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Buki LP, Rivera-Ramos ZA, Kanagui-Muñoz M, Heppner PP, Ojeda L, Lehardy EN, Weiterschan KA. "I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema. ACTA ACUST UNITED AC 2021; 17:17455065211002488. [PMID: 33764235 PMCID: PMC8010798 DOI: 10.1177/17455065211002488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema. Methods: Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology. Results: The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices. Conclusions: Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.
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Affiliation(s)
- Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,University of Illinois, Champaign, IL, USA
| | - Zully A Rivera-Ramos
- Department of Educational Psychology, University of Illinois, Champaign, IL, USA.,Counseling & Wellness Center, University of Florida, Gainesville, FL, USA
| | - Marlen Kanagui-Muñoz
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Psychiatry, Kaiser Permanente Medical Center, Richmond, CA, USA
| | - Puncky P Heppner
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Lizette Ojeda
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Education and Human Development, Texas A&M University, College Station, TX, USA
| | - Emaan N Lehardy
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Department of Behavioral Health, University of Nebraska Medicine, Omaha, NE, USA
| | - Kari A Weiterschan
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Rush University Medical Center, Chicago, IL, USA
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202
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Cano-Ibáñez N, Zolfaghari Y, Amezcua-Prieto C, Khan KS. Physician-Patient Language Discordance and Poor Health Outcomes: A Systematic Scoping Review. Front Public Health 2021; 9:629041. [PMID: 33816420 PMCID: PMC8017287 DOI: 10.3389/fpubh.2021.629041] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: This systematic review assessed whether physician-patient language concordance, compared with discordance, is associated with better health outcomes. Methods: A systematic literature search was conducted, without language restrictions, using PubMed, EMBASE, Web of Science, and PsycINFO, from inception to July 2020. We included studies that evaluated the effects of physician-patient language concordance on health outcomes. Articles were screened, selected, and data-extracted in duplicate. Review protocol was prospectively registered (PROSPERO, CRD42020157229). Results: There were 541 citations identified through databases and eight citations through reverse search and Google Scholar. A total of 15 articles (84,750 participants) were included reporting outcomes within five domains: diabetes care (four studies), inpatient care (five studies), cancer screening (three studies), healthcare counseling (two studies), and mental health care (one study). Ten studies were of good quality, four were fair, and one was poor, according to the modified Newcastle-Ottawa Scale. Eight studies (53%) showed a significant negative association between language discordance and at least one clinical outcome. Five studies (33%) found no association. Conclusion: Over half the evidence collated showed that physician-patient language concordance was associated with better health clinical outcomes.
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Affiliation(s)
- Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Yasmin Zolfaghari
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain
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203
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Raper SE, Clapp JT, Fleisher LA. Improving Surgical Informed Consent: Unanswered Questions. ANNALS OF SURGERY OPEN 2021; 2:e030. [PMID: 37638239 PMCID: PMC10455139 DOI: 10.1097/as9.0000000000000030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/28/2020] [Indexed: 01/11/2023] Open
Abstract
Objective This study reviews randomized clinical trials that have attempted to improve the process of informed consent. Consent should be guided by the ethical imperatives of autonomy, beneficence, and social justice. Summary Background Informed consent is constantly evolving. Yet our review of the randomized trials done to improve the surgical informed consent process raises a number of questions: How does one define surgical informed consent? What interventions have been tried to measure and improve informed consent? Have the interventions in informed consent actually led to improvements? What efforts have been made to improve informed consent? And what steps can be taken to improve the process further? Methods A literature search for randomized controlled trials (RCTs)on informed consent identified 70 trials. Demographics, interventions, assessments, and a semi-quantitative summary of the findings were tabulated. The assessments done in the RCTs, show the surrogate for patient autonomy was comprehension; for beneficence, satisfaction and mental state (anxiety or depression); and, for social justice, language, literacy, learning needs, and cost. Results There were 4 basic categories of interventions: printed matter; non-interactive audiovisual tools; interactive multimedia; and a smaller group defying easy description. Improvement was documented in 46 of the 65 trials that studied comprehension. Thirteen of 33 trials showed improved satisfaction. Three of 30 studies showed an increase in anxiety. Few studies tried to assess primary language or literacy, and none looked at learning needs or cost. Conclusions No single study improved all 3 principles of informed consent. Validated interventions and assessments were associated with greater impact on outcomes. All 3 ethical principles should be assessed; autonomy (as comprehension), beneficence (as satisfaction, anxiety), and social justice. Not enough consideration has been given to social justice; appropriate language translation, standardized reading levels, assessment of learning needs, and cost to the individual are all important elements worthy of future study.
