Quality lines
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Immigrant patients with poor language skills might not report problems with healthcare delivery. The experiences of patients with little or no English who had attended a hospital where English was the spoken language were explored in focus groups. Inability to communicate in English, poor patient and family involvement with staff, powerlessness, staff shortages, staff negligence, and treatment delays were reported by some patients. Others discounted or minimised the significance of similar experiences, suggesting a construct, called here "The Happy Migrant Effect" in which there is reluctance to assert healthcare rights. Patients appear "happy" and satisfied, despite problems with their hospital care. Explanatory factors for the construct include extreme powerlessness related to communication barriers, a positive comparison of health care in the new country compared with the old, patriotism, cultural norms that proscribe acceptance, politeness or social desirability, self-denigration for not having learned English, and a fear of reprisals if they
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