Research points towards the use of audio-recorded content supplementing existing materials for patients/customers with limited English proficiency.



Parents with limited English proficiency (LEP) demonstrate lower comprehension of discharge instructions. A study was conducted to (1) determine the feasibility of providing a greeting card with language-specific, audio-recorded discharge instructions to LEP parents; (2) describe use of and satisfaction with the cards; and (3) evaluate card effect on instruction comfort with home care and comprehension.


LEP parents of children undergoing day surgery from April to September 2016 were eligible. Participants were randomized to usual discharge instructions, or usual instructions plus a three-minute card with language-specific audio instructions that could be replayed repeatedly. Parents were surveyed by telephone two to seven days postdischarge to assess card use and satisfaction, comfort with home care, and discharge instruction recall (medications, home care, follow-up, and return precautions). Parent-reported instructions were compared to instructions in the medical record; concordance was determined by two blinded reviewers. Due to difficulty achieving recruitment goals, analysis focused on feasibility and acceptability.


Of  83 parents enrolled, 66 (79.5%) completed the follow-up survey. Most had not completed high school (61.0%) and spoke Spanish (89.2%). Parents reported high satisfaction with the card (4.5/5 for ease of use, helpfulness, and understandability). Ninety-four percent shared the card with others, and 45.2% reported listening > 5 times. Besides reviewing the care instructions generally, parents reported using the card to review medications and engage others in the child’s care.


Providing language-concordant, audio-recorded discharge instructions was feasible, and parents reported high satisfaction with and frequent use of the cards with multiple caregivers.


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And some easy DIY fixes! (because who doesn’t like a little DIY?)

Ellias Appel
Ellias Appel | 4 Mar 2019

For effective communication it’s best to leave judgements, presumptions and assumptions at the door. For organisations and businesses this is exceedingly important when speaking with our culturally diverse, non-English speaking customers. Most of us are time poor, and our learned and habitual professional behaviours and social instincts may be hard to shake, but they generally serve us well. But just as our society has woken up over recent years to how these habits and behaviours may affect others who we interact with, it is equally important to include a consideration for Culturally and Linguistically Diverse customers in this re-examination.

Research suggests that non-English speakers are often left stranded, finding it difficult to access services like health and welfare, struggling to comprehend the jargon and terminology used by professionals. They are at a distinct disadvantage in the areas of health literacy and social cohesion as a consequence of their language disparities. There can also be cultural misfires (no, not everyone celebrates Christmas, and who’s New Year are we celebrating this month?), unwanted handshakes, misunderstood social conventions (unexpected double cheek kisses) and unintended confusion.

There is no doubt that taking some time to build awareness around the issues culturally diverse non-English speakers face will be invaluable to for you, and your organisation.


1 – Be Aware of Your Own Communication Style


Most service providers operate within the framework of their cultural ideology – which for most of us is primarily Anglo Australian. Within that framework, staff members bring individual value systems, beliefs and cultural habits. We are psychologically predisposed to consider those outside our “tribe” as the other, and according to Gestalt theory we tend towards the formation of stereotypes or archetypes.

In Gestalt Theory our brains group things together to make them easier to understand. This applies to people as well as shapes.

It is human nature for us to make assumptions about others based on the dominant cultural, social and behavioural traits that we and those around us exhibit. And this lends itself to a kind of shorthand communication style, in which waving someone away while you’re on a phone call is not taken personally. It is important to recognise that these communication habits may not be appropriate when interacting with those from diverse cultural backgrounds, or non-English speakers.

“It is important to be aware of your own values, beliefs, expectations and cultural practices, and consider how these impact on your responses, interactions and service provision to people from cultures different from your own.”

Queensland Department of Health.


More than how we speak, our communication style is a big contributing factor to how effectively we are engaging our clients. This includes more than just our speech (speed and tempo of delivery) and use of language (terminology, abbreviations and slang). It also extends to the handling of certain topics; for example illness, domestic violence or death may be discussed or thought of differently depending on your culture.