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Affiliation(s)
- Steven E. Raper
- From the Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justin T. Clapp
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lee A. Fleisher
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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204
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Wandell GM, Wang X, Whitlock KB, Weber AK, Sie KCY, Bonilla-Velez J. Are Spanish-Speaking Families Less Satisfied with Care in Pediatric Otolaryngology? Laryngoscope 2021; 131:E2393-E2401. [PMID: 33586795 DOI: 10.1002/lary.29387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Language barriers may impact family experience, which is a key measure of healthcare quality. We compared family satisfaction between Spanish-speaking families (SSF) and English-speaking families (ESF) in pediatric otolaryngology. STUDY DESIGN Retrospective cohort study. METHODS Responses from the Family Experience Survey (FES), a hospital quality benchmarking survey, were analyzed from 2017 to 2019 at one academic pediatric otolaryngology practice. Question responses were compared between SSF versus ESF using mixed effect logistic regression models, adjusting for patient age, medical complexity, and insurance. RESULTS A total of 4,964 FES survey responses were included (14% SSF). In multivariate analysis adjusting for age, medical complexity, and insurance, SSF were 1.7 times more likely than ESF to rate their provider with the highest rating (i.e. 9-10/10; 95% confidence interval [CI] 1.24-2.22). However, SSF were less likely than ESF to provide the highest rating on many individual aspects of care, including whether providers explained things intelligibly (odds ratio [OR] 0.43, 95% CI 0.25-0.74), listened carefully (OR 0.36, 95% CI 0.28-0.47), knew their medical child's history (OR 0.53, 95% CI 0.44-0.64), provided understandable information (OR 0.36, 95% CI 0.16-0.83), spent sufficient time with them (OR 0.38, 95% CI 0.31-0.48), allowed them to discuss their questions (OR 0.57, 95% CI 0.47-0.70), or had enough input in their children's' care (OR 0.46, 95% CI 0.26-0.80). CONCLUSIONS In a large cohort of pediatric otolaryngology patients, SSF rated many individual aspects of their child's care less positively compared to ESF, despite rating their provider highly. Further research is needed to explore the reasons for these differences and how they can be improved. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2393-E2401, 2021.
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Affiliation(s)
- Grace M Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xing Wang
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kathryn B Whitlock
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Alizabeth K Weber
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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205
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Ju M. Addressing Health Inequities for Limited English Proficiency Patients: Interpreter Use and Beyond. Pediatrics 2021; 147:peds.2020-032383. [PMID: 33468599 DOI: 10.1542/peds.2020-032383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mindy Ju
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, California
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206
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Scharf A, Voigt L, Vardhana S, Matsoukas K, Wall LM, Arevalo M, Diamond LC. What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably? AMA J Ethics 2021; 23:E97-108. [PMID: 33635189 PMCID: PMC8366686 DOI: 10.1001/amajethics.2021.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.
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Affiliation(s)
- Amy Scharf
- Member of the ethics committee at Memorial Sloan Kettering Cancer Center in New York City
| | - Louis Voigt
- Associate professor of clinical medicine and anesthesiology at Weill Cornell Medical College in New York City
| | - Santosha Vardhana
- Medical oncologist at Memorial Sloan Kettering Cancer Center in New York City
| | - Konstantina Matsoukas
- Research informationist at the Memorial Sloan Kettering Cancer Center's Medical Library in New York City
| | - Lisa M Wall
- Clinical nurse specialist and ethics consultant at Memorial Sloan Kettering Cancer Center in New York City
| | - Maria Arevalo
- Clinical nurse at Memorial Sloan Kettering Cancer Center in New York City
| | - Lisa C Diamond
- Member of the research faculty of the Memorial Sloan Kettering Cancer Center Immigrant Health and Cancer Disparities Service
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207
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Stockbridge EL, Webb NJ, Dhakal E, Garg M, Loethen AD, Miller TL, Nandy K. Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data. BMC Health Serv Res 2021; 21:69. [PMID: 33461561 PMCID: PMC7812734 DOI: 10.1186/s12913-020-06045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). METHODS We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. RESULTS Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the associations differed; each was significantly associated with antipsychotic medication non-adherence (a marker of suboptimal care quality) but an increased likelihood of diabetes screening (a marker of quality care). Compared to whites, blacks and Hispanics had a significantly greater risk of medication non-adherence. Increasing age was significantly associated with increasing medication adherence, but the association between age and diabetes screening varied by sex. Other characteristics significantly associated with quality variations according to one or both measures were education (associated with antipsychotic medication adherence), urbanization (relative to urban locales, residing in suburban areas was associated with both adherence and diabetes screening), obesity (associated with both adherence and diabetes screening), language (non-English speakers had a greater likelihood of diabetes screening), and anxiety, asthma, and hypertension (each positively associated with diabetes screening). CONCLUSIONS The characteristics associated with variations in the quality of care provided to Medicaid enrollees with SMI as gauged by two HEDIS measures often differed, and at times associations were directionally opposite. The variations in the quality of healthcare received by persons with SMI that were identified in this study can guide quality improvement and delivery system reform efforts; however, given the sociodemographic and clinical characteristics' differing associations with different measures of care quality, multidimensional approaches are warranted.
