Health policy (Amsterdam, Netherlands) · 2026
Defining competencies for language-discordant care in migrant and refugee mental health: an international modified e-Delphi study.
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Forray Alina-Ioana, Cherecheș Răzvan Mircea, Oltean Ovidiu, Kreienbrinck Annika, Hanft-Robert Saskia, Al-Kalaf Houda, Sumerlin Timothy S, Liem Andrian, Madzamba Rowan, Schouten Barbara, Anthonissen Christine, Al-Rousan Tala, Hall Brian J, Eisenbruch Maurice, Mösko Mike
Аннотация
BACKGROUND: Migrants and refugees experience a higher prevalence of mental disorders than host populations, and language discordance undermines care from help-seeking through diagnosis, adherence and outcomes. The WHO Refugee and Migrant Health: Global Competency Standards for Health Workers set broad behavioural expectations for individual health workers but do not operationalise language-discordant care, leaving clinicians and administrators without measurable standards.
OBJECTIVE: To develop an international, consensus-based competency framework for healthcare professionals working in language-discordant mental health care, paired with a priority-versus-feasibility gap analysis to direct policy investment.
METHODS: We conducted an international modified e-Delphi study between May and October 2025, reported in accordance with the ACCORD and CONFERD-HP guidelines. Evidence-derived items, organised into five domains and stratified for healthcare providers and administrators, were rated for priority and feasibility; consensus required at least 75% "Mandatory" agreement.
RESULTS: In Round 1, 101 experts from 24 countries participated; 51 (50.5%) completed Round 2 with non-differential attrition, and 16 ratified borderline items in Round 3. Seventy-six items reached consensus across People-Centred Care (19), Communication (27), Collaboration (6), Evidence-Informed Practice (7) and Personal Conduct (17). The widest gaps fell in systemic, infrastructure-dependent competencies, including 24-hour interpreter access and interpreter-coincident scheduling (mean gap 29.6 percentage points; 33 items >30 points).
CONCLUSIONS: This first international competency framework defines the reciprocal behaviours clinicians and administrators must meet in language-discordant (mental) health care. Paired with a gap analysis, it offers a behaviourally specific basis for training and accreditation and shows where policy investment is most needed.
OBJECTIVE: To develop an international, consensus-based competency framework for healthcare professionals working in language-discordant mental health care, paired with a priority-versus-feasibility gap analysis to direct policy investment.
METHODS: We conducted an international modified e-Delphi study between May and October 2025, reported in accordance with the ACCORD and CONFERD-HP guidelines. Evidence-derived items, organised into five domains and stratified for healthcare providers and administrators, were rated for priority and feasibility; consensus required at least 75% "Mandatory" agreement.
RESULTS: In Round 1, 101 experts from 24 countries participated; 51 (50.5%) completed Round 2 with non-differential attrition, and 16 ratified borderline items in Round 3. Seventy-six items reached consensus across People-Centred Care (19), Communication (27), Collaboration (6), Evidence-Informed Practice (7) and Personal Conduct (17). The widest gaps fell in systemic, infrastructure-dependent competencies, including 24-hour interpreter access and interpreter-coincident scheduling (mean gap 29.6 percentage points; 33 items >30 points).
CONCLUSIONS: This first international competency framework defines the reciprocal behaviours clinicians and administrators must meet in language-discordant (mental) health care. Paired with a gap analysis, it offers a behaviourally specific basis for training and accreditation and shows where policy investment is most needed.