconfig%3E , R package version 2.0.3, < https://CRAN.R-project.org/package=pkgconfig%3E . https://www.unicef.org/media/120836/file/%20Global%20Report%20on%20Assistive%20Technology%20.pdf Additional Declarations No competing interests reported. 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Sociologists Heritage and Maynard described medical consultation as an interactive communicative process in which the doctor and the patient take turns to formulate and allow for the construction of the interaction (1). This communication allows for a basic conversation which involves interaction between a patient and a healthcare professional, where the ultimate objective is to improve the patient\u0026rsquo;s health and to deliver medical care (2). Communication and interactions between the healthcare professional and a patient follow the principle of common ground, which in the simplest of terms is the knowledge shared between the parties or the participants involved to allow for communication between them (3). Information exchange between the patient and the healthcare professional is the dominant communication model, with current approaches including patient-centered communication or shared decision-making (4). An essential feature of medical interactions is their ritual nature, in that they take place to considerable extent in a ritualized, prescribed manner. This perhaps is a necessity, in that medical encounters \u0026ldquo;accomplish a social role \u0026ndash; the \u0026lsquo;provision\u0026rsquo; of care and the maintenance of public health \u0026ndash; and are therefore regulated by legal and social norms\u0026rdquo; (5).\u003c/p\u003e\n\u003cp\u003eGood doctor-patient communication allows patients to share vital information essential for an accurate diagnosis of their problems, enables doctors to have a better understanding of their patient\u0026apos;s needs and potentially lead to better symptom reduction (6). The 2-way communication between the patient and the doctor being reciprocal and dynamic is also an example of collaborative communication (7). In this approach, the doctor facilitates discussion and negotiation with patients according to their needs thereby evaluating possible treatment options (2). Communication skills extend beyond verbal exchanges to include the full range of nonverbal forms such as body language and written communication (8). In healthcare, strong communication abilities have been linked to greater patient enablement (9) and play a vital role in building trust with patients, their families, and other members of the healthcare team (8).\u003c/p\u003e\n\u003cp\u003eWithin the healthcare communication literature, \u003cem\u003ethe term \u0026lsquo;language barriers\u0026rsquo; is commonly used to highlight difficulties in communication that may result in misunderstandings or breakdowns in communication\u0026nbsp;\u003c/em\u003e(10). In its simplest form, miscommunication can be attributed to a mismatch between the speakers\u0026apos; intention and the hearer\u0026apos;s interpretation (11). Coupland and his colleagues argue that miscommunication is a theoretically \u0026ldquo;slippery\u0026rdquo; construct\u0026mdash;broad and multidimensional, and is subject to varying interpretations based on the definitional lens employed (12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA desirable way to overcome language barriers is to use a professional interpreter, as the gold standard technique (13-15). Nevertheless, studies have found an underuse of professional interpreters in health-care settings (13, 15). In routine health care encounters where language barriers are present, communication commonly proceeds without professional interpreters or by use of non-professionals or family members (16). This has been described in the literature as \u0026lsquo;getting by,\u0026rsquo; whereby practitioners depend on nonverbal cues and a limited repetition of words in the target language (16-18). The \u003cem\u003egetting by\u0026nbsp;\u003c/em\u003eapproach has the potential for miscommunication, which may lead to inappropriate or inadequate care provision and patients\u0026rsquo; needs being unmet. A difference in the linguistic knowledge of the participants involved, notably communication discordance has been attributed to language barriers (14). Language discordance between patients and healthcare providers can obstruct effective communication, thereby compromising the quality of care (14). Research has demonstrated that perceived language barriers are associated with a range of adverse health related outcomes, including: i) impaired understanding of medication instructions, including dosage and usage, as provided by physicians or pharmacists (19); ii) prolonged hospital stays, both in inpatient and emergency care settings (20); iii) an increased risk of hospital readmission (21); iv) critical communication errors and omissions (22); and v) a heightened risk of serious medical events (23).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs the de facto capital of Europe and a hub of migration, Brussels presents a highly diverse linguistic landscape. This diversity, which varies significantly across regions, offers a compelling context for examining the communicative experiences of healthcare professionals in their interactions with patients. As of 1st January, the total population in Belgium with a migration background was 4 million (34% of the total population)\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e1\u003c/sup\u003e, residing across the different regions of the country. The 1963 Language Use in Administration Act cemented Belgium\u0026rsquo;s division into distinct language regions, requiring public administrations to operate exclusively in the official language of their respective areas\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e2\u003c/sup\u003e. It enshrined the territorial use of its languages Dutch in Flanders, French in Wallonia, German in the German province, and Brussels region being Bilingual with French and Dutch, making it a key step in the foundation of Belgium\u0026rsquo;s multilingual structure. While there is no specific legislative law in Belgium, \u003cem\u003eThe Belgian Patients\u0026rsquo; Rights Act of 2002 (\u0026quot;Wet betreffende de rechten van de pati\u0026euml;nt \u0026quot; / \u0026quot;Loi relative aux droits du patient\u0026quot;)\u003csup\u003e3\u003c/sup\u003e\u003ca href=\"#_ftn3\" name=\"_ftnref3\" title=\"\"\u003e\u003c/a\u003e\u0026nbsp;\u003c/em\u003eis a key legal framework that establishes and protects the rights of patients in healthcare settings across Belgium. It came into effect on October 6, 2002, and applies to all healthcare