Introduction and Objectives

Effective communication is essential for the delivery of high-quality health care. Barriers to communication can occur when the patient and their health care provider speak different languages. This study focuses on Arabic-speaking women with bothersome stress urinary incontinence (SUI) from the period of May 2022 to October 2023. The 2021 American Community Survey (IPUMS-USA) from Pew Research Center showed that the Detroit metro area contains approximately 13% of all Arabic speakers in the US and 91% of Arabic speakers in the state of Michigan.¹ Unsurprisingly, the Detroit metro area has the largest concentration of Arabic speakers in the country, with 4.7% of residents age 5 or older speaking Arabic in the home.¹ Evidence supports that patients who do not speak the local language have poorer access to health care compared to those who do speak the local language.² A recent systematic review concluded that medical interpreter services are necessary to overcome this communication barrier.³

Although medical interpretation services can help overcome this communication barrier, it is not appropriate in all situations. Due to cultural preferences and the sensitive nature of SUI, Arabic-speaking women routinely request same-sex interpreters. In addition to preferring same-sex interpreters, Arabic-speaking individuals generally prefer interpreters that share the same dialect.⁴ Same-sex interpreters and those who speak the same dialect as the patient are not always readily available, and therefore effective communication cannot always be achieved. Another solution to provide effective communication between patients and health care providers who do not speak the same language is the use of Arabic written medical information (AWMI). This written medical information helps patients to understand suggested medical interventions so that they may make a more informed decision regarding their care.⁵ AWMI has the added benefit of being understood by Arabic-speaking individuals who speak different dialects. This is because although there are many spoken forms of Arabic, there is one written form, known as MSA (Modern Standard Arabic).⁶ This written form of Arabic language allows for a broader understanding among those who speak different dialects.

A brochure containing AWMI explaining the Bulkamid urethral bulking procedure for SUI was made by Axonics Co and became available in February 2023. This work aims to better our understanding of the potential benefits AWMI has in improving communication between providers and the Arabic-speaking community.

Methods

From May 2022 to January 2023, all female patients in a single provider’s clinic who only spoke/read Arabic and were diagnosed with SUI were provided a brochure explaining the Bulkamid procedure in English. These patients were encouraged to take the English brochure home with them and have a family member or friend read it with them. From February 2023 to October 2023, all female patients in the same clinic who only spoke/read Arabic and were diagnosed with SUI were provided a professionally translated AWMI version of the Bulkamid brochure to read. The number of Bulkamid procedures scheduled 9 months before the AWMI became available was compared to the number of Bulkamid procedures scheduled during the 9 months after the AWMI became available. The independent variable was the language in which the Bulkamid brochure was presented to patients, either in English or MSA. The dependent variable was the number of Bulkamid procedures scheduled by patients after receiving the brochure.

Results

At the conclusion of this study, 70 women were provided with the English version of the brochure and 65 were provided with the AWMI version of the brochure. The median age of our cohort was 53 years (range 37-69). From May 2022 to January 2023, of the 70 patients provided with the English-written brochure, 40 (57%) scheduled a Bulkamid procedure. From February 2023 to October 2023, of the 65 who received the AWMI Bulkamid brochure, 60 (92%) scheduled a Bulkamid procedure. The difference was statistically significant (z = 4.62, P = .000002).

Discussion

Our study provides evidence that AWMI on the Bulkamid procedure results in more acceptance of the proposed procedure among Arabic-speaking females. This is evidenced by the statistically significant increase in the number of Bulkamid procedures scheduled by patients receiving AWMI compared to patients who only received the information on the procedure in English. Providing AWMI to Arabic-speaking females may allow for better understanding of a proposed treatment, which allows for a more informed decision by the patient. Additionally, Arabic-speaking patients provided with AWMI may feel more comfortable with providers who recognize language as a potential barrier to care. Seeing that a provider has medical information in a patient’s primary language can help to strengthen the patient-provider relationship. A strong therapeutic alliance fosters trust between patient and provider and may lead to more productive conversations that can lead to more effective treatment. Patients who know their providers care about bridging barriers, cultural or otherwise, may feel more comfortable sharing more sensitive information. These patients may be more inclined to share cultural nuances that impact care, understanding that their provider respects and cares to understand these cultural differences.

This AWMI has the potential be applied broadly to other areas of medical care as well. Other applications outside of information about procedures include patient instructions, information on medications, and social resources for patients. This work demonstrates the benefit AWMI has in providing quality care for Arabic-speaking females and opens the door for implementation of AWMI in other aspects of patient care.

Conclusion

Our study suggests that the use of AWMI leads to better patient understanding and consent for a proposed procedure by allowing greater access to medical information, and this is reflected in the increased acceptance of a procedure. Arabic-speaking females have unique barriers to health care, and AWMI attempts to address the challenge of providing accurate, accessible, and easily understandable information. This work could be applied more broadly to include other types of medical information presented to patients. More research is needed to identify other barriers specific to this patient population and provide access to quality health care.