A problem of communication? Diabetes care among Bangladeshi people in Bradford.

People of Bangladeshi origin in the UK continue to experience poorer health and poorer healthcare than other sections of the community. Although communication with medical and nursing staff has long been recognised as key to the provision of effective healthcare services, efforts to overcome communication problems have often been minimal: many practitioners and patients rely on informal interpreters, usually family members, to assist them, despite the shortcomings of these arrangements. The present paper examines the experiences of 12 Bangladeshi people in Bradford, obtained during the course of a wider evaluation of diabetes services. All but one of the in-depth interviews were carried out in Sylheti and explored respondents' experiences of diabetes and local services. Software-assisted analysis of the transcripts followed a framework approach. It was found that, in the absence of alternatives, informal interpreting support was a necessity for many people: making appropriate arrangements frequently involved disruption to family members' routines and responsibilities, yet access to healthcare was often not possible without them. Despite the acknowledged problems, informal arrangements were often preferred: the benefits included greater privacy, support in the consultation, and a shared understanding of advice and instructions. Many patients nonetheless received poor quality care, although this appeared to be related less to language difficulties than to professional attitudes and methods of working.