Effective Communication with Refugees and Immigrants

A Scoping Review of Limited English Proficiency and Immigration in Pediatric Surgery

INTRODUCTION

With increasing globalization and diversity, the intersection of immigration and language barriers can impact patient outcomes. This scope review aims to summarize current evidence on immigration and language barriers on pediatric surgical outcomes.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched with Medical Subject Heading terms describing pediatric surgery, immigration, limited English proficiency (LEP), and refugees between 2000-2023. Four independent reviewers screened and analyzed texts for final inclusion.

RESULTS

Thirty-three studies were included. Ten studies described disease incidence and severity, finding that LEP, immigrant, and refugee patients were more likely to present with severe disease in appendicitis and traumatic injuries. five studies described pain management, finding patients with LEP received fewer pain assessments, waited longer for analgesia, and had more discrepancies in pain scores. Seventeen studies investigated treatment receipt and delay, finding that immigrants and patients with LEP had longer time to and reduced rates of treatment. Seventeen studies described surgical outcomes, finding that patients with LEP have longer length of stay and more postoperative emergency department visits but fewer follow-up appointments. In kidney transplants, patients with LEP and immigrants had worse outcomes, but these trends are not seen in immigrants from Europe. Overall, immigrants and refugees have higher rates of complications and mortality.

CONCLUSIONS

Immigrants and patients with LEP and are more likely to present with advanced disease and severe injuries, receive inadequate pain management, experience delays in surgery, and suffer more complications. There is continued need to assess the impact of LEP and immigration on pediatric surgery outcomes.

Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention

OBJECTIVES

Back pain is one of the most challenging health conditions to manage. Healthcare providers face additional challenges when managing back pain for patients with culturally diverse backgrounds including addressing linguistic barriers and understanding patients' cultural beliefs about pain and healthcare. Knowledge about patients with culturally diverse backgrounds experiencing back pain and the interventions available to them is limited. Therefore, this study aims to describe the characteristics of patients with culturally diverse backgrounds experiencing back pain and the video interpretation intervention offered to them and further to explore the clinician's perspective on this intervention.

METHODS

Data were collected from the electronic medical records and the Interpreter Gateway. Four clinicians participated in a group interview, where they described and evaluated the video interpretation intervention in detail inspired by the template for intervention description and replication (TIDieR) checklist and guide.

RESULTS

A total of 119 (68%) patients accepted the intervention (53% women, mean 44 years). These patients represent 24 different languages, with 50% having at least one hospital-registered diagnosis and a mean number of five outpatient contacts, 1 year before receiving the intervention. Fifty-seven patients did not accept the intervention and declined interpretation or opted to use relatives or through video conferencing equipment. The intervention was positively evaluated by the clinicians.

CONCLUSIONS

The detailed description of the population and the intervention together with the clinician perspective provides a valuable foundation for developing and refining similar interventions, allocating resources, and designing future research studies. The intervention consisted of a consultation lasting up to 2 h delivered by a rheumatologist and a physiotherapist, with a remote interpreter connected.

Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study

BACKGROUND

Minoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension.

METHODS

A total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior.

RESULTS

Several barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members' support with home monitoring served as an important facilitator to SMBP.

CONCLUSIONS

There are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.