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Affiliation(s)
- Erica L Stockbridge
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc, 4800 N Scottsdale Rd #4400, Scottsdale, AZ, 85251, USA.
| | - Nathaniel J Webb
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Eleena Dhakal
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Manasa Garg
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
- Loopback Analytics, 14900 Landmark Blvd # 240, Dallas, TX, 75254, USA
| | - Abiah D Loethen
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc, 4800 N Scottsdale Rd #4400, Scottsdale, AZ, 85251, USA
| | - Thaddeus L Miller
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Karabi Nandy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Room E1.401A, South Campus, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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208
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Ortega P, López-Hinojosa I, Park YS, Girotti JA. Medical Spanish Musculoskeletal and Dermatologic Educational Module. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11071. [PMID: 33473381 PMCID: PMC7809932 DOI: 10.15766/mep_2374-8265.11071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/26/2020] [Indexed: 05/28/2023]
Abstract
INTRODUCTION While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts. METHODS An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels. RESULTS Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups. DISCUSSION An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).
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Affiliation(s)
- Pilar Ortega
- Clinical Assistant Professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine
| | | | - Yoon Soo Park
- Director of Health Professions Education Research, Massachusetts General Hospital, Harvard Medical School
| | - Jorge A. Girotti
- Assistant Professor, Department of Medical Education, and Former Director, Hispanic Center of Excellence, University of Illinois College of Medicine
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209
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Velazquez AF, Velasquez A, Tuot DS. Limited english proficiency and concordance of CKD awareness among primary care providers and patients. BMC Nephrol 2020; 21:538. [PMID: 33302896 PMCID: PMC7727194 DOI: 10.1186/s12882-020-02155-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Understanding how patients may become aware of CKD is critical to their participation in healthy behaviors to slow CKD progression. We examined factors associated with the concordance of CKD awareness among patients and providers and hypothesized that concordance of CKD awareness would be influenced by social and demographic factors that impact communication, such as limited English proficiency (LEP) and health literacy. METHODS Between July 2011 to July 2014, patients with CKD from three primary care clinics in a public healthcare delivery system were surveyed with questions regarding their health, including awareness of their CKD status. Chart review was performed to identify PCP recognition of CKD, defined as CKD listed anywhere in the problem list within nine months before patient enrollment into the study. We used logistic regression to determine the association between provider recognition and patient awareness of kidney disease among those patients with CKD, adjusting for patient demographics, co-morbidities, and provider training. RESULTS The study population (n = 152) had a mean age of 57.4 (SD 13), was 48.7% male and was racially/ethnically and linguistically diverse: 89.5% self-identified as Black, Hispanic, or Asian and 32.2% had LEP. Most patients had hypertension (89.5%) and diabetes (77.6%); mean eGFR was 66.1 ml/min/1.73m2 (SD 32.8). Positive concordance of CKD awareness was 42% (n = 64). Odds of positive concordance with their providers were much higher among patients with LEP compared to English speaking patients (adjusted odds ratio = 11.07, 95%CI 1.60-76.39). CONCLUSIONS Concordance of CKD awareness among PCPs and their patients with CKD in one public delivery system was higher among patients with LEP. While speculative, this may be due to greater caution in provider communication about CKD with LEP patients.
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Affiliation(s)
| | | | - Delphine S Tuot
- Division of Nephrology, University of California, San Francisco, USA. .,Center for Vulnerable Populations, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Ave, Bldg. 100, Room 342, San Francisco, CA, 94110, USA.