providers and institutions. Although the law does not explicitly require multilingual services, the right to understandable information indirectly requires that communication should be adapted to the patient\u0026apos;s language and comprehension level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe goal of this study was to examine the experiences of healthcare professionals (HCPs), both medical and allied in Belgium on encountering language barriers in clinical settings, when communicating with patients. The research questions thus formulated were:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cem\u003eWhat is the effect of language barriers on healthcare professionals when interacting with Foreign Language (FL) speaking patients during a medical interaction\u003c/em\u003e? and\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eHow do healthcare professionals perceive the impact of language barriers on their ability to execute their services when interacting with FL speaking patients?\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cem\u003eStudy Design\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;The purpose of this study was to investigate communication due to language barriers when encountered by working healthcare professionals (HCPs). We were interested in investigating to what extent they were able to overcome the language discordant situation and maintain communication during patient interactions; and to gain insight into the alternative techniques or methods they used. Critical clinical parameters in line with the study goal were: 1) professional branch in healthcare, 2) work profile and tenure, 3) language fluency, and 4) self-perception of estimating the patients understanding them and their medical advice. Additionally, we also addressed whether any of these factors predicted the use of a professional interpreter by the clinician.\u003c/p\u003e\n\u003cp\u003eThis study employed a \u003cstrong\u003equantitative cross-sectional survey design\u003c/strong\u003e to assess the experiences of HCPs in interactions with patients when encountered with language barriers. The study aimed to collect standardized data on personal and professional experiences encompassing communication challenges, coping strategies, and the impact of language barriers on patient communication and care as experienced by health care professionals. To maintain the quality of the survey, the CHERRIES checklist (Checklist for Reporting Results of Internet Surveys) was followed (24).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eSurvey Development:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eA multi-lingual structured questionnaire survey was designed using Microsoft Forms to ensure ease of access and data collection. The survey was developed in three languages: Dutch, English, and French. The questionnaire was developed based on existing literature of communication experiences of HCPs in scenarios of language discordance or no language commonality. To check on its content validity, expert consultation was done by members of the research team, which comprised of two practicing doctors and two linguistic professionals. The survey consisted of 28 questions which were divided into 5 segments: 1) study information and informed consent (Q1), 2) respondent demographics (Q2 \u0026ndash; Q5), 3) professional profile (Q6 \u0026ndash; Q9); 4) language knowledge and language barrier cases (Q10 \u0026ndash; Q17), and 5) Likert scale questions on their self-perceived assessment of patient interactions (Q18 \u0026ndash; Q28). The survey questions were designed to assess participants perceived abilities during encounters and factors influencing their communication. Segment 1 outlined the study\u0026rsquo;s purpose, duration, and obtained consent, allowing only consenting participants to continue. Segments 2\u0026ndash;5 included mostly single-answer and Likert-scale questions, with some open responses on language proficiency and strategies for overcoming language barriers.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eSurvey piloting:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eA test version of the survey was distributed within the research unit of the project partners, to check for its workability and accessibility. The research unit is comprised of researchers from the field of medicine and allied healthcare field (pharmacists, nurses, midwives, dentists, physiotherapists). The test version was online for 3 weeks from 14\u003csup\u003eth\u003c/sup\u003e May 2024, access for which was through the web-link sent by email. Within the three weeks, 16 responses were received. Feedback received from the respondents was positive with regards to the working, distribution, access, and response of the survey. Following this, the definitive version of the survey was made ready for distribution.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eSurvey Participants and Distribution:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe survey targeted HCPs working across Belgium, in the regions of Brussels, Flanders, and Wallonia. Participants were recruited through professional healthcare networks and institutional email distributions to ensure a diverse and representative sample. Eligible participants were required to be actively practicing HCPs with direct patient contact. Individuals employed in healthcare-related roles without patient interaction\u0026mdash;such as administrative financial staff or laboratory personnel without direct patient contact\u0026mdash;were excluded.\u003c/p\u003e\n\u003cp\u003eTo maximize geographic and professional reach, the survey was digitally disseminated via multiple channels: a) university and general hospitals located in various provinces across Belgium; b) registered membership organizations representing healthcare professions, including pharmacists, dentists, midwives, nurses, general practitioners, and emergency medical personnel; c) professional medical journals and websites that publish healthcare-related content within Belgium. In addition to digital outreach, physical posters of the survey to encourage wider participation were strategically placed in areas of participating hospitals, like staff social rooms, doctors\u0026apos; changing rooms, cafeterias frequented by HCPs, and meeting rooms. The survey was open for responses from July 25, 2024, to February 23, 2025, following its distribution through the identified networks, organizations, and hospital sites.