Be sure to take into consideration your client’s cultural sensitivities, and be particularly attuned to non-verbal communications such as body language. If they struggle to make eye contact, for example, this might be a mark of respect within their culture, as opposed to what one might assume is shyness or inhibition. You may need to vary your communication style depending on your client’s cultural background and / or English language proficiency. By taking a few extra moments with your non-English speaking client, you can ascertain whether it may be more useful to relay information via an audio messaging service like LiME, or use an interpreter.


2 –  Do Not Assume English Proficiency


There is evidence to suggest non-English speakers experience anxiety when attempting to communicate in English. This may manifest in a number of ways – from antisocial behaviour, to avoiding group activities, ultimately contributing to an overall sense of isolation. Imagine a non-native speaker surrounded by a group of doctors (already an intimidating situation) who are discussing a diagnosis and using complex terminology. The doctors may have assumed a high level of English proficiency based on prior interactions with the patient, but evidence indicates that the patient would be experiencing anxiety simply as a consequence of the complicated interaction, and this may obfuscate their ability to communicate effectively.

Conversely just because your client is smiling and nodding at what you’re saying doesn’t necessarily indicate full understanding, it may be a nervous act to imply competency rather than apprehension. A useful technique for ascertaining the need for an interpreter is to avoid asking questions that require a yes/no answer. Instead, pose questions that require sentence-based responses, or have them repeat information you have presented to them in their own words. This isn’t intended to embarrass them, but rather to illuminate if there is a crisis of comprehension.


3 – Don’t Equate English Skill with Intelligence


Poor language skills are not synonymous with a lack of intelligence. Your client may well have been a professional in their native country, or display a good degree of understanding of your services. Through engaging language services the potential for fruitful and useful conversation and problem-solving becomes possible.

Conversely common English phraseology might make little sense when translated, despite your client possessing a reasonable grasp of the English language. Different cultures have different norms or rituals in regard to things such as diet, hygiene and gender roles. Concepts such as ‘low fat diet’ and ‘high blood pressure’ might be completely perplexing, and direct translations might not display parity with your intended meaning. As an example, ‘hook-turns’ (a peculiar, tram friendly Melbourne invention) when put into Google Translate becomes ‘link turn’ in Arabic. This is just one situation where not utilising appropriate language services might cause an escalation of issues.

Sandals, pluggers, flip flops, thongs?

Ensure that your communications and messaging are engaging for your clients by seeking to enter into meaningful conversations.


4 – Expecting Competent Literacy in their Native Language is a Mistake


Poor literacy impacts more people than you might expect (14%-46% of Australians). Don’t presume that non-English speaking clients will be literate in their own language (if they even have a written language). It’s important to consider multiple channels when delivering information to your clients. Commonly used documents like info-brochures, FAQs, privacy statements and onboarding documents might be more effective when converted into audio.


“Multilingual messaging services such as LiME give you the flexibility to deliver pre-recorded audio to low literacy and non-English speaking clients across multiple communication channels”


Repurpose your communications to meet the needs of your clients, whether that means transforming your brochure into a telephone message line, or embedding your organisation’s contact details in a neat little audiogram that can be shared across social channels. Audio is an effective equaliser when it comes to catering for those with complex communication barriers.


5 – Failing to Involve an Interpreter


A number of Australian studies indicate that many service providers consider interpreting needs can be adequately met by bilingual family members or staff. Some estimates suggest that 20% of GPs do not consider a qualified interpreter is necessary to gain informed consent.

Some organisations may be concerned about privacy, and some clients may be concerned about interpreters having social connections within their community groups. It is for this reason that it is of particular importance to engage with interpreters and language service providers who adhere to strict industry ethical guidelines.


“We can help you best serve your non-English speaking and low literacy clients.”



  • Australia. Queensland Health. Queensland Health Language Services Policy [online] 2000 [cited July 2007]
  • Blennerhassett, J. & Hilbers, J. (2011). Medicine management in older people from non-English speaking backgrounds. Journal of Pharmacy Practice and Research, 41(1), p. 35.
  • Friedman-Rhodes, E. & Hale, S. (2010). Teaching Medical Students to work with interpreters. The Journal of Specialised Translation, 14, p. 125.
  • Department of Health. (2010). Language services in health care policy consultations: discussion paper. Government of Western Australia: p. 10.