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210
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Spanish proficiency and interpreter use among emergency providers: A survey study. Am J Emerg Med 2020; 38:2756-2757. [DOI: 10.1016/j.ajem.2020.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022] Open
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211
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Ortega P, Shin TM, Pérez-Cordón C, Martínez GA. Virtual Medical Spanish Education at the Corazón of Hispanic/Latinx Health During COVID-19. MEDICAL SCIENCE EDUCATOR 2020; 30:1661-1666. [PMID: 32839674 PMCID: PMC7438160 DOI: 10.1007/s40670-020-01058-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Pilar Ortega
- Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL 60612 USA
| | - Tiffany M. Shin
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Cristina Pérez-Cordón
- Language and Communication Training Unit, United Nations Headquarters, New York, NY USA
| | - Glenn A. Martínez
- Department of Spanish and Portuguese, Ohio State University, Columbus, OH USA
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212
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Pereira JA, Hannibal K, Stecker J, Kasper J, Katz JN, Molina RL. Professional language use by alumni of the Harvard Medical School Medical Language Program. BMC MEDICAL EDUCATION 2020; 20:407. [PMID: 33158441 PMCID: PMC7648424 DOI: 10.1186/s12909-020-02323-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. METHODS Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar's test for comparing proportions with paired data. The study was determined not to constitute human subjects research. RESULTS The response rate was 26% (206/803). More than half of respondents (n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar's p-value < 0.0001). Respondents (n = 113, 56%) reported that clinical electives abroad influenced their cultural understanding of the local in-country population and their language proficiency. Only 13% (n = 27) of respondents have worked in a setting that required formal assessments of non-English language proficiency. CONCLUSIONS HMS alumni of the Medical Language Program reported improved language proficiency after the medical language courses' conclusion, suggesting that the courses may catalyze long-term language learning. We found that a majority of respondents reported that the medical language courses influenced their desire to work with individuals who spoke the language of the courses they took. Medical language courses may equip physicians to practice language-concordant care in their careers.
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Affiliation(s)
| | | | | | - Jennifer Kasper
- Department of Pediatrics and Global Health and Social Medicinem, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey N Katz
- Department of Medicine and Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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213
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Feinberg I, O'Connor MH, Owen-Smith A, Ogrodnick MM, Rothenberg R. The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States. Health Lit Res Pract 2020; 4:e230-e236. [PMID: 33313933 PMCID: PMC7751446 DOI: 10.3928/24748307-20201109-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: There are 3 million refugees living in the United States today whose health and wellbeing may be diminished by not being able to understand and use health information. Little is known about these barriers to health in multiethnic refugee communities. Objective: This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US, and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health. Methods: Refugees (N = 136) age 18 to 65 years were recruited using health clinics and refugee resettlement agencies. Survey questions included demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to getting health care. Interpreters were used as necessary. We used a cross-sectional study with purposeful sampling. Key Results: There is a high correlation (Pearson's r = 0.77) between health literacy and English proficiency; they were moderately correlated with health status (r = 0.40 and 0.37, respectively). Length of time in the US only modestly correlated with health status (r = 0.16). Health literacy and English proficiency taken individually were strong predictors of health status (health literacy odds ratio [OR] = 4.0; 95% confidence interval [1.6–9.9], English proficiency OR = 3.6, confidence interval [1.5–9.0]) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction = 1.67, OR = 5.1, p < .05). Conclusions: English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population. [HLRP: Health Literacy Research and Practice. 2020;4(4):e230–e236.] Plain Language Summary: The combined effects of limited English proficiency and low health literacy can create significant barriers to good health outcomes in refugee populations. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.
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Affiliation(s)
- Iris Feinberg
- Address correspondence to Iris Feinberg, PhD, Adult Literacy Research Center, Georgia State University, PO Box 3978, Atlanta, GA 30302;
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Lor M, Martinez GA. Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare. PATIENT EDUCATION AND COUNSELING 2020; 103:1883-1901. [PMID: 32507590 DOI: 10.1016/j.pec.2020.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care. METHODS We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings. RESULTS Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care. CONCLUSIONS The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction. PRACTICAL IMPLICATIONS The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States.
| | - Glenn A Martinez
- Department of Spanish and Portuguese, Ohio State University, OH, United States.