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAfter data collection, all survey responses\u0026mdash;across all languages\u0026mdash;were compiled into a Microsoft Excel worksheet. To enable structured analysis, a predefined coding tree was developed based on thematic patterns identified in the responses. These codes were applied to the data and converted into numerical values in Excel, facilitating subsequent quantitative analysis. Descriptive statistics were used to summarize the characteristics of the survey respondents, their experiences, and challenges in communicating with patients, and the strategies they employed to improve communication. Statistical analyses were conducted in R via RStudio\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e4\u003c/sup\u003e, comprising descriptive statistics and regression modeling\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e5\u003c/sup\u003e. Segments 2 and 3 of the survey were analyzed descriptively. To explore potential factors influencing the frequency with which respondents encounter language barriers and the types of alternative techniques they used to overcome these barriers, a series of Pearson\u0026rsquo;s Chi-squared tests were conducted for four independent variables of the respondents: sex, professional role, years of work experience, and number of languages spoken.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eEthical Considerations\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eEthical approval of the study was received in line for project MaLBUC by the ethics committee of UZ Leuven, Gasthuisberg (study number S- 67908). On accessing the survey, the participants were informed about the purpose of the study. It also gave information about the survey duration, and their right to withdraw from the survey at any time. Anonymity and confidentiality were guaranteed all through the survey, as no personal data in any form was recorded.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eEthics Approval and Consent to participate:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained by all participants who accessed the survey.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u0026nbsp;A total of 192 respondents accessed the survey. Most responses were in Dutch (181). Eleven respondents (6%) declined participation, leaving 181 completed surveys (94%): 176 in Dutch, 3 in French, and 2 in English. The two English responses were excluded after review, as the respondents showed limited knowledge of Belgium\u0026rsquo;s national languages, creating a language bias. The final sample analyzed consisted of 179 responses.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003ea. Participant Demographics (questions 2 - 5)\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eOf the 179 respondents, 117 (65%) were aged 25\u0026ndash;44 years, 46 (26%) were 45\u0026ndash;64 years, 7% were 18\u0026ndash;24 years, and 4 (2%) were 65+ years. Women represented 64% of the sample, men 35%, and one respondent did not disclose gender (table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: Participant Demographics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e25-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e45-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e65 years or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePlace of Residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAntwerp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBrussels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEast Flanders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWest Flander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLimburg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWalloon Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFlemish Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePlace of Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAntwerp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBrussels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEast Flanders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWest Flander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLimburg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFlemish Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cem\u003eb. Professional Profile (questions 6 - 9)\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe survey included a diverse range of healthcare professionals. General physicians (n=43, 24%) and hospital doctors (n=43, 24%) formed the largest groups, followed by hospital nurses (n=33/18%) and pharmacists (n=26, 15%). 84 respondents (47%) were affiliated with a university hospital, while 48 (27%) worked in group practices and 24 (14%) in private practices. In terms of work schedules, 126 professionals were working full-time (70%), while 44 reported (25%) working 51\u0026ndash;80%. Among the respondents, 35 (20%) had less than 3 years of work experience, while the largest group, 43 (24%), reported 4\u0026ndash;7 years of experience. Smaller proportions were observed in the other categories, including 17 (9%) with 8\u0026ndash;10 years, 25 (14%) with 11\u0026ndash;15 years, 17 (9%) with 16\u0026ndash;20 years, 15 (8%) with 21\u0026ndash;25 years, and 27 (15%) with 26 years or more (table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Participant professional profile\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Profile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHealthcare Role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGeneral Physician\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAdministrative work\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHospital Doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHospital Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNursing Centre Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePsychologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAmbulance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDispatch Staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWork Facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePrivate Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGroup Practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGeneral Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eRegional Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUniversity Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMultiple clinics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWorking Schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePart Time (less than 30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePart Time (31 \u0026ndash; 50 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePart Time (51 \u0026ndash; 80 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFull Time (100 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWork Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLess than 3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4 \u0026ndash; 7 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8 \u0026ndash; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e11 \u0026ndash; 15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e16 \u0026ndash; 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e21 \u0026ndash; 25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e26 years or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cem\u003eLanguage knowledge (question 10)\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eIn terms of languages spoken fluently or with expert proficiency, all respondents reported proficiency in Dutch, English, and French, with 67.6% also speaking German (n=121). Other languages included Spanish (n=61)), Italian (n=33), Arabic (n=5), and Turkish (n=4). 