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Nielsen TR, Franzen S, Watermeyer T, Jiang J, Calia C, Kjærgaard D, Bothe S, Mukadam N. Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol 2024:1-31. [PMID: 38588670 DOI: 10.1080/13854046.2024.2335113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment. METHOD A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments. RESULTS ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered. CONCLUSION Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Franzen
- Department of Neurology & Alzheimer Center, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamlyn Watermeyer
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clara Calia
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Daniel Kjærgaard
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Bothe
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Siette J, Meka A, Antoniades J. Breaking the barriers: overcoming dementia-related stigma in minority communities. Front Psychiatry 2023; 14:1278944. [PMID: 38179250 PMCID: PMC10765564 DOI: 10.3389/fpsyt.2023.1278944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, Australia
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Anjani Meka
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Affiliate Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Royal Melbourne Hospital, Parkville, VIC, Australia
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Essén B, Eriksson L. Paradoxes in the cultural doula concept for migrant women: Implications for gender-inclusive care versus migrant-friendly maternity care. Midwifery 2023; 126:103805. [PMID: 37714043 DOI: 10.1016/j.midw.2023.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to policies of gender equality and diversity. DESIGN An interview study was designed to analyse perceptions of the cultural doula concept among healthcare providers in Swedish sexual and reproductive healthcare. Through the framework of Bacchi's approach 'What Is the Problem Represented to Be?' and Hochschild's concept of 'global care chains', we analyzed whether the introduction of the cultural doula concept is in line with the policies of gender equality and culturally sensitive care by exploring paradoxes, unintended consequences and what was not reflected upon. SETTING AND PARTICIPANTS Semi-structured interviews (n = 18) with midwives and obstetricians at hospitals in two Swedish counties during 2022. MEASUREMENTS AND FINDINGS The interviews were analyzed through thematic analysis. Cultural doulas were perceived as multi-tasking resources for facilitating integration and providing healthcare information and psychosocial support. Respondents did not identify doula support as a cultural practice in migrants' origin countries. Despite awareness of cultural differences in gender norms, many respondents stated that doula support included male partners. KEY CONCLUSIONS The cultural doula concept includes paradoxes in relation to gender equality and diversity. Rather than empowering migrant women, the cultural doula concept is related to gendered patterns of low-educated, underpaid care work. Labour support interventions including migrant women's social network and intensified partner involvement would be more in line with Swedish policies of gender equality, shared parenting and cultural sensitivity when needed. However, doulas may be an imperfect solution for women lacking partners or social networks, for example, newly arrived migrant women, if no support is to be found within the perinatal care system. IMPLICATIONS FOR PRACTICE Midwives and obstetricians need reflexivity about what the problem is represented to be when it comes to gender equality and cultural sensitivity in their collaboration with cultural doulas, boundaries between roles, how they handle confidentiality, and why cultural doulas are needed in relation to migrant women's integration.
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Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden
| | - Lise Eriksson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden; Faculty of Social Sciences, Business and Economics, Åbo Akademi University, Vänrikinkatu 3 B, Turku FI-20500, Finland.
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Gilbert AS, Antoniades J, Hwang K, Gonzalez E, Hlavac J, Enticott J, Lin X, Woodward-Kron R, Low LF, LoGiudice D, White J, Cavuoto MG, Brijnath B. The MINDSET Study: Co-Designing Training for Interpreters in Dementia and Cognitive Assessments. DEMENTIA 2023; 22:1604-1625. [PMID: 37455144 DOI: 10.1177/14713012231190578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
There is a growing demand for interpreter-mediated cognitive assessments for dementia. However, most interpreters lack specialist knowledge of dementia and cognitive assessment tools. This can negatively affect the way instructions and responses are conveyed between clinicians and patients, undermining clinicians' ability to accurately assess for cognitive impairment. This article reports on the co-design of an online dementia training package, MINDSET, which aims to address this gap. Two iterative online co-design workshops were conducted in October and November 2021, using a World Café approach. Sixteen clinicians, interpreters, and multilingual family carers of a person with dementia participated. Based on these workshops, training and assessment materials were developed and tested with 12 interpreters from April to June 2022. The training package comprises online modules: 1) Knowledge of Dementia and Australia's Aged Care System, 2) Briefings and Introductions, 3) Interpreting Skills, 4) Interpreting Ethics, and 5) Cross-cultural Communication. The codesign process highlighted divergent perspectives between clinicians and interpreters on an interpreter's role during a cognitive assessment, but it also facilitated negotiation and consensus building, which enriched the training content. The training is now developed and will be evaluated in a randomized control trial and subsequent implementation study.
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Affiliation(s)
- Andrew S Gilbert
- National Ageing Research Institute, Parkville, VIC, Australia
- La Trobe University, Bundoora, VIC, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Parkville, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Kerry Hwang
- National Ageing Research Institute, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
| | | | - Jim Hlavac
- Monash University, Clayton, VIC, Australia
| | | | | | | | - Lee-Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Dina LoGiudice
- University of Melbourne, Parkville, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Marina G Cavuoto
- National Ageing Research Institute, Parkville, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
- University of Western Australia, Perth, WA, Australia
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Nielsen TR. Cognitive Assessment in Culturally, Linguistically, and Educationally Diverse Older Populations in Europe. Am J Alzheimers Dis Other Demen 2022; 37:15333175221117006. [PMID: 36325840 PMCID: PMC10581111 DOI: 10.1177/15333175221117006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to increasing cultural, linguistic, and educational diversity in older populations across Europe, accurate assessment of cognitive functioning in people from diverse backgrounds becomes increasingly important. This paper aims to provide a state-of-the-art review of cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe, focusing on challenges and recent advances in cross-cultural assessment. Significant work has been carried out on the identification of challenges in cognitive assessment in culturally, linguistically, and educationally diverse older populations and on development and validation of cross-cultural cognitive tests. Most research has addressed the influences of language barriers, education and literacy, and culture and acculturation and in particular, the European Cross-Cultural Neuropsychological Test Battery (CNTB) and the Rowland Universal Dementia Assessment Scale (RUDAS) are well-validated across European countries. However, cross-cultural cognitive assessment is largely still a developing field in Europe, and there is a continuing need for developments within the field.
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Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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