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COVID-19 Barriers to Care for Pregnant Patients in Prolonged Isolation. Case Rep Obstet Gynecol 2020; 2020:8847859. [PMID: 32908746 PMCID: PMC7468627 DOI: 10.1155/2020/8847859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent responsible for coronavirus disease 2019 (COVID-19), continues to have a devastating impact on healthcare systems worldwide, and many questions remain unanswered. The effect of COVID-19 on the pregnant population is widely debated, and the unique risks in pregnancy have not yet been elucidated. What has been established, however, is the recommendation for healthcare workers to use personal protective equipment (PPE) for both contact and airborne precautions to prevent transmission of the pathogen—adding another barrier to care for vulnerable populations. We report a case of a young woman from Haiti during her first pregnancy, who was admitted to the antepartum service at 22 weeks of gestation with preterm premature rupture of membranes (PPROM) and remained admitted in isolation, though asymptomatic, for over six weeks due to persistent positive SARS-CoV-2 testing. Our case highlights the unique barriers to care that COVID-19 poses to antepartum patients, particularly in the setting of pregnant women with persistent positive testing.
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216
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Diamond LC, Jacobs EA, Karliner L. Providing equitable care to patients with limited dominant language proficiency amid the COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2020; 103:1451-1452. [PMID: 32571503 PMCID: PMC7304953 DOI: 10.1016/j.pec.2020.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Lisa C Diamond
- Memorial Sloan Kettering Cancer Center, Department of Behavioral Sciences, and Department of Medicine and Weill Cornell Medicine, Department of Population Health Sciences, United States.
| | - Elizabeth A Jacobs
- Dell Medical School, The University of Texas at Austin, Departments of Medicine and Population Health, United States
| | - Leah Karliner
- University of California San Francisco, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, United States
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217
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Mustajoki M, Eriksson JG, Forsén T. Health behaviour among bilingual Swedish speaking patients in the Finnish healthcare setting. J Family Med Prim Care 2020; 9:4045-4052. [PMID: 33110808 PMCID: PMC7586555 DOI: 10.4103/jfmpc.jfmpc_317_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We assessed the prevalence and consequences of discordant language communication between bilingual Swedish speaking emergency patients and general practitioners (GPs) in Finnish healthcare. We compared the results with Finnish speaking emergency patients provided with language concordant healthcare. MATERIALS AND METHODS A researcher-designed questionnaire was used to collect data about both Swedish and Finnish speaking emergency patients' health and socioeconomic status, reason for emergency visits and use of healthcare. Furthermore, the Swedish speakers' nonnative language proficiency and preferred communication language were examined. The study was performed in 16 healthcare centers and outpatient departments in bilingual regions in Finland. RESULTS The Swedish speakers (n = 139) visited healthcare centers less than the Finnish speakers (n = 736) (P = 0.001) and communicated less frequently with the GP in their native language (P < 0.001). The Swedish speakers more often planned to revisit their assigned GP (P < 0.001) after the emergency visit. No differences in health conditions and socioeconomic status between the language groups were observed. CONCLUSION Although Swedish and Finnish speaking emergency patients report a similar prevalence of chronic noncommunicable diseases, Swedish speakers make fewer annual visits to a physician. We suggest that discordant language communication might relate to decreased healthcare visits among bilingual Swedish speaking emergency patients.
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Affiliation(s)
- Marianne Mustajoki
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Johan G. Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Tom Forsén
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
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218
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Chauhan A, Walton M, Manias E, Walpola RL, Seale H, Latanik M, Leone D, Mears S, Harrison R. The safety of health care for ethnic minority patients: a systematic review. Int J Equity Health 2020; 19:118. [PMID: 32641040 PMCID: PMC7346414 DOI: 10.1186/s12939-020-01223-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/16/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. OBJECTIVES To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. METHOD A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. RESULTS Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. CONCLUSION Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter- and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. REVIEW REGISTRATION This systematic review is registered with Research Registry: reviewregistry761.
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Affiliation(s)
- Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia.
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Sydney, 2006, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, 3025, VIC, Australia
| | - Ramesh Lahiru Walpola
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Monika Latanik
- Multicultural Health, Western Sydney Local Health District, Westmead, 2145, NSW, Australia
| | - Desiree Leone
- Multicultural Health, Western Sydney Local Health District, Westmead, 2145, NSW, Australia
| | - Stephen Mears
- Hunter New England Health Libraries, Hunter New England Local Health District, Tamworth, 2310, NSW, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
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219
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de Moissac D, Savard J, Savard S, Giasson F, Kubina LA. Management strategies to improve French language service coordination and continuity for official language Francophone seniors in Canada. Healthc Manage Forum 2020; 33:271-276. [PMID: 32527149 DOI: 10.1177/0840470420931115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence suggests that language barriers present obstacles to healthcare access and quality for Francophone seniors in official language minority communities across Canada. Addressing language barriers and providing continuity is challenging, as French language services (FLSs) rely heavily on bilingual providers and the practice of active offer by all staff. This qualitative research used semi-structured group and individual interviews to explore mechanisms supporting FLS coordination and continuity in two Canadian provinces. Identification of the language variable in health records, virtual healthcare, and FLS directories are conducive to FLS continuity, but financial and resource limitations present major obstacles. Management strategies to facilitate continuity of FLS across health organizations are discussed.