115 respondents (64%) reported speaking up to five languages, while 39 (22%) spoke up to three languages, and 23 (13%) spoke up to seven languages (table 3).\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003ec. Language Barrier (LB) Cases (questions 11 - 17)\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eMost respondents reported frequent LB cases, with 59 HCPs (33%) encountering up to five cases weekly and 64 HCPs (36%) handling more than five per week. In the last 7 days, 124 HCPs (69%) had recent LB cases, while 31 HCPs (17%) reported last LB cases between 7\u0026ndash;14 days, and 15 LB cases (8%) between 2\u0026ndash;4 weeks. Most language barrier cases were identified through the patient\u0026rsquo;s stature and body language (72 cases, 40%), or mentioned during registration process (41 cases, 23%), or with input from an accompanying person (24 cases, 13%). For confirming understanding from the patient, body language (71 cases, 40%) and fluent responses (58 cases, 32%) were identifying elements, while some used the teach-back method (32 cases, 18%). Regarding consultation time, 71 HCPs (40%) took longer time but that did not disrupt their schedules, whereas 53 said they (30%) required two appointment slots and 46 reported (25%) delays caused to subsequent appointments (table 3).\u003c/p\u003e\n\u003cp\u003eTable 3: Languages knowledge and Language Barrier Case frequencies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLanguages and Case Experiences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-Assessed Language Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDutch\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eFrench\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eGerman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e67.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSpanish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e34%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eItalian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eArabic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTurkish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Languages spoken\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eUpto 3 languages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eUpto 5 languages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eUpto 7 languages\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMore than 7 languages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase Frequencies due to LB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eLess than 2 cases per month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003e2 to 5 cases per month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eUpto 5 cases per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMore than 5 cases per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost recent case of LB\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eLast 7 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e69%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eBetween 7 \u0026ndash; 14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eBetween 2 \u0026ndash; 4 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMore than 4 weeks ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMore than 6 mnths ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIdentifying cases of LB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eStature and body language of the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eNoted during registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eInformed by accompanying person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePatients unresponsive to doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePatient uses translation app or device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfirming from Patient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTeach back Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; response is fluent and clear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eStature and body language of patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePatient nods his/her head\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsultation Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTime same as regular consult duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTime more than regular consult, no effect on following appointments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTime more than regular consults, two appointment slots needed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMore time consuming, hampers following appointment schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003eAlternative Techniques\u003c/h3\u003e\n\u003cp\u003eAbout the use of alternative techniques, the most common method was speech-to-word translation devices or applications, reported by 97 HCPs (54%). Other notable approaches included use of ad hoc interpreters (n=24, 13%), professional interpreters (n=15, 8%), and online or app-based services (n=13, 7%). Less frequent methods were tele-interpreting (n=9, 5%), or using pictures or graphics (n=5, 3%) or use of AI tools like ChatGPT (n=1, 1%) (table 4b). Across different providers, \u003cem\u003espeech-to-word translation devices\u003c/em\u003e were by far the most widely used (97 cases), especially among hospital doctors (24), nurses (21), pharmacists (15), and general physicians (20). Ad hoc interpreters were used in 24 cases, mainly by general physicians (8) and hospital doctors (6), while professional interpreters were engaged in 15 cases, most often by psychologists (2) and hospital doctors (5). Online interpreting services were less frequent (13 cases), with small contributions across physicians, nurses, pharmacists, and others (table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: Alternative techniques for communication\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"583\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlternative Techniques\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe use of an ad hoc interpreter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe use of a professional interpreter\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eUse of an interpreting service: tele-interpreting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eUsing online interpreting services like applications or websites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe patient records the diagnosis to ask peers or family members at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eUsing a speech to word translation device or application\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThrough the use of pictures and graphics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThrough the use of AI applications like Chat GPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 455px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eSelf-perceived assessment of patient interactions (questions 18 \u0026ndash; 28)\u003c/h2\u003e\n\u003cp\u003eThe Likert scale results reflect respondents\u0026rsquo; perceptions of their ease in interacting and communicating with patients when language barriers were present. Mean scores ranged from 6.36 to 7.33, with standard deviations between 1.96 and 2.32, suggesting relatively consistent, though not entirely uniform, response patterns.\u003c/p\u003e\n\u003cp\u003eThe highest-rated activities were advising or informing patients about dietary or lifestyle changes (M = 7.33, SD = 1.96) and assessing patient health literacy (M = 7.30, SD = 1.96), followed closely by advising patients on treatment options (M = 7.15, SD = 1.97). Conversely, informing patients about follow-up appointments (M = 6.36, SD = 2.31) and providing information regarding laboratory or radiological examinations (M = 6.39, SD = 2.26) received comparatively lower ratings (table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5: Self perceived ability of healthcare professionals:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 385px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 to 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 to 7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 to 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eUnderstanding the chief complaint of the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.56\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eInforming about referring or transfer to another doctor or clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.87\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eInforming the patient about the diagnosis of chief complaint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.84\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eAdvising the patient about treatment options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.97\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eInforming the patient about laboratory testing or radiological exam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eGiving the patient information about medication and dosage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.73\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eGiving the patient information about follow up appointments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eAssessing the health literacy of the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.96\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eAdvising to follow the prescribed medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 385px;\"\u003e\n \u003cp\u003eAdvising or informing about the dietary or lifestyle changes that are deemed necessary for the condition or treatment that they need\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.33\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.96\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn response to the Likert scale question assessing how often language barriers among patients affect appointment scheduling (1 = very rare; 10 = very often), the average score reported by participants was 7.10.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e\u003cem\u003eSignificance testing of variables affecting Language Barriers and Alternative Techniques\u003c/em\u003e\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFor language barrier frequency, none of the examined variables were found to be statistically significant, gender (p = 0.659), professional role (p = 0.119), work experience (p = 0.092), and number of languages spoken (p = 0.511) all demonstrated non-significant associations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, when examining the use of alternative techniques, one variable emerged as significant. Professional role showed a statistically significant association with the use of alternative communication techniques (p = 0.002). This finding indicates that the professional role of respondents influenced the type of alternative techniques they employed to overcome communication barriers. Other factors: gender (p = 0.343), work experience (p = 0.051), and languages spoken (p = 0.430)\u0026mdash;did not show significant effects. This finding suggests that communication strategies vary substantially across professional groups (table 6).\u003c/p\u003e\n\u003cp\u003eTable 6: HCP characteristics on Language Barrier frequency and Alternative Techniques\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"572\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eX\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003edf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguage Barrier Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessional Role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguage Barrier Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWork Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguage Barrier Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguages Spoken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguage Barrier Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.2632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlternative Techniques Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessional Role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlternative Techniques Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e198.