Improving health services for Irish-speaking patients

A new study exploring cultural sensitivity in healthcare for people in Gaeltacht regions highlights gaps between cultural policy and clinical practice. Niamh Cahill reports 

Inadequate communication between patients and clinical staff in healthcare settings can lead to deficits in care.

While this is a recognised and well-established fact, effective communication and cultural sensitivities are often overlooked.

This can be particularly significant for minority language speakers, whose linguistic and cultural needs may not always be recognised within mainstream healthcare services.

In Ireland, this includes people living in Gaeltacht communities, where Irish remains the primary language for many residents.

The issue is explored in a new paper, ‘Cultural sensitivity concerning the Gaeltacht people of Ireland – A concept analysis’, recently published in Health Policy, an international peer-reviewed journal.

The analysis was undertaken by registered nurse Ms Cassandra Uí Ghogáin, Director of Nursing, Older Persons Services, HSE Donegal, as part of a Masters in Science in Professional Nursing at Dundalk Institute of Technology.

Speaking to the Medical Independent (MI), Ms Uí Ghogáin said her experience working in healthcare in a Gaeltacht region strongly influenced her interest in the area of cultural sensitivity.

Ms Uí Ghogáin has a special interest in older persons’ care and people living with dementia.

“What drew me towards this topic was my first-hand experience of caring for older people in Gaeltacht regions. In practice, I have seen how recognition of a person’s language and culture can bring comfort, build trust, and support their recovery and care planning,” Ms Uí Ghogáin told MI.

“I feel very fortunate to work in an area where there are opportunities to have Irish-speaking staff and a workforce with an awareness of Gaeltacht culture. However, even within Gaeltacht services, I have seen that assumptions can still be made that a person is comfortable communicating through English or fully understands English. When this is not the case, it can create a real deficit in care.”

Ms Uí Ghogáin explained that misunderstandings around language can cause distress for patients, particularly when they are older, unwell, frightened, or cognitively impaired.

“This showed me that language is not just about translation – it is closely connected to dignity, identity, comfort, safety, and person-centred care.”

Analysis

In the paper, cultural sensitivity (CS) is defined as the “awareness of traditions, customs, values, and beliefs that are distinctive to oneself and diverse communities; the appreciation of both the similarities and differences identified between oneself and others; and the demonstration of respectful presentation and response both verbally and non-verbally”.

Regarding policy, “CS represents both an interpersonal skill and an institutional obligation to provide equitable, linguistically appropriate, and culturally competent care for all populations, including the Gaeltacht communities of Ireland.”

Ms Uí Ghogáin undertook a concept analysis of CS in relation to healthcare for people in the Gaeltacht using nursing scholars Walker and Avant’s eight-step concept analysis framework.

The aim of the analysis was “to identify defining attributes, antecedents, and consequences of CS within healthcare contexts”.

The paper reveals a profound gap between cultural policy and clinical practice.

“The findings demonstrate that while the Irish language holds official status, healthcare services often fail to reflect this equality, placing an undue burden on Irish-speaking patients to assimilate into an English-speaking health system,” according to the conclusion.

“This mirrors broader patterns of linguistic exclusion observed in other bilingual societies such as Wales and Canada. The lack of Irish-speaking healthcare providers, limited translation services, and an overall deficit in linguistic and cultural awareness contribute to health disparities among Gaeltacht populations.”

The paper details a number of implications for healthcare practice and policy following the research outcomes.

Recommendations

According to the paper, healthcare providers must receive training beyond generic cultural competence to include “culturally specific modules addressing the Gaeltacht context”.

The paper said that including Irish language education and awareness of Gaeltacht customs within medical curricula was vital.

“Recruitment policies should prioritise Irish-language proficiency for healthcare workers in Gaeltacht areas to ensure culturally congruent communication.”

In addition, national policy frameworks must change to recognise the Gaeltacht population as a distinct cultural and linguistic group in healthcare planning.

“Similar to the provisions made for the Traveller community, the Gaeltacht community warrants formal recognition, targeted funding for research, development of bilingual clinical guidelines, and workforce strategies reflecting its cultural needs,” according to the paper.

“Furthermore, the Central Statistics Office should refine its data collection to capture the cultural and linguistic identity of Gaeltacht individuals more accurately.”

Speaking to MI, Ms Uí Ghogáin said that when looking at Census records for 1926, there was more detailed recognition of Irish-language ability at that time.

“Today, while we still collect information on Irish-language ability and frequency of use, I feel there is a need to better understand Irish as a first language, as a mother tongue, and as part of a person’s identity and healthcare experience,” she said.

Recognition

Recognition is a hurdle that must be overcome in order to improve cultural sensitivity, Ms Uí Ghogáin said.

“One of the main challenges facing enhanced cultural sensitivity in healthcare is recognition of this demographic in itself. The language and cultural needs of Gaeltacht communities may not always be fully recognised within healthcare planning, particularly where there is an assumption that a person can communicate comfortably through English.”

Ms Uí Ghogáin acknowledged that staffing shortages and the fact that many healthcare workers are immigrants are other factors within the health service that can have an impact on cultural sensitivity for Irish speakers.

“There will not always be an opportunity to provide care from staff who are fluent in Irish and I fully recognise the staffing pressures that exist across healthcare,” she said.

“However, it is very important that services have an awareness that a person may need interpretation or support to communicate safely and comfortably in Irish.

“This is especially important for people from Gaeltacht regions who may need to transfer outside of their own area for acute or specialist care.”

She said, in these cases, communication of a sensitive nature often takes place around diagnosis, treatment, consent, deterioration, recovery, discharge planning, or end-of-life care.

“It is vital that healthcare services recognise the person’s language, identity, and cultural background, and that appropriate translation or communication supports are considered where needed.”

Ms Uí Ghogáin noted that national commitments have been made on increasing the number of Irish-speaking staff in the public sector.

The HSE has developed measures, such as the Gaeltacht scholarship scheme, to help support workforce planning in Gaeltacht regions. But turning policy aspirations into practice has proved challenging for the Irish healthcare service in the past.

She argued that to protect and preserve the Irish language those who speak Irish must be supported to do so.

“My particular interest is in older persons’ care and people living with dementia,” Ms Uí Ghogáin said in conclusion.

“I feel this area is especially relevant because language, memory, identity, comfort, and familiarity can be deeply connected. However, this is not only an ageing issue. In the future, I would love to see research that places the person themselves at the centre and captures the lived experiences of Irish speakers within healthcare.”