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Affiliation(s)
- Danielle de Moissac
- Faculty of Science, 33529Université de Saint-Boniface, Winnipeg, Manitoba, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Savard
- School of Social Work, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Florette Giasson
- School of Social Work, 33529Université de Saint-Boniface, Winnipeg, Manitoba, Canada
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Krystallidou D, Vaes L, Devisch I, Wens J, Pype P. Study protocol of OncoTolk: an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium). BMJ Open 2020; 10:e034426. [PMID: 32513878 PMCID: PMC7282320 DOI: 10.1136/bmjopen-2019-034426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/11/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings. METHODS AND ANALYSIS A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur. ETHICS AND DISSEMINATION The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators.
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Affiliation(s)
| | - Lena Vaes
- Faculty of Arts, Sint Andries Campus, KU Leuven, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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221
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Toomey D, Wiener E, Greene N, Weisman A, Wittels K, Wilcox SR. Mystery Medications and Renal Failure. J Emerg Med 2020; 58:807-809. [PMID: 32402479 DOI: 10.1016/j.jemermed.2020.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022]
Affiliation(s)
- David Toomey
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Wiener
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nattaly Greene
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashley Weisman
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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222
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Mindlis I, Livert D, Federman AD, Wisnivesky JP, Revenson TA. Racial/ethnic concordance between patients and researchers as a predictor of study attrition. Soc Sci Med 2020; 255:113009. [PMID: 32371270 DOI: 10.1016/j.socscimed.2020.113009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/31/2020] [Accepted: 04/19/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE The differential attrition of racial/ethnic minority participants in clinical research is a major threat to advancing medical and behavioral science. OBJECTIVE Our aim was to examine the influence of racial/ethnic concordance between participants and research staff on study attrition. METHOD Data were pooled from participants and clinical research coordinators (CRCs) in six longitudinal studies of respiratory illness. Dyads were classified as concordant if the patient and CRC were of the same racial/ethnic group. Multilevel modeling examined the effect of racial/ethnic concordance on attrition at the first and one-year follow-ups. RESULTS Spanish language, lower education, and greater depressive symptoms predicted greater attrition, but these effects disappeared in adjusted models. Race/ethnicity, age, gender and health literacy did not predict attrition. Contrary to hypotheses, attrition was greater among concordant than discordant dyads: Attrition was almost five times greater at first follow-up for Black and Hispanic participants in concordant dyads, and almost four times greater at one year. CONCLUSIONS Racial/ethnic concordance between participant and CRCs was related to greater attrition in a highly diverse sample of adults with respiratory illness. Differential attrition of racial/ethnic minorities is a major threat to advancing public health. Interactions with research staff may be critical to bridging the disparities gap.
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Affiliation(s)
- Irina Mindlis
- Psychology Department, The Graduate Center, City University of New York, NY, USA.