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWork Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlternative Techniques Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.05101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLanguages Spoken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlternative Techniques Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found that healthcare professionals (HCPs) encountered cases of language barriers on variable frequencies, in line with their work profile. This finding is consistent with earlier studies (4-6) and is of practical relevance, given the importance of providing just and appropriate care and treatment to all patients. Communication, and medical communication in particular lies on the give \u0026amp; take and exchange of information between patients and HCP personnel to understand each other (3). The alternative techniques used by professionals to overcome the communication deficit also gave insight into what they preferred and their self-perceived ability to understand patients.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eLanguage Barriers as Cases:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eRegarding identification and management of language barrier cases, the survey reveals reliance on non-verbal cues and initial patient interactions. Patient stature and body language were the primary indicators of potential communication difficulties (40%), followed by information obtained during the registration process (23%) and through accompanying people (13%). These findings align with previous studies emphasizing the adjunct role of non-verbal communication and contextual cues in clinical encounters when language proficiency is limited (25, 26). Similarly, confirmation of patient understanding was also grounded in both verbal and non-verbal communication. Body language (40%) and fluent responses (32%) were commonly used to assess comprehension, while the teach-back method was employed less frequently (18%). This suggests that while HCPs utilize intuitive and interactive methods to ensure understanding, structured strategies such as teach-back may be underutilized, despite evidence supporting its efficacy in improving patient comprehension and adherence (2). In their study to acknowledge the effect of teach-back method during discharge process, they confer that the teach back method had a positive retention of discharge information on short term basis with regards to follow up, medications and department transfer (27). Verbal instructions when provided to patients were preferred over written discharge details, as the patient found it engaging to further ask questions to follow up (28).\u003c/p\u003e\n\u003cp\u003eConsultation time was affected in a proportion of language barrier cases. Forty percent of respondents reported longer consultations without disrupting schedules, whereas 30% required double appointment slots and 25% experienced delays impacting subsequent appointments. The increase time for the consultation can reflect to the principle of good patient-doctor communication for understanding each other (2, 6). These findings highlight the operational challenges posed by language barriers, including potential workflow disruptions and resource allocation issues, which must be addressed through strategic planning and support, such as interpreter services or multilingual staff deployment (21).\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAlternative Communication Technique:\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe findings reveal a clear dependency on speech-to-word translation devices among HCPs (54%), indicating a strong preference for rapid, technology-mediated solutions to address linguistic diversity in clinical encounters. This trend may reflect the increasing availability and perceived efficiency of such tools in facilitating basic communication; however, their use raises concerns regarding the adequacy of conveying complex or culturally competent information (28). The reliance of digital tools for translation and assistance throughs apps and websites has prompted studies in the past to check for their accuracy and efficiency in clinical practice, along with user satisfaction levels (29). One study assessed translations of 10 common pre anesthetic assessment questions from English into 10 languages, reporting considerable variability in accuracy: Vietnamese and Polish scored the lowest (10%), while Spanish was highest (80%) (30). Another study of 10 medical phrases across 26 languages found an overall accuracy of 58%, with substantial variation by region: African (42%), Asian (46%), Eastern European (62%), and Western European languages (74%) (31).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe relatively low uptake of professional interpreters (8%) and online or app-based services (7%) suggests that structural or logistical constraints\u0026mdash;such as cost, time limitations, or lack of institutional support\u0026mdash;hamper the routine integration of formal language \u0026nbsp;support services into healthcare practice (15, 32). The use of interpreters as an alternative techniques is the gold standard and should be embedded in health care as a standardized and quality-assured procedure (13-15). However, its use is subject to factors like healthcare providers own knowledge and access of such services, economic \u0026nbsp;costs, availability and time constraints, both logistical and service oriented (33).\u003c/p\u003e\n\u003cp\u003eThe persistence of ad-hoc interpretation (13%), often involving family members or bilingual colleagues, underscores an enduring reliance on informal communication strategies despite evidence of associated risks to confidentiality, accuracy, and patient autonomy (21, 22). Similarly, the limited employment of AI-based tools (1%), such as ChatGPT, indicates that innovative or multimodal approaches to multicultural communication remain underutilized. In contrast the gaining reliance on automatic translation with app, translation devices or websites do bring attention on their use (34). These patterns collectively highlight a tension between the practical need for immediate communication and the ethical imperative of culturally and linguistically competent care (35). To support effective multicultural healthcare interactions, institutions might consider improving access to professional interpreting services, offering staff training on the culturally sensitive use of translation technologies, and exploring emerging digital tools that can enhance both linguistic accuracy and cross-cultural communication\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e1\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe correlation on the use of alternative communication techniques was \u003cem\u003esignificantly associated with professional role\u003c/em\u003e (\u0026chi;\u0026sup2; = 198.74, df = 144, p = 0.0017), suggesting that the type of healthcare provider influenced the likelihood of employing strategies such as translation devices, professional interpreters, or ad hoc interpreters. In contrast, no significant associations were observed for sex (\u0026chi;\u0026sup2; = 17.68, df = 16, p = 0.34), work experience (\u0026chi;\u0026sup2; = 65.06, df = 48, p = 0.051), or the number of languages spoken (\u0026chi;\u0026sup2; = 16.33, df = 16, p = 0.43), indicating that these factors do not strongly predict the use of alternative techniques in clinical interactions. The absence of significant effects for work experience and multilingual capacity may suggest that access to, or familiarity with, communication tools is more depended upon by professional role and responsibilities than by individual characteristics.