Abstract

As communities worldwide become increasingly multicultural, the need to communicate in healthcare situations using one's second language (L2) has become increasingly common. This raises the question: Are there any special consequences of using—or even of anticipating having to use—one's L2 during a healthcare encounter? This dissertation addresses this issue by examining one potential barrier to healthcare access that people in a linguistic minority situation often experience, anxiety related to having to use an L2 to receive health services. The overarching goal of this thesis project is to examine the effects of second language (L2) health communication anxiety on willingness to use L2 services as well as the factors underlying this anxiety. Four empirical studies, reported in two manuscripts, have been conducted to achieve these research goals. In these studies, participants were members of Quebec's English-speaking minority.
Manuscript 1 reports on two studies looking at health communication anxieties associated with language-discordant situations, that is, where a patient has to communicate using an L2 with a health provider using a first language (L1) different from the patient's L1. Study 1 was concerned with developing a Health Communication Anxiety (HCA) scale for language-discordant situations, separately for physical and mental health contexts. Study 2 examined the relationship of L2 health communication anxiety on willingness to use health services provided in the L2. Results from Study 1 and Study 2 indicate that the HCA scales provide valid and internally reliable measures of L2-specific forms of health-communication anxiety experienced in both physical and mental health contexts and these are associated with reluctance to use healthcare services in that language.
Manuscript 2 reports two studies examining the factors underlying the L2-specific health communication anxiety affecting willingness to use L2 services. Study 1 was concerned with indirect effects of health-focused anxiety – that is, of general worry about health in the link between L2 health communication anxiety and healthcare use. The results showed that there were no significant effects of general health-focused anxiety in the L2-specific effect of L2 health communication anxiety on willingness to use L2 health services. Study 2 continued investigating the indirect effects of predictive uncertainty and predicted quality of the medical service encounter as factors underlying this link. The results of this study indicate that uncertainty and predicted quality of encounters are important components in language-discordant communication anxiety in healthcare environments.
This dissertation identified L2-specific health communication anxiety, which predict reluctance to use L2 health services in both physical and mental health settings. More importantly, it demonstrated that the association between L2-specific health communication anxiety and willingness to use L2 health services is explained by the effects that L2-specific health communication anxiety influenced medical uncertainty, which in turn had a negative impact on predicted quality of medical encounter in L2.