ACCAN Informed Consent Project (21 August 2009)

5.7. Culturally and linguistically diverse consumers

Case study 6 – [from CTN]

In the Project Survey, caseworker organisations and regulators reported a low to moderate proportion of consent complaints regarding culturally and linguistically diverse consumers. However, many representatives asserted that culturally and linguistically diverse consumers are under-represented in complaints data due to a combination of their reluctance to make official complaints and language barriers they faced in accessing complaints services.

There is some evidence of deliberate exploitation of consumer’s lack of English proficiency (with a crossover into unconscionable conduct in some matters). Key regulators reported concerns regarding the number of complaints received from people who did not speak English, but who had been subscribed to phone plans or premium services based on documentation that was only available in English.

However, there are also some obvious concerns regarding the expense of potential solutions to this issue. This is a globally recognised problem, but very few solutions have been proposed other than expensive interpreters, hiring of bi-lingual staff and the translation of documents into multiple languages. [34]

Some other sectors / jurisdictions do require a very comprehensive and detailed approach to ensuring consent has been obtained properly from culturally and linguistically diverse consumers. For example QLD Health[35] includes the following requirements for medical consent:

COMMUNICATION AND CULTURAL ISSUES:

The patient/ parent/ guardian/ substitute decision-maker who does not speak English, or is profoundly hearing impaired must be offered a qualified interpreter during the informed consent process.

The qualified interpreter shall:

countersign the consent form to indicate that he/ she has given a verbal translation of the procedure/ operation relating to consent in the language that the patient understands.

specify the language.

In the event that the only interpreter available is a telephone interpreter service, the interpreter's name and contact details must be documented on the consent form by the treating Medical Practitioner (or delegate) in the ‘Interpreter's statement’ section.

The patient who has specific cultural needs will also be asked if they require a Cultural Support Worker and same provided as indicated.

Another approach is to focus on making consent documents easy to read / understand. – for example the Flesch-Kincaid method measuring the readability of a document and in particular, the readability of an informed consent form. The research looks into the best way to develop informed consent forms for those for whom English is a second language:[36]

Case study 6 – [from CTN]

Complaint: Ms A., expectant mother, with English as a second language, starts receiving SMS messages on a daily basis with trivial relationship advice, similar to Spam. Leading a busy lifestyle in the lead up to the birth of her first child she does not follow up on the origin of the messages. The messages drop down from daily to every second or third day over the period of a month. Ms A. then receives her monthly phone bill from Optus and discovers she has been charged $130 for the unsolicited text messages.

Action: Ms A. called Optus to complain and was advised to contact the company sending the SMS and ask for them to unsubscribe her. She called the company and informed them she was never aware that she signed up for their service and wished to be removed immediately and the charges refunded. When the company refused to disclose how she signed up and give a refund she went back to Optus. Optus agreed to reimburse Ms A. $40 of the bill, leaving her with an incurred charge of $90. Ms A. is still unaware of how she became subscribed to this service. ‘It is very strange’ she said, ‘I do not do anything on the net except check my emails, I don’t even do online shopping. I do not give my number out to many people, so I don’t know how this happened’.

[34] BG Wilson, Linguistic diversity: A global threat to informed consent, Eradimaging, 1 November 2006, <http://www.eradimaging.com/site/article.cfm?ID=3>.

[35] Queensland Health, Informed consent for invasive procedures, policy 14025, Queensland Health, Brisbane, 2007, <http://www.health.qld.gov.au/informedconsent/ConsentForms/14025.pdf>.

[36] J Ancker, Developing the Informed Consent Form: A Review of the Readability of Literature and an Experiment, American Medical Writers Association, 2004, <http://www.amwa.org/default/publications/vol 19 no 3/vol 19 no 3developing.pdf>.





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