| | - David Livert
- Psychology Department, Penn State Lehigh Valley, PA, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Tracey A Revenson
- Psychology Department, The Graduate Center, City University of New York, NY, USA; Psychology Department, Hunter College, City University of New York, NY, USA
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223
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Khoong EC, Rivadeneira NA, Hiatt RA, Sarkar U. The Use of Technology for Communicating With Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Cross-Sectional Survey. J Med Internet Res 2020; 22:e16951. [PMID: 32250280 PMCID: PMC7171563 DOI: 10.2196/16951] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 01/17/2023] Open
Abstract
Background Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non–English speaking or low-income individuals. Objective This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. Methods From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest—language preference, smartphone ownership, and type of clinic for usual care—were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. Results Nearly one-third of participants watched Web-based health videos (367/1027, 35.74%) or used emails to communicate with their clinician (318/1027, 30.96%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio [aOR] 0.27, 95% CI 0.13-0.56), using online health support groups (aOR 0.14, 95% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. Conclusions In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients’ use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Natalie A Rivadeneira
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States.,Hellen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
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Solomon A, Calotta N, Kolarich A, Enumah Z, Al Efishat M, Kovler M, Azar F, Haut ER, Garcia AV. Surgical Residents as Certified Bilingual Speakers: A Quality Improvement Initiative. Jt Comm J Qual Patient Saf 2020; 46:359-364. [PMID: 32165106 DOI: 10.1016/j.jcjq.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this quality improvement initiative was to identify general surgery residents proficient in a non-English language and have each attempt the Clinician Cultural and Linguistic Assessment (CCLA) to become qualified bilingual staff speakers. METHODS General surgery house staff were asked to self-identify as proficient in a language other than English. Fees for the certification examination were waived, and each resident was excused from clinical duties to complete the exam. McNemar's test was used for statistical analysis. RESULTS All residents responded to the initial survey, with 18/65 reporting a non-English language proficiency. Of the 12 residents who sat for the CCLA exam, 9 (75.0%) passed, with 5 certifying in the most commonly spoken non-English languages at this institution. The number of certified residents increased from 1 to 10 (1.5 % to 15.4%, p = 0.004). CONCLUSION Language barriers result in health care disparities for patients with limited English proficiency. This reproducible quality improvement initiative significantly increased the number of qualified bilingual speakers, while 25.0% of self-described proficient speakers did not demonstrate adequate language proficiency. These newly certified providers allow for increased language concordant care, which may be associated with improved outcomes.
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Volkman HR, Walz EJ, Wanduragala D, Schiffman E, Frosch A, Alpern JD, Walker PF, Angelo KM, Coyle C, Mohamud MA, Mwangi E, Haizel-Cobbina J, Nchanji C, Johnson RS, Ladze B, Dunlop SJ, Stauffer WM. Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices. PLoS One 2020; 15:e0229565. [PMID: 32163426 PMCID: PMC7067457 DOI: 10.1371/journal.pone.0229565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.
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Affiliation(s)
- Hannah R Volkman
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St Paul, MN, United States of America
| | | | | | - Anne Frosch
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- Hennepin Healthcare, Minneapolis, MN, United States of America
| | | | - Patricia F Walker
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Kristina M Angelo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Christina Coyle
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mimi A Mohamud
- Minnesota Department of Health, St Paul, MN, United States of America
| | - Esther Mwangi
- Minnesota Department of Health, St Paul, MN, United States of America
| | | | - Comfort Nchanji
- Minnesota Department of Health, St Paul, MN, United States of America
| | - Rebecca S Johnson
- Sierra Leone Community in Minnesota, Minneapolis, MN, United States of America
| | - Baninla Ladze
- Minnesota Cameroon Community, Minneapolis, MN, United States of America
| | - Stephen J Dunlop
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- Hennepin Healthcare, Minneapolis, MN, United States of America
| | - William M Stauffer
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
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Ortega P. In Reply to Schmuter. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:172. [PMID: 31990717 DOI: 10.1097/acm.0000000000003082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Pilar Ortega
- Clinical assistant professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ; Twitter: @pilarortegamd; ORCID: http://orcid.org/0000-0002-5136-1805
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227
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Ortega P, Diamond L, Alemán MA, Fatás-Cabeza J, Magaña D, Pazo V, Pérez N, Girotti JA, Ríos E. Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:22-31. [PMID: 31365394 DOI: 10.1097/acm.0000000000002917] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient-physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.
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Affiliation(s)
- Pilar Ortega
- P. Ortega is clinical assistant professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-5136-1805. L. Diamond is assistant attending, Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York. M.A. Alemán is professor, Department of Medicine, University of North Carolina School of Medicine, and director, Comprehensive Advanced Medical Program of Spanish, Chapel Hill, North Carolina. J. Fatás-Cabeza is associate professor, Department of Spanish and Portuguese, and director, Undergraduate Translation and Interpretation Program, University of Arizona, Tucson, Arizona. D. Magaña is assistant professor, Department of Literature, Languages and Cultures, University of California, Merced, Merced, California. V. Pazo is instructor, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and course director, Medical Spanish, Harvard University, Boston, Massachusetts. N. Pérez is director, School of Medicine Special Programs and Hispanic Center of Excellence, University of Texas Medical Branch, Galveston, Texas. J.A. Girotti is assistant professor, Department of Medical Education, and director, Hispanic Center of Excellence, University of Illinois College of Medicine, Chicago, Illinois. E. Ríos is president, National Hispanic Health Foundation, Washington, DC
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Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Teaching Medical Spanish to Improve Population Health: Evidence for Incorporating Language Education and Assessment in U.S. Medical Schools. Health Equity 2019; 3:557-566. [PMID: 31701080 PMCID: PMC6830530 DOI: 10.1089/heq.2019.0028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Language concordance between patients and physicians is an important factor in providing safe and effective health care, with Spanish as the predominant and fastest growing non-English language in the United Sates. However, despite increasing demand for medical Spanish education, valid concerns about inadvertently increasing provider use of limited Spanish with patients, lack of knowledge of best practice in education and assessment, and lack of institutional support still present barriers to medical Spanish education in medical schools. Methods: The authors conducted a narrative review of existing literature that evaluates the link between medical Spanish education of physicians and language concordance. Results: Medical Spanish educational efforts, although increasing, are not consistently linked to learner assessment. The literature to date supports that for medical Spanish education to improve patient outcomes, it should be linked to assessment methodology that demonstrates improvement in language concordance with Spanish-speaking patients, and should include safety measures to prevent inadvertent communication errors. The authors review data for published medical Spanish postcourse language assessment strategies and provide recommendations to ensure responsible and competent use of medical Spanish skills. Conclusion: The authors propose three structural elements that should be considered when incorporating or enhancing medical Spanish education in medical schools: institutional endorsement of the role of medical Spanish education within a national health disparities context; precourse proficiency testing to establish student starting level; and learner postcourse communications skills and limitations assessment to provide individualized recommendations and assure patient safety.
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Affiliation(s)
- Pilar Ortega
- Department of Emergency Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Norma Pérez
- Hispanic Center of Excellence, School of Medicine Special Programs, University of Texas Medical Branch, Galveston, Texas
| | - Brenda Robles
- Language Interpreters Program, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Yumirle Turmelle
- Department of Pediatrics, Washington University St Louis School of Medicine, St Louis, Missouri
| | - David Acosta
- Association of American Medical Colleges, Washington, District of Columbia
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Khoong EC, Fernandez A. Language, culture and preventable readmissions: pragmatic, intervention studies needed. BMJ Qual Saf 2019; 28:859-861. [DOI: 10.1136/bmjqs-2019-009836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 11/03/2022]
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Lor M, Vang X, Rabago D, Brown RL, Backonja M. “It Hurts as If…”: Pain-Associated Language, Visual Characterization, and Storytelling in Hmong Adults. PAIN MEDICINE 2019; 21:1690-1702. [DOI: 10.1093/pm/pnz268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractObjectivePain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communicate their pain to providers in primary care settings.MethodsA qualitative study with 67 Hmong participants (63% female and x̄ age = 53.7 years) were recruited from a Midwestern state. Semistructured interviews on pain communication were conducted, audio-recorded, transcribed, and analyzed using directed content analysis.ResultsThe Hmong participants described pain using stories that generally had the same dimensions of information that providers require for pain assessment. These included references to time, causality, associated symptoms or related experiences, intensity, and consequences of pain. However, the participants expressed some pain dimensions in language that was not shared by providers: visual metaphors that were generally in reference to pain quality and fewer words for pain location, intensity, and some qualities. Participants used two strategies to decide whether they should tell their pain story: assessing the provider and determining whether their story was appreciated. The perception that providers underappreciated their stories resulted in dissatisfaction and undertreatment of pain. Ultimately, this resulted in having less frequent contact with providers or changing providers.ConclusionsFindings demonstrate a discordance in the expected process and content of the clinical interaction between LEP Hmong patients and providers, suggesting the need for culturally appropriate pain assessments in this population.
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Affiliation(s)
- Maichou Lor
- Columbia University School of Nursing, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Xia Vang
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Rabago
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Backonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education. Health Equity 2019; 3:312-318. [PMID: 31294243 PMCID: PMC6615346 DOI: 10.1089/heq.2019.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient–physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.
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Affiliation(s)
- Pilar Ortega
- Department of Emergency Medicine, College of Medicine, University of Illinois, Chicago, Illinois.,Department of Medical Education, College of Medicine, University of Illinois, Chicago, Illinois
| | - Norma Pérez
- Special Programs, School of Medicine, Hispanic Center of Excellence, University of Texas Medical Branch, Galveston, Texas
| | - Brenda Robles
- Language Interpreters Program, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Yumirle Turmelle
- Washington University St. Louis School of Medicine, St. Louis, Missouri
| | - David Acosta
- Association of American Medical Colleges, Washington, District of Columbia
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