\u003c/p\u003e\n\u003cp\u003eFrom the Likert scale analysis, we observe the greater ease of HCPs in delivering patient education information, particularly with respect to dietary or lifestyle guidance (M = 7.33) and assessment of health literacy (M = 7.30), indicating a focus on long-term health management (22, 36). Conversely, procedural communication tasks, including the explanation of follow-up appointments (M = 6.36) or laboratory investigations (M = 6.39), received lower ratings, identifying areas more susceptible to disruption by language barriers. The mean score of 7.10 regarding the influence of language barriers on appointment scheduling further emphasizes their frequent impact on routine clinical operations. This indicates that procedural communication tasks may receive less attention relative to treatment- and education-focused interactions. Collectively, these results underscore the value of structured communication support, such as professional interpreters or translation technologies, in facilitating both educational and procedural interactions within multilingual healthcare contexts (21, 37).\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eStrengths and Limitations\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThis survey provides valuable insights into the experiences of HCPs across Belgium when communicating with patients due to language barriers. One of the key strengths of the study lies in its broad scope: it was designed to include professionals from all healthcare fields who come in contact with patients, capturing a wide range of perspectives from physicians, nurses, and allied health workers. The nationwide distribution of the survey further enhances its relevance, ensuring geographic diversity and representation from various healthcare institutions and linguistic regions. This comprehensive approach strengthens the applicability of the findings to healthcare systems operating in multilingual and multicultural contexts. Another positive aspect was that all the responses were complete, thereby implying the intention of the participants to complete the survey fully.\u003c/p\u003e\n\u003cp\u003eHowever, several limitations should be acknowledged. The reliance on self-reported data may introduce recall bias or socially desirable responses, potentially affecting the reliability of the results. Although the survey was made available in three languages to improve accessibility (Dutch, English, and French), subtle differences in translation may have influenced how respondents interpreted questions. Additionally, the use of a predefined coding tree, while useful for structured analysis, may have constrained the richness of qualitative responses by fitting them into fixed categories. Finally, the analyzed sample may not fully represent the entire spectrum of HCPs working in multilingual settings, which limits the generalizability of the findings. There were more responses from the Dutch speaking regions of Belgium as opposed to the French speaking regions, thereby the results cannot be generalized through all of Belgium.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aimed to examine the perspectives and experiences of HCPs across Belgium in their interactions with patients who face language barriers. The findings demonstrate that language barriers affect all categories of healthcare providers, irrespective of their professional role or stage of patient interaction\u0026mdash;whether during registration, clinical consultation, discharge procedures, or medication dispensing. Across these encounters, respondents highlighted several recurring concerns, including accuracy in understanding patient complaints, the degree of patient cooperation, the duration of appointments, and the ability to confirm patients\u0026rsquo; comprehension of communicated information.\u003c/p\u003e\n\u003cp\u003eThe survey results further illustrate that communication in multilingual settings\u0026mdash;often complicated by varying levels of health literacy\u0026mdash;constitutes a significant and persistent challenge for HCPs. Respondents reported moderate to high levels of difficulty across most communication tasks, as reflected in Likert scale responses. These responses also suggest that HCPs can differentiate between tasks perceived as relatively straightforward and those deemed more complex. Notably, particular difficulties were associated with explaining complex medical information, assessing patients\u0026rsquo; health literacy, and delivering lifestyle counseling in a manner that ensures comprehension and engagement.\u003c/p\u003e\n\u003cp\u003eOverall, these findings highlight the influence and presence of linguistic and cultural diversity on clinical communication within the Belgian healthcare system and the need for targeted, evidence-based interventions. Strategies such as specialized communication training, systematic use of professional interpreters, and culturally tailored health education materials could enhance equity and effectiveness in patient\u0026ndash;provider interactions. Future research should further investigate context-specific barriers through qualitative inquiry and assess the impact of targeted communication interventions in multilingual healthcare settings to inform policy and practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLB\u0026rsquo;s: Language Barriers\u003c/p\u003e\n\u003cp\u003eHCP\u0026rsquo;s: Healthcare Professionals\u003c/p\u003e\n\u003cp\u003eFL: Foreign Language\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e Ethical approval for this study was obtained as part of the MaLBUC project (Managing Language Barriers in Unplanned Care) from the Ethics Committee of UZ Leuven, Gasthuisberg (study number S-67908). In accordance with the principles of the Declaration of Helsinki, all ethical considerations, including confidentiality and respondent anonymity, were fully addressed. The first segment of the survey contained the study information, its purpose along with the consent question. Informed consent was obtained from all individuals who voluntarily completed the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe dataset used for this particular study is available upon reasonable time of request from the first author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding/Support\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The authors have not received a specific grant for this paper. The study was conducted with the internal funding of KU Leuven (IDN: ZKE2482-00-W01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIdea and concept: MI, BS\u003c/p\u003e\n\u003cp\u003eData processing: MI\u003c/p\u003e\n\u003cp\u003eData Analysis: MI, BS\u003c/p\u003e\n\u003cp\u003eWriting of the manuscript: MI\u003c/p\u003e\n\u003cp\u003eReviewing and commenting on drafts: AC, MS, HS, BS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHeritage J, and D.W. Maynard. Introduction: Analyzing Interaction between Doctors and Patients in Primary Care Encounters\u0026rsquo;. Communication in Medical Care Interaction between Primary Care Physicians and Patients: Studies in Interactional Sociolinguistics; 2006.\u003c/li\u003e\n \u003cli\u003eLongnecker JFHN. 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BMC Health Serv Res. 2023;23(1):886.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://statbel.fgov.be/en/themes/population/structure-population\u003c/span\u003e\u003cspan address=\"https://statbel.fgov.be/en/themes/population/structure-population\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.docu.vlaamserand.be/node/12981#:~:text=The%20establishment%20of%20the%20linguistic,of%20a%20system%20of%20facilities\u003c/span\u003e\u003cspan address=\"https://www.docu.vlaamserand.be/node/12981#:~:text=The%20establishment%20of%20the%20linguistic,of%20a%20system%20of%20facilities\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/wet_van_22_augustus_2002_betreffende_de_rechten_van_de_patient_onofficiele_coordinatie.pdf\u003c/span\u003e\u003cspan address=\"https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/wet_van_22_augustus_2002_betreffende_de_rechten_van_de_patient_onofficiele_coordinatie.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e R Core Team (2025). _R: A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing, Vienna, Austria. \u0026lt;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.R-project.org/%3E\u003c/span\u003e\u003cspan address=\"https://www.R-project.org/%3E\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Cs\u0026aacute;rdi G (2019). _pkgconfig: Private Configuration for 'R' Packages_. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.32614/CRAN.package.pkgconfig\u003c/span\u003e\u003cspan address=\"10.32614/CRAN.package.pkgconfig\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u0026lt;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.32614/CRAN.package.pkgconfig%3E\u003c/span\u003e\u003cspan address=\"10.32614/CRAN.package.pkgconfig%3E\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, R package version 2.0.3, \u0026lt;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://CRAN.R-project.org/package=pkgconfig%3E\u003c/span\u003e\u003cspan address=\"https://CRAN.R-project.org/package=pkgconfig%3E\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unicef.org/media/120836/file/%20Global%20Report%20on%20Assistive%20Technology%20.pdf\u003c/span\u003e\u003cspan address=\"https://www.unicef.org/media/120836/file/%20Global%20Report%20on%20Assistive%20Technology%20.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"language barrier, communication, patient-doctor relationship, medical interactions, experiences","lastPublishedDoi":"10.21203/rs.3.rs-8337472/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8337472/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical consultation is an interactive communicative process in which the doctor and the patient take turns to formulate and allow for the construction of the interaction. Communication challenges between patients and healthcare professionals during consultations can lead to miscommunication or complete breakdowns in interaction. Language barriers are a primary contributor to these difficulties. With increasing migration, the number of non-native language-speaking patients seeking medical care has risen substantially.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo explore the experiences of medical and allied healthcare professionals in Belgium when encountering language barriers during patient communication in clinical settings.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA quantitative, multilingual, cross-sectional survey study was conducted in Belgium to examine the experiences of healthcare professionals during patient interactions involving language barriers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 179 healthcare professionals completed the survey. All respondents reported encountering patients with whom communication was hindered by language barriers. Patients\u0026rsquo; body language and lack of responsiveness were key indicators of these barriers. The professional role of respondents significantly influenced the type of alternative communication technique employed (p\u0026thinsp;=\u0026thinsp;0.00171). Speech-to-text translation was the preferred strategy, reported by 54% (n\u0026thinsp;=\u0026thinsp;97) of participants, followed by ad hoc interpretation by accompanying people or other staff members.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLanguage barriers impact all categories of healthcare providers, regardless of their professional role\u0026mdash;whether during treatment, registration, discharge, or medication collection. Implementing strategies such as targeted communication training, greater use of professional interpreters, and culturally adapted health education tools may help mitigate these challenges and enhance patient\u0026ndash;provider communication.\u003c/p\u003e","manuscriptTitle":"Bridging the Gap: Experiences of Healthcare professionals on Language Barriers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 15:10:13","doi":"10.21203/rs.3.rs-8337472/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5a6ef5a4-f711-4338-ac28-1f226efae30f","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T05:56:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 15:10:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8337472","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8337472","identity":"rs